Food is a powerful primary and secondary reinforcer, and obese persons find food more reinforcing than nonobese persons. In addition, obese persons may find alternatives to food less reinforcing than nonobese persons, providing a mechanism to understand why obese persons consume excess calories. The food deprivation that is associated with a calorie reduced diet may increase the reinforcing value of food, paradoxically making it more difficult for some obese persons to maintain the decreased caloric levels needed for weight loss and maintenance. This study is designed to test an innovative program for pediatric obesity based on behavioral economic theory that provides reinforcement for obese children for alternatives to their usual high-fat/low nutrient density eating, reduces access to intake of high-fat foods, and teaches parents to reduce behaviors that may increase the reinforcing value of high-fat foods. One hundred twenty obese children will be randomized to one of two groups, an innovative experimental treatment based on behavioral economic principles, and our standard family-based behavioral intervention program. Children will be followed through 2 years after randomization. Dependent measures will include body mass index, changes in percent overweight, changes in the eating and activity environment, parent control and restriction of food intake, child perception of dietary restriction, caloric and nutrient intake, physical activity, and the reinforcing value of noneating alternatives to high-preference, palatable high-fat/low nutrient density foods. This study will yield important information on new ways to treat pediatric obesity, minimizing dietary restriction and maximizing children learning healthier eating habits.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Study Section
Special Emphasis Panel (ZRG1-RPHB-2 (01))
Program Officer
Grave, Gilman D
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State University of New York at Buffalo
Schools of Medicine
United States
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Epstein, Leonard H; Raja, Samina; Daniel, Tinuke Oluyomi et al. (2012) The built environment moderates effects of family-based childhood obesity treatment over 2 years. Ann Behav Med 44:248-58
Epstein, Leonard H; Wrotniak, Brian H (2010) Future directions for pediatric obesity treatment. Obesity (Silver Spring) 18 Suppl 1:S8-12
Temple, Jennifer L; Legierski, Christina M; Giacomelli, April M et al. (2008) Overweight children find food more reinforcing and consume more energy than do nonoverweight children. Am J Clin Nutr 87:1121-7
Epstein, Leonard H; Dearing, Kelly K; Temple, Jennifer L et al. (2008) Food reinforcement and impulsivity in overweight children and their parents. Eat Behav 9:319-27
Epstein, Leonard H; Paluch, Rocco A; Beecher, Meghan D et al. (2008) Increasing healthy eating vs. reducing high energy-dense foods to treat pediatric obesity. Obesity (Silver Spring) 16:318-26
Wilfley, Denise E; Tibbs, Tiffany L; Van Buren, Dorothy J et al. (2007) Lifestyle interventions in the treatment of childhood overweight: a meta-analytic review of randomized controlled trials. Health Psychol 26:521-32
Epstein, Leonard H; Leddy, John J; Temple, Jennifer L et al. (2007) Food reinforcement and eating: a multilevel analysis. Psychol Bull 133:884-906
Paluch, Rocco A; Epstein, Leonard H; Roemmich, James N (2007) Comparison of methods to evaluate changes in relative body mass index in pediatric weight control. Am J Hum Biol 19:487-94
Epstein, Leonard H; Roemmich, James N; Stein, Richard I et al. (2005) The challenge of identifying behavioral alternatives to food: clinic and field studies. Ann Behav Med 30:201-9
Epstein, Leonard H; Saad, Frances G; Handley, Elizabeth A et al. (2003) Habituation of salivation and motivated responding for food in children. Appetite 41:283-9