The challenge of identifying behavioral alternatives to food: clinic and field studies

Background: One of the basic principles of behavioral economics interventions is identification of alternative behaviors to compete with the reinforcing value of a highly rewarding commodity.Purpose: Two experiments that attempt to increase alternatives to eating in obese youth are presented.Methods: A randomized, controlled trial was used in Study 1 to compare a comprehensive family-based behavioral treatment program or an experimental treatment that incorporated reinforcing children for engaging in alternative behaviors to eating for 41 overweight 8-to 12-year-old children. Study 2 used a within-subject design with baseline, enriched environment and a second baseline phase to determine the influence of providing activities that compete with eating for 13 overweight 8-to 12-year-old children. Measurements included body mass index (BMI) change, alternatives to eating, eating, and physical activity.Results: In Study I both treatments were associated with significant (p < .05) and maintained reductions in z-BMI over the 24 months of observation. The experimental group showed a significantly (p < .05) greater increase in alternatives to eating, and both groups showed significant (p < .05) increases in physical activity. In Study 2 alternative behaviors to eating were increased by almost I hr/day (p < .001) but were not associated with significant changes in energy intake or physical activity.Conclusion: These results suggest that using the methods studied, increasing behaviors that could compete with eating did not influence relative weight in a clinical outcome study or energy intake in a controlled field study. Dr. Richard Stein is now at the Center for Human Nutrition, Washington University School of Medicine. Dr. Leonard Epstein is a consultant to Kraft Foods. This research was supported in part by grant HD 39792 awarded to Leonard Epstein. Appreciation is expressed to Rekha Trivakram for coordinating the implementation of Experiment 2.