Family therapy treatment: Working with obese children and theirfamilies with small steps and realistic goals

YWONNE PETERSON

TMK Konsult AB, Blentarp, Sweden

AbstractChildhood obesity treatment can be discussed from several points of view, and there are many forms of treatment. Solution-focused brief therapy (SFBT) and systemic family therapy can be useful in a wide range of contexts and settings such as socialcare, education and healthcare. They can also be used wherever practitioners sometimes feel that they have very little impacton the patient and where the patient seems to be resistant to acknowledging his/her problem. Health professionals need toassist by starting to explain main goals and medical information in terms of a single, small, concrete and important goal,described as the beginning of a new behaviour, not as the end of something. This report focuses on some useful tools andmethods taken from casework examples from multidisciplinary obesity team meetings with more than 300 families during a3-y project approximately between 2002 and 2003 at the Childhood Obesity Unit at University Hospital, Malmo. Othercasework examples are taken from supervision and training professionals who are currently working with or are going to workwith childhood obesity using a solution-focused model. The main aim of this report is to discuss and think about the differencebetween problem-solving and solution-building interview questions when it comes to treatment regarding how best to helpchildren and parents with serious obesity health problems.

Conclusion: There is a great need for treatment models and the prevention of childhood obesity now and in future, whichpresents an interesting and urgent challenge for open-minded thinking and new fields of research.

KeyWords:Childhood obesity,multidisciplinary team, interviewing skills, salutogenic, solution-focused brief therapy, small steps

Introduction

Childhood obesity is an increasing problem in most

developed countries, and many different kinds of treat-

ment for obesity have been investigated, mostly by

medical studies including genetic influences, medica-

tion, surgery, diet, exercise and some studies from

behavioural cognitive therapy [1]. The multifactorial

causes of obesity probably require more than one treat-

ment. One frequently asked question by professionals/

parents when it comes to practical work is: How do we

work with clients/patients that are not motivated?

Multidisciplinary obesity teams with a solution-

focused approach can be one way that gives the child/

teenager and their family some ideas about what they

need to know in order to make lifestyle changes.

Solution-focused brief therapy (SFBT):

A working model

Solution-focused brief therapy (SFBT) is based on

some of the same interactions, individuals in the

context of environmental ideas, as family therapy. The

SFBT view is based on the idea that stability is nothing

but an illusion based on memory, and it views human

life as a continuously changing process. It is not possible

to put life on hold. The philosophical belief in SFBT is

that the best way to provide services and treatment to a

child is by strengthening and empowering the family as

a unit. SFBT uses more time thinking about how to get

out of the problem than how the problem began [2–5].

The solution-focused approach builds upon the client’s

resources. It helps clients to achieve their preferred

outcomes by evoking and constructing solutions to

their problems [6]. When working with this approach,

focus is on what Antovnovsky [7] called salutogentic

aspects rather than pathogenetic ones. Health profes-

sionals like doctors, nurses and trainers work in

different contexts to professionals in a psychodynamic

context. The aim and context is different when you

work with long-term treatment than it is in a short

meeting with a doctor in a hospital, but long-term

treatment does not have to be more effective compared

to brief treatment [8,9]. In the first meeting at a

hospital, it can be very helpful to use a context that

Correspondence: Ywonne Peterson, TMK Konsult AB, SE-270 35 Blentarp, Sweden. Tel: +46 416 24396. Mobile: +46 70 370 60 40. E-mail:

ywonne.peter@telia.com

Acta Pædiatrica, 2005; 94(Suppl 448): 42–44

ISSN 0803-5326 print/ISSN 1651-2227 online # 2005 Taylor & Francis Group Ltd

DOI: 10.1080/08035320510035573

takes us into a conversation that gives the obese child

and his/her family the feeling of being involved in the

treatment. Merely making a correct diagnosis of the

illness and knowing the correct method of treatment is

not enough. It is also important that the child/teenager

and his/her family are receptive to the treatment and

cooperative in regard to it.

The solution-focused approach, based on respect for

and collaboration with the client, concentrates on

success, exceptions and solutions. How can we be

helpful to families affected by obesity who need lifestyle

changes? Therapists develop goals together with the

patient rather than imposing ideas and assumptions

about what the client needs to do. How can we learn

about what they need in order to move to realistic

goals? How can we focus on the development of con-

fidence and competence of parents/caregivers and

children in moving towards their preferred futures and

goals? What needs to happen in a meeting that tells the

family that it was worth coming? [10]. What kind of

questions do they want to know more about? One way

to find out is to ask them how we can be helpful. Clients

sometimes describe their goals in an idealistic, trouble-

free way and sometimes they do not find the goal

achievable and therefore turn it into a statement where

the locus of control of the situation is too far away from

where they stand. A central belief in SFBT is that clients

have most or all the resources and strengths they need

to solve their problems [3,11]. Obese children/teen-

agers and their parents need to emphasize the growing

awarenessofplayingapart in theirown lifestyle changes.

A sense of coherence including comprehensibility,

manageability and meaningfulness is important when

health professionals try to find a way to promote health-

related messages to patients and their families [7]. It

is very difficult to force people to make lifestyle

changes; and if we try to do this, they will probably not

come back. Health professionals need to assist by

starting to explain main goals and medical information

in terms of a single, small, concrete and important goal,

described as the beginning of a new behaviour, not

as the end of something. It does not help if the

doctor, nurse and psychologists are experts if clients/

families do not understand or feel included in the

treatment [10].

Motivated/unmotivated clients

Health professionals want to do their best to give

treatment that helps the obese child/teenager to obtain

a better health situation. In order to understand how

they can be helpful, they sometimes try to find a reason

for different kinds of “eating disorders” in disturbed

communication between parents and their child or

their environment. Different ideas about what causes

obesity are described by professionals and families alike:

“bad experience in childhood”, “school problems”,

“parents’ divorce” or “unmotivated personality”, etc.

Another common question asked by professionals and

parents/caregivers is how to motivate the child/teen-

ager. Human motivation is a complex question that

leads us into new and interesting fields including

linguistic research and construction: What do we mean

by the word “motivated”? What do we mean by resis-

tance? [4,5,12]. Sometimes this thinking assumes that

the patient’s motivation is something that either he/she

has or has not. One way to change from being problem

focused is to think about mandated clients/patients/

families as they have multiple goals, different desires

and ideas about what might be helpful and realistic

goals for them in order to make lifestyle changes.

Clients’ goals are central to solution-focused therapy

[3,10]. If we assume that families affected by obesity

have good reasons for doing what they do, then we as

professionals must have good reasons for being helpful

and creating a cooperative relationship to change

things.

Conclusions

Medical and other health professionals need to be open

to psychosocial factors and other disciplines in order to

provide opportunities for practising interviewing skills

and guidelines for goal setting in professional practice.

One aim is to recognize the difference between

problem-solving and solution-building interview

questions when it comes to treatment regarding how

best to help children and parents with serious obesity

health problems. Methods for reducing childhood

obesity, including a consensus about framework,

interventions and priorities, seem to be important in

avoiding contradictory messages that families affected

by obesity sometimes find confusing. Highlighting

individual and family resources can be helpful in

providing the incentive for a change in behaviour

towards a healthier lifestyle.

We need to know more about the effects of doctor–

patient relationships on the potential and limits of the

doctor’s involvement with the patient and how these

partners respond to each other.

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44 Y. Peterson