| | Components | Description |
| | Screening phase/individual counseling | During the screening phase, children and their parents were interviewed at two separate occasions and all individually by the multidisciplinary team consisting of a dietitian, a child physiotherapist, a child psychologist, and a social worker. Throughout those two separate meetings, an individual advice was given by the multidisciplinary team, based on the personal situation of each participating family. |
| | Individual nutritional advice | A 3-day dietary recall (1 weekend day included) was used by the dietitian to get more insight in dietary habits of the children. Information was provided about nutrition and healthy eating behavior according to the traffic light nutritional list [25]. The traffic light nutritional list identifies several main food groups (fruits, vegetables, grains, milk and other dairy products, meat, fish, and others). Foods within each group were color-coded so as to reflect the caloric density per average serving and Dutch standards for healthy nutrition. The colors are green for “go”, orange for “approach with caution”, and red for “stop”. The children and parents were involved in planning their own daily diet for themselves according to the traffic light nutritional list. |
| | Individual physical activity counseling | To obtain insight in the child’s general physical activity behavior during the week, a physical activity questionnaire was filled out by a child physiotherapist. Children were asked about how they traveled to school (by foot, by bicycle, by public transportation, or by car), physical fitness classes at school, spire time sport activities, and daily computer and TV use as well as the duration spend at all these activities. The information from this questionnaire was used for advice on how to increase and optimize physical activity during everyday life, such as walking to nearby destinations and reducing sedentary activities (computer and TV use). |
| | Individual psychological counseling | By means of motivational interviewing, the child psychologist helped the children to adapting to a new lifestyle in order to reduce body weight. Before the child started with the group sessions, individual treatment goals (reduction of 10% of body weight during 3 months of group sessions) were written down in a contract to avoid disappointment. |
| | Children’s group meetings | Most children with obesity have negative experiences with group activities. For example, they are often not included in social events or chosen last by peers during sport activities. Therefore, during the first session much time is spent in getting acquainted with each other. A good group bond is important for the effect of the treatment because peer support can be very helpful in the treatment of obese children. The main educational focus of the first two meetings is on nutritional information of a healthy eating pattern and the balance between energy intake and energy expenditure. During the subsequent meetings, emphasis was put in self-control techniques to cope with difficult situations (e.g., birthday parties, holidays, lunch breaks at school, being at home alone). Problem solving alternatives are debated (e.g., to avoid a situation, doing something else, participate in a situation and eat less, or participate followed by extra exercise afterwards). Other psychoeducational topics reviewed were self-reward (when coping well with a difficult situation) and self-regulation situations (making a plan how to integrate healthy behavior in daily living). Stimulus control was also one of the psychoeducational topics (remove unhealthy stimuli at home, encourage healthy behavior, eat at the dinner table, reduction of environmental stimuli linked to eating). Topics of the last two meetings were self-image (focus on positive things about themselves) and coping strategies on dealing with teasing. |
| | Parent group meetings | Topics discussed during the parent meetings included the necessity to change their own lifestyle as well, information on healthy nutrition (product information, quantities, eating moments, eating locations), and how to help their children. Parents received advice on parenting styles (boundaries setting with regard to eating behavior, giving positive feedback). During the last meeting, a therapist discusses the role of all other family members with regard to the treatment in the family (e.g., are other family members supportive, how do they cope with the lifestyle changes). |
| | Follow-up meetings | In order to maintain the newly learned behavior, refresh follow-up meetings were given during the first two years (2-3 meetings/year). The child psychologist and the social worker organize this follow-up meetings. The topics repeated were problem solving techniques and relapse prevention techniques. |
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