Addressing childhood obesity through self-determination theory using sensory integration – a pilot programme. Nahory H. Mancilla.1,2,3 1
National Health Service Oxford Health Foundation Trust, Oxford, UK. International Organisation of Psychology and Education-INOPSYE, London, UK. 3 University of Westminster, London, UK. 2
Keywords: childhood obesity, positive behavioural interventions, self-determination theory, sensory integration, cost-effective school interventions.
Abstract The present programme aims to address childhood obesity in children aged 5 to 11. This is a school-based intervention, however a multi-disciplinary approach that involves communication between GP ↔ Family ↔ Schools is recommended. Even though school-based interventions have been implemented before to address obesity, time to perform a programme along with the national curriculum has proved to be a difficult task according to Peterson and Fox (2007). The authors recommended schools to integrate activities and nutrition into core subjects. Undoubtedly, some programmes have attempted this, “Planet Health” (Wiecha et al., 2004) was a success with children aged 11-12. Results showed greater remission of obesity among intervention girls vs control girls (odds ratio= 2.16; 95% confidence interval= 1.07-4.35; p = .04). However, no difference was found amongst boys. Nevertheless, the intervention reduced TV-viewinghours amongst boys and girls. Although TV-viewing-hours has been used as a predictor of obesity before, further research is needed to achieve generalisability (Miller, Taveras, Rifas‐shiman & Gillman, 2008). In fact, the environment where children are in also influence their eating habits and life style as Smith (2010) highlighted. Furthermore, emotional, biological, educational, and economic matters could be contributing factors that perpetuate obesity. All these factors are often affected by governmental policies, lack of budget; and a culture where good health is not enough to motivate children to practise a healthy lifestyle. In fact, Deci and Ryan (2000) described how intrinsic motivation is essential to practise a healthy lifestyle with autonomy. Although behavioural and dietary treatments are effective for quick weight-loss the effects do not seem to be long-lasting (Wooley & Garner, 1994). Bogle and Sykes (2011), after reviewing diverse studies in the subject, concluded that it was necessary to create more imaginative ways to address childhood obesity. Therefore, the present programme uses sensory integration (SI) activities (Ayres, 1979), to allow children to develop their neuromotor-system in relation to their unique situation (cognitive-biological-psychological-social). This intervention aims to get children used to an active lifestyle where nurturing games that help their development, are combined with the national curriculum. Every activity can be tailored to specific requirements, hence children are enabled with the necessary competencies and autonomy to replicate the activities in any environment to share the activities, thus providing opportunities to form or strengthen social relationships whilst they become more active (DeSantis, Harkins, Tronick, Kaplan & Beeghly, 2011).
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Additionally, SI can help to balance brain functions, it works by developing the integration of how the five senses, in addition to proprioception and vestibular systems, receive the information through the body to then send such information to the brain. This programme involves SI with particular focus on vestibular stimuli (running, rolling, jumping) and proprioception (crawling, pulling, and climbing) to prompt core-strength, developing of executive functions, self-regulation and tolerance in accordance to their age. The activities are planned for a minimum of 30 minutes every day, allowing pair, team, and individual work to develop social skills. Equally important is the promotion of a non-judgemental environment to help children to become autonomous. Therefore, self-determination theory (SDT) will serve this intervention by helping adults to enable children to satisfy the three psychological universal needs; competence (confidence and mastery to overcome obstacles or seek guidance), autonomy (when the individual values beneficial behaviours due to his/her believes) and relatedness (to feel understood, respected and cared for), (Ng, Ntoumanis, ThøgersenNtoumani, Deci, Ryan, Duda, & Williams, 2012). The latter encourages intrinsic motivation, a type of motivation that comes from within the individual. This would be evident when children replicate the games or ask teachers to play the games because they enjoy the activity, not because they expect a reward or because they need to complete a school task. To summarise, this intervention should help children to have volition to achieve long-lasting self-management to practise a more active and healthy lifestyle. Correspondence: Nahory H. Mancilla, INOPSYE. E-mail: nahory@inopsye.co.uk Received for publication February 2016; Revised 22 February 2016; Accepted 7 March 2016.
Š International Organisation of Psychology and Education
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References Addison, L. R., Piazza, C. C., Patel, M. R., Bachmeyer, M. H., Rivas, K. M., Milnes, S. M., & Oddo, J. (2012). A comparison of sensory integrative and behavioral therapies as treatment for pediatric feeding disorders. Journal of Applied Behavior Analysis, 45(3), 455-471. doi:10.1901/jaba.2012.45-455 Ayres, J. (1979). Sensory integration and the child. Western Psychological Service: USA. Bogle, V., & Sykes, C. (2011). Psychological interventions in the treatment of childhood obesity: What we know
and
need
to
find
out.
Journal
of
Health
Psychology,
16(7),
997-1014.
doi:10.1177/1359105310397626 DeSantis, A., Harkins, D., Tronick, E., Kaplan, E., & Beeghly, M. (2011). Exploring an integrative model of infant behavior: What is the relationship among temperament, sensory processing, and neurobehavioral measures? Infant Behavior and Development, 34(2), 280-292. doi:10.1016/j.infbeh.2011.01.003 Jelalian, E., Steele, R. G. (2008). Childhood and adolescent obesity. New York: New York: Springer. Miller, S. A., Taveras, E. M., Rifas‐shiman, S. L., & Gillman, M. W. (2008). Association between television viewing and poor diet quality in young children. International Journal of Pediatric Obesity, 3(3), 168-176. doi:10.1080/17477160801915935 Ng, J. Y. Y., Ntoumanis, N., Thøgersen-Ntoumani, C., Deci, E. L., Ryan, R. M., Duda, J. L., & Williams, G. C. (2012). Self-determination theory applied to health contexts. Perspectives on Psychological Science, 7(4), 325-340. doi:10.1177/1745691612447309 Peterson, K. E., & Fox, M. K. (2007). Addressing the epidemic of childhood obesity through School‐Based interventions: What has been done and where do we go from here? Journal of Law, Medicine & Ethics, 35(1), 113-130. doi:10.1111/j.1748-720X.2007.00116.x Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68-78. doi:10.1037/0003-066X.55.1.68 Smith, P. K. (2010). In Cowie H., & Blades M. (Eds.), Understanding children's development (5th ed. ed.). Oxford: Oxford : Wiley-Blackwell. Wiecha, Jean L.; El Ayadi, Alison M.; Fuemmeler, Bernard F.; Carter, Jill E.; Handler, Shirley; Johnson, Stacy; Strunk, Nancy; Korzec-Ramirez, Debra; & Gortmaker, Steven L. (2004). Diffusion of an Integrated Health Education Program in an Urban School System: Planet Health. Journal of Pediatric Psychology, 29(6), 467-474. doi: 10.1093/jpepsy/jsh050 Wooley, C. S., & Garner, D. M. (1994). Controversies in management: Dietary treatments for obesity are ineffective. Bmj, 309(6955), 655. doi:10.1136/bmj.309.6955.655
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