Maintaining Social Facilitation

Today is the first day of the rest of your life

The first study to focus on pediatric long-term weight control using the socio-ecological model was conducted by Dr. Denise Wilfley. The basis is cognitive behavioral therapy. The research team concluded that, even after a successful weight loss program has been completed, it is essential to focus on a child’s social ecology via continued contact and interaction. In this paradigm,

The treatment targets extend beyond the individual to incorporate a supportive environment, which more comprehensively addresses the multi-contextual problem of weight control…. Involving the family, peers, healthcare providers, and community network is crucial.

The overall goal is to make it easy for kids to choose healthful alternatives, by bringing the maximum possible number of other people in on the action. Most important of all, of course, are the immediate family members, blood-related or not, who share the domestic headquarters.

Last time we discussed how Dr. Wilfley’s team would work with children ages 7 to 11 and their families, during the initial four-month behavioral weight loss treatment. SFM stands for social facilitation maintenance, which is the object of the subsequent eight-month program, working to maintain whatever weight loss had been achieved. This group of researchers also observed the built environment in which each child would continue to live.

One of the tenets of SFM is that intervention steps should be built in at all levels of existence whenever possible. It does indeed take a village to raise a child, and a village is made up not only of other people but of physical objects and structures both large and small. For instance, if the “village” contains convenience stores and fast-food joints on every corner, that will be a problem for some people. For a child trying to stay within healthy-living parameters, it’s truly a “bad neighborhood” and he or she needs more support than another child who lives, for instance, in a rural area.

In these matters, society is limited in what it can do. Common sense says, take the kid out of the bad neighborhood, or legislate to make the neighborhood less bad. These are both huge undertakings, and we live in a free country. Many kinds of damage can’t be stopped by fiat, so parents and health care professionals are stuck with the only available alternative, treating victims one by one.

Learning to make healthy choices isn’t hard, but new behaviors have to be practiced repeatedly until they become ingrained. In the areas of weight loss and addiction treatment, almost anyone can achieve positive, and even spectacular, results in the short term. The “long run” is what counts. When someone experiences that flush of victory, too often attention is then turned away — including the person’s own attention. It is all too easy to slip back into old ways.

Dealing with this inevitable letdown and the temptation to backslide is difficult enough for adults, who are expected to be equipped with at least a partial set of life skills. For a child, a day seems like a week and a week seems like a year, and the concept of a year is ungraspable. For those who are trying to hang in there and maintain, the old saying “Today is the first day of the rest of your life” has special meaning.

Your responses and feedback are welcome!

Source: “Cognitive Behavioral Therapy for Weight Management and Eating Disorders in Children and Adolescents,” NIH.gov, 04/01/12
Source: “Dr. Denise Wilfley: Successful Interventions for Curbing Pediatric Obesity,” NIH.gov, 11/23/11
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