Why parents need to be involved in the treatment of their obese teenagers ?
Results of a qualitative study
C. Chamay Weber1,2, N. Camparini,1L. Lanza2, C. Torriani, F. Narring1
1Adolescent
Medicine Unit, Adolescent and Young Adult Program, 2 Exercise Medicine, Paediatric Cardiology Unit, Department of Child and Adolescent &
Department of Community Medicine and Primary Care, University Hospital of Geneva and University of Geneva, Switzerland
Purpose: Family dynamics are strongly associated with teenage obesity. Our aim was to assess parents' and adolescents’ perceptions before
and at the end of a six month Family-Based Behavioral Treatment (FBBT) program for obese teenagers.
Methods: We conducted 4 focus group sessions with obese adolescents
Contrepoids©
Program for
adolescents
aged 12-18 and their parents participating in a FBBT program (2 before and
Adolescents and
4 after the program, 13 parents and 18 adolescents in separate groups).
Adolescents
Parents
Parents
Open ended questions were used to explore their perceptions at the
beginning and at the end of the program :
Psycho educational’
Psycho educational’
sports'
- How are family interactions ?
sessions
sessions
sessions
- What can they say about their/their child’s well-being ?
- What do they think about their participation in the program ?
Some of the topics discussed in the groups: Motivation, diet, family
Sessions were recorded, transcribed and content analysis was performed.
dynamics, family values, adolescence and development, emotion and
eating, conflicts management, self-esteem.
Results:
Parents' perceptions before the program
Responsibility: “ I want him to grow up and to learn how to eat
and how to face life ”
“ I would like him to have self-control about food. What I am
doing for him now, he has to be able to do it by himself ”
Conflicts: “ there is many conflicts. Always behind her saying :
don’t eat that, you have enough, don’t open the fridge ! ”
“ So many conflicts that we can’t speak together anymore ”
“ For six month I have put the food under key, because she was
eating all the food we have ”
“ We have tried everything: to hide food, to be nasty, blackmail ”
Adolescents' perceptions before the program
 Responsability: “ My mom is always watching me, she checks
up on everything I eat. She doesn’t understand that I can cope
by myself. She has gotten used to doing this for a long time ”
Discouragement: “ Sometimes, my parents tell me not to eat
this or that. I’m fed up. I feel discouraged ”
“ Sometimes, I ‘m walking through the kitchen and my mom
says: stop, don’t do that ! even if I haven’t planned to eat
anything . That irritates me ”
To take control: “I hope to control myself not to eat ”
To take care of oneself : “ It’s also about learning how to take
care of oneself : my daughter doesn’t take any interest in her
To break isolation: “ I hope to make friends ”
appearance, whether for brushing her hair or her teeth. She
would go out any which way ”
Evolution throughout
the program
Parents 'perceptions at the end of the program
Feeling co responsable : “ I though that it was a matter
of will and that he had to make the first step. I then realized,
through these discussions, that I also have a role to play in order
trying to make things better ”
Restoring trust and communication : “A kind of trust has been
established: the trust she expected of us and the one we were
expected of her ”
“ We communicate better ”
Avoiding food conflicts: “ I have understand that my role was not
about enter ing systematically into conflict about food… our
relationship has changed ”
Stepping back from the situation: “Since the beginning of the
program, it’s been less of an issue, because we’ve been able to
delegate it to the group. We speak about it less at home, so it’s
less stressful ”
Group support: “It is a bit of a paradox: on one hand I’ve realized
that obesity is a serious illness, but on the other hand, we
(the family) stress about it less because we have support”
Adolescents 'perceptions at the end of the program
Being more responsible/growing up: “ It helps us to make a
step forward, to see things in a different way, to grow up”
“ I don’t know if I can say I’m more mature, but I feel I’m more
responsable ”
Having parents trust /less conflicts : “ My mother gives me
more freedom, she doesn’t say anymore «you already took a
second helping, so be careful ». We now have nice meals with
no conflicts and that has really changed ”
“ Things are better now. Mealtimes used to be very conflictual.
As I was upset, I didn’t appreciate what I was eating or would
take my revenge on food and eat twice as much because I was
angry! ”
Restoring self-esteem/breaking isolation : ”I felt alone in life. I
felt fat and ugly. Since I have started coming here, I don’t think
that anymore. I’m just like everyone else… I have friends. Even if
I haven’t lost weight, it doesn’t matter. It doesn’t have the same
importance now. What’s important is that I feel good about
myself ”
Conclusions : Obesity has substantial repercussions on family dynamics which may have a negative impact on weight loss in adolescents.
Weight loss programs for teenagers up to 18 years of age must include parents in order to relieve their distress of having an obese child, modify
family’s interactions and allow teenager’s autonomy and self-efficacy.