Obesity in children is a major public health concern; in fact, 18.5 percent of children in the United States are considered obese. For autistic children, evidence suggests the percentage is even higher. Factors such as unusual dietary preferences, noncompliant behavior, decreased exercise, social isolation, and frequent use of psychotropic medication associated with weight gain may contribute to that higher percentage.
Through a two-year study funded by OAR in 2016, William Sharp, Ph.D., T. Lindsey Burrell, Ph.D., and Larry Scahill, Ph.D., principal investigators from the Marcus Autism Center in Atlanta, Ga., evaluated an intervention that targets obesity in autistic children to evaluate its acceptability, feasibility, and preliminary efficacy. The Changing Health in Autism through Nutrition, Getting Fit and Expanding Variety (CHANGE) program is a multidisciplinary, manual-based intervention that combines behavioral intervention and nutrition education to address each child’s unique behavioral, feeding, and nutritional profile. CHANGE uses a “parent as co-therapist” model designed for cost-efficiency and flexible usage. The manual includes methods to increase dietary diversity and reduce grazing between meals/intake of sweetened beverages, as well as in-clinic activities and homework assignments to promote physical activity.
For the study, the research team enrolled seven children between the ages of 5 and 12, along with a parent/caregiver, to participate in 16 sessions over six months with a therapist who delivered the intervention and worked with the parents. The initial 10 sessions were delivered weekly, followed by six booster sessions to support continued progress. The researchers’ goals were to:
- Revise the manual to include individualized treatment components and create relevant worksheets for parents and interventionists. The curriculum provided caregivers with tools to build toward a healthier lifestyle (e.g., physical activity; nutrition planning). Through manual development, CHANGE now involves therapist scripts to describe the previously developed protocols in more detail so that therapists deliver treatment in a consistent manner.
- Provide education regarding obesity in autism spectrum disorder (ASD), track child behavior, and increase physical activity. The first three sessions described behaviorally based, ASD-specific guidance to assist caregivers in systematically monitoring child behavior and subsequently increasing child participation in physical activity, while concurrently reducing sedentary behavior. The fourth and fifth sessions provided guidelines related to nutrition, assessing current meal practices and identifying sources of excess calories. The manual also includes strategies for reducing excess calories, improving mealtime structure, and managing problematic mealtime behaviors. Sessions six through 10 focused on empowering caregivers to work toward attainable goals for healthy behaviors by providing guidance regarding approaches to introduce behavior change and preparing them to continue to plan and implement the treatment package once sessions moved to less frequent clinical support (e.g., biweekly and then monthly).
- Evaluate the feasibility of implementing the CHANGE program. Feasibility included recruitment metrics (i.e., enrollment, attendance, retention, study completion) as well as therapists’ delivery of intervention.
While none of the participants experienced significant weight loss during the research study, there was improvement in:
- Increased participation in physical activity: Five of the seven participants (71%) met the target benchmark of one hour of exercise per day following intervention.
- Healthy eating: Four of the seven participants (57%) showed improvement with progress in reducing snacking, adhering to a healthy meal plan, and controlling portions during meals.
Overall, caregivers were satisfied with the intervention, based on a score of four out of five regarding treatment acceptability. Therapists delivered the intervention with high integrity (80 percent or greater).
These results provide provisional evidence to support continued study of the CHANGE program, including determining the long-term sustainability and impact of the observed healthy lifestyle changes.