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. Author manuscript; available in PMC: 2018 Sep 1.
Published in final edited form as: Curr Obes Rep. 2018 Sep;7(3):235–246. doi: 10.1007/s13679-018-0316-9

Table 2.

Treatment Components of FBT Weight loss and Maintenance Treatments and Relationship to Disordered Eating

Specific Treatment Targets/Activities Relationship to Disordered Eating

Individual Behaviors

Diet Quality and
Quantity
- Children and parents shape to less than 15 servings of high-fat foods a week - A flexible eating style within a generally healthy diet (e.g., not completely restricting access to high-calorie, palatable or “forbidden” foods) reduces disordered eating symptomology
- Children and parents eat 5 servings of fruits and vegetables a day

Physical/
Sedentary Activity
- Children reduce screen time to less than 2 horns a day - Physical activity for health and body esteem, not energy-balance, is emphasized
- Children increase physical activity to 90 min/day and parents to 60 min/day - Physical activity promotes executive functioning, which may protect against dysregulation in disordered eating
- Reduced screen time reduces time spent sedentary, overeating cues and exposure to body ideals

Healthy Routines - Children and parents eat 3 meals and 1– 2 snacks per day - Meal regularization is important to regulate hunger cues and prevents long periods without eating, which can be a trigger for disordered eating behaviors
- Children and parents keep a consistent and regular activity schedule - Consistent routines and structure counter-act dysregulation
- Children and parents keep consistent bedtimes and bedtime routines to ensure adequate sleep duration

Goal setting and Pre-planning - Children and parents identify short and long-term weight and behavioral goals - Prospective thinking and pre-planning help to build executive function skills and allow for planning around disordered eating behavior triggers
- Children and parents pre-plan meals, snacks, and physical activity each week

Self-Monitoring - Children and parents track weight, food, and physical activity to monitor progress towards goals - Regular weighing replaces too-frequent or avoidance of weighing that can perpetuate disordered eating thoughts and behaviors
- Monitoring of food and physical activity instances can help identify triggers contributing to disordered eating

Problem-Solving - Children and parents problem solve around barriers to healthy eating and activity. - Problem solving may be used for disordered eating behaviors, which could include improving decision making to avoid binge eating or finding alternatives to extreme weight control behaviors

Behavior Chains and Cognitive Restructuring - Children identify antecedents and consequences to behaviors - Behavior chains and cognitive restructuring may also be used for disordered eating attitudes and behaviors and are a key component of CBT for EDs
- Children identify negative automatic thoughts regarding the self and create a rational response

Building a Healthy Body Image - Children participate in activities to reduce overvaluation of weight and shape and expand self-evaluation above and beyond appearance - Overvaluation of weight and shape and body dissatisfaction are key features of eating disorders and activities included in FBT mimic evidence-based treatments for improving body image

Family and Home

Family Meetings and Contingency Management - Children and parents identify a time each week to meet and discuss progress and barriers - Family meetings promote interaction and cohesion among the child and parent, which may help to protect against disordered eating development
- Praise and external rewards are used to promote child buy-in to participation in FBT.

Communication and Parenting Skills - Parents are taught communication skills and limit setting around energy-balance behaviors - Parent behaviors (e.g., weight-based teasing of child, pressure to be thin) have been identified as risk factors for development of disordered eating.

Parental Modeling - Parents are taught to model the behaviors they expect of their child to promote healthy child energy-balance behaviors - Parental modeling of healthy energy-balance behaviors may replace unhealthy dieting behaviors, which have been identified as a risk factor for disordered eating.
- Parental modeling of healthy body image attitudes encourages development of healthy body image in the child

Healthy Home
Environment
- Parents are encouraged to create a home environment that easily supports healthy energy-balance behaviors, reducing temptations for sedentary behavior and high-fat foods. - Creation of a healthy home environment reduces temptations that may “trigger” disordered eating attitudes and behaviors

Peers and Social Networks

Making New Friends and Active Get-Togethers - Children are encouraged to build and form relationships with peers that support healthy eating and activity habits and can serve as an alternative rewarding experience to unhealthy eating and sedentary behavior - Interpersonal conflict and isolation are related to disordered eating. Focusing on improving peer relationships helps reduce disordered eating.

Interpersonal
Communication
- Children learn about communication styles and build interpersonal communication skills - Communication skill building serves to foster friendships and reduce conflict

Coping with
Teasing
- Children are taught to “tease the tease, not the teaser” (e.g., avoid insults) and to avoid emotional reactions that perpetuate the teasing cycle - Weight-based teasing is related to disordered eating and adaptive coping strategies may prevent use of disordered eating behaviors

School, Work, Community, and Culture

Advocating for Healthy Social Environments and Navigating Barriers - Children and parents identify and navigate environmental barriers that are weight-gain promoting and advocate within their community to promote healthy habits - Creation of healthy environments and problem solving around unhealthy environments may reduce triggers for disordered eating
Understanding Stigma and Interpreting Media Messages - Children are taught media literacy skills to interpret messages regarding ultra-thin ideals and obesity stigma in media - Reduction in internalization of the thin ideal may work towards preventing and treating disordered eating attitudes and behaviors