1. Working with obese children and their families with small steps and realistic goals Andrew Duggan Senior Lecturer Health & Human Sciences University of Huddersfield.

2. 1 Warm up…… From getting up this morning to this point in time tell me one thing that tell you life is good? Think about the end of the day and tell me one thing that you may find useful?

3. 2 A modern concern……..?

4. 3 Social/Psychological Effects of Obesity Being perceived as obese can affect how you are treated and how you feel about yourself. Stereotype obese as slow, lazy, and sloppy, less sincere, less friendly, meaner, and more obnoxious – Rychman et al. (1989). Negative social attitudes even in young children age 5

5. 4 Social/Psychological Effects of Obesity Reasons for negative attitudes – it’s under the persons control he/she could stop eating if he/she wanted to stop – Dejon (1980) study of likeability of normal weight and overweight pictures of girls.

6. 5 Shifting Paradigms: Beyond Sickness “We’re all mad here. I’m mad. You’re mad.” “How do you know I’m mad?” said Alice “You must be, ” said the cat, “or you wouldn’t have come here.” Alice didn’t think that proved it at all. Lewis Carroll – Alice’s Adventures in Wonderland

7. 6 Shifting Paradigms: Beyond Sickness Generate expectations and hope. Help the child and their family picture a preferred future – use the miracle question. Validate that the change is already happening. Begin to notice what the child brings other than being obese. Help the child recruit ‘supporters’.

8. 7 Motivated/unmotivated Children UNMOTIVATEDMOTIVATED Bad experience in childhoodWhat have they come to see you? Resistant to changeWhat past successes have they had? Parental divorce/School problems What are their best hopes? Unmotivated personalityWho stands with the child?

9. 8 Get to know the Child Apart from the Problem What are the successes in the child’s life? What are they, their parents, their teachers etc most proud of? If the people that know the child the best were asked about their strengths, resources and skills what would they say? What else?

10. 9 Seeing Beyond the Mirror Help the child make their ‘unrecognised differences’ become a difference that makes a difference’

11. 10 What does the child want to change? There is often a need to ‘hang-on’ to behaviours that, however destructive they may seem, promised a degree of safety. What is the child’s preferred future? What has been helpful in the past? How will the child or family know that change is happening?

12. 11 Step 1.Removing the problem from the child Children often feel that they are the problem. “I am fat” or “I am an obese child” The problem is the problem, not the child. Give obesity a different name and characterise it

13. 12 Step 1 Removing the problem from the child Depending on the nature of the problem and the families preferred relationship to obesity, a multitude of different metaphors can be created. Some problems invite being tickled with wit and humour, others deserve to be killed off, kicked out, or vanquished from the child’s life.

14. 13 Step 2. Looking for evidence that challenges obesity What good things have happened since you found out you were coming to see me? What has been going well since we last met? What has obesity tried to stop you doing? When have you stopped obesity talking complete control of your life?

15. 14 Step 2. Looking for evidence that challenges obesity What successes have you had with obesity in the past? Start a ‘sparkling moments’ diary. When has the child or the family taken effective action against obesity? What was different at these times?

16. 15 Step 3. Setting small realistic goals Realistic and achievable goals should emerge from the conversation with the child, that are geared towards deconstructing or dissolving the complaint.

17. 16 Step 3. Setting small realistic goals Salient to the child. Described in situational and contextual terms. Described as the ‘presence of something’ rather than the ‘absence of something’. Realistic and achievable within the context of the child’s life.

18. 17 Step 4. Preparing for Setbacks We all have days when acorns fall from the sky, it does not mean that the sky is falling in!

19. 18 Step 4. Preparing for Setbacks What will happen on the days when ‘obesity’ takes control? What has the child or his family done in the past? What has worked before? Use the child and family as case consultants. Rainy day letters.

20. 19 Step 5. Telling and Celebrating a New Story Recruit an audience for the child’s new story/ How does the child want to celebrate success? Use the ‘sparkling moments’ diary. What next – renegotiation of goals.

21. 20 Useful Interventions “Would you tell me please, which way I ought to go from here?” “That depends a good deal on where you want to get to,” said the Cat. “ I don’t care much where….. So long as I get somewhere,” Alice added as an explanation. “Oh, you’re sure to do that, ” said the Cat, “if you only walk long enough”. Lewis Carroll – Alice’s Adventures in Wonderland

22. 21 Useful Interventions Circle of influence (use of scales) Turning ‘failures’ into successes. Nothing is constant – look for exceptions. What is different at these times? What needs to happen for these to happen again?

23. Thank you a.duggan@hud.ac.uk