C H A P T E R 7 er, interventions that specifically targeted children from lower socio-‐economic status groups showed limited evidence of effect on behavior while in adolescents just moderate effect was found for educational interventions and multicomponent programs on behavior28. Appearance and awareness of its consequences are more prominent present in adolescence than in childhood. These days in several countries a program is applied called the Triple P Positive Parenting Program. This program has been focusing on the support of parents. It is a multi-‐level parenting and family support strategy developed by the University of Queensland in Brisbane29. The Triple P program has been based on social learning principles and adopts a system-‐contextual or ecological perspective in supporting parents. The efficacy of Lifestyle Triple P has been tested in a randomized con-‐ trolled trial (RCT) in Australia30. West et al. showed that their intervention signifi-‐ cantly decreased children’s body size and body fat, decreased their weight-‐related problem behavior, increased parental confidence in managing weight-‐related prob-‐ lem behavior, and decreased ineffective parenting31. Moreover, Triple P Positive Parenting Program is applied successfully in the South of The Netherlands. The Centre for Overweight Adolescent and Children’s Healthcare (COACH) from the Maastricht University Medical Centre (MUMC) helps children and adolescents with obesity. By COACH children, adolescents and their parents are accompanied by a multidisciplinary team to treat obesity with dietary-‐, sport-‐ and psychological ad-‐ vices. Children are coached until they reach the age of 35 years. During this pro-‐ gram also scientists will be closely involved. The most important aim is to change life style. After all, prevention of excessive weight gain in children is based on a different mechanism than prevention of weight gain in adults: children can reduce their BMI while growing without losing weight, whereas adults have to lose weight in order to reduce their BMI32. Parents are the primary caregivers, who are largely responsible for their children’s nutrition and physical activity patterns, particularly in the early years of life33. Mo-‐ tivational interviewing is a method that can be used to approach parents of children with obesity. Motivational interviewing is a way of approaching people to help them recognizing their problem and to stimulate them to solve this problem. In case of parents with an obese child, this approach is very important. Most parents do not want to admit that their child is too heavy. They are often not aware of the problem and think that their obese child only suffers from a little bit baby fat. They feel attacked and guilty, because they think their education and upbringing is not correct. They will often seek for external factors as cause for the obesity problem of their child. If parents are willing to change their own behavior and thereby improv-‐ ing the health of their children, this is an important step in the prevention of obesi-‐ ty development. 112
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