Marcus was an 11-year-old African American boy who lived with his mother and two younger brothers and attended middle school. His body mass index (BMI) was at the 99th percentile for his age and gender. He had a very close relationship with his mother and did well in school, but he also needed additional support in completing tasks because of his diagnosis of ADHD. He had preferences for sweet and high-calorie foods, and sometimes had difficulty resisting them. One of his most important family and community times was Sunday church dinner, which often included a number of higher-fat foods and other tempting options. Marcus enjoyed physical activity, but his mother had not been able to get him involved in sports because of her work schedule and the demands of managing him and his two brothers as a single parent. She didn’t have many healthy food options at home and the family ate fast food frequently, given constraints on their time and finances. The family was highly motivated to improve Marcus’ weight, as they had a family history of diabetes and hypertension.
The psychologist working with Marcus’ family focused their brief treatment in two areas. The first was to improve their eating behaviors by making small changes in the foods they kept in the home and the choices they made when eating out. The family began by reviewing their usual meals with a dietician and learned about the often high salt and low nutrient value of typical fast food choices. This helped the family make healthier food choices as they now understood the potential relationship between weight, high salt intake and development of hypertension, a condition that many family members experienced. The psychologist also talked with Marcus and his mother about the importance of pre-planning decisions about food given his executive functioning difficulties.
The second area of focus was incorporating enjoyable, no-cost physical activities into the family’s routine. This treatment leveraged each of the systems at play in Marcus’ life—his school, his family, and their church community—to affect multiple avenues of change. In treatment, it was important for the psychologist to keep in mind the family’s limited time and finances.
Marcus, his mother, and his brothers all participated in treatment. This made sense because of their close relationships, but also because of Marcus’s age and his ADHD diagnosis. These relationships provided necessary support for Marcus to make changes in his behavior. For example, through discussion, the psychologist helped the family recognize the relevance of Marcus‘ ADHD to his eating behaviors (particularly with respect to his impulsivity and difficulty focusing). The psychologist used a solution-focused approach to identify strategies that had allowed Marcus to get on track in other areas, such as planning ahead, writing his plans down, and having his mother arrange and prepare for activities ahead of time.
The family was able to apply these previously successful strategies to eating behaviors. For example, Marcus’ mother began to plan ahead for snacks and meals, and the boys would help her place groceries into individual servings on Saturday afternoons that could be used for the week. Marcus, his mother and the psychologist identified the healthy options at the fast food establishments they often went to. His mother wrote these options down on a note in her phone so that they knew what to order in advance.
The psychologist also helped the family increase their physical activity. Marcus’ mother said that evenings after work were difficult for her as she struggled to get food ready, help the boys with homework, and do chores while keeping the boys entertained. In response, the psychologist helped her identify activities that the boys could engage in while she completed her own tasks, such as fun and child-friendly exercise routines on YouTube. The psychologist also helped to create fun physical activity challenges for the boys to do during commercial breaks while watching television. An exercise specialist introduced Marcus and his brothers to some new physical activities that they could engage in at home and nearby. The brothers particularly enjoyed tossing a frisbee and identified a space near their home that was appropriate and safe for them to play.
Regarding dinners with the family’s church community, the psychologist helped Marcus and his mother to identify their favorite foods at Sunday dinners and discussed ways they could make the recipes healthier or engage in more portion control. Opportunities for physical activity during these events were also discussed. For example, Marcus was excited about the idea of creating scavenger hunts for the kids to do as the adults sat and talked. He said this would help him move around instead of being tempted by the food at the dinner.
Marcus qualified for free meals at school and often ate school breakfasts and lunches. His mother did not have control over what was served there, and the options were not always ideal. His mother was encouraged to look at the menus ahead of time to help Marcus decide what his best options were and what portions to reduce to avoid excess calories during these meals. Marcus’ mother was also encouraged to talk to the school nurse about potential accommodations for Marcus during meals, such as having more healthful options available, as well as ask how the school might enable him to get additional activity. The nurse responded by having him be a “helper” in the office, walking notes to and from teachers’ classrooms, to get a little more activity in the middle of the day. Marcus appreciated this and felt good about the activity rather than singled out.
These changes, and particularly the involvement of the family and community, helped Marcus to make some important modifications to his eating and exercise, even within the confines of limited finances, resources, and time. His family’s motivation to improve his health and be healthy together assisted them in making many of these changes. The psychologist’s support in helping with problem-solving, demonstrating the relevance of Marcus’ ADHD to his eating behaviors, and addressing some of the barriers to success were useful in improving his health and enabled initial reductions in BMI.