Allison M. Sweeney

Promoting Social Nurturance and Positive Social Environments to Reduce Obesity in High-Risk Youth

Nurturing environments within the context of families, schools, and communities all play an important role in enhancing youth’s behavioral choices and health outcomes. The increasing prevalence rates of obesity among youth, especially among low income and ethnic minorities, highlight the need to develop effective and innovative intervention approaches that promote positive supportive environments across different contexts for at-risk youth. We propose that the integration of Social Cognitive Theory, Family Systems Theory, and Self-Determination Theory offers a useful framework for understanding how individual, family, and social-environmental-level factors contribute to the development of nurturing environments. In this paper, we summarize evidence-based randomized controlled trials that integrate positive parenting, motivational, and behavioral skills strategies in different contexts, including primary care, home, community, and school-based settings. Taken together, these studies suggest that youth and parents are most likely to benefit when youth receive individual-level behavioral skills, family-level support and communication, and autonomous motivational support from the broader social environment. Future investigators and healthcare providers should consider integrating these evidence-based approaches that support the effects of positive social climate-based interventions on promoting healthy eating, physical activity, and weight management in youth.

The Role of Behavioral Medicine in Integrated Healthcare

This chapter reviews evidence from randomized controlled trials that demonstrate the importance of behavioral interventions for improving lifestyle behaviors and preventing and treating chronic diseases. Taking a lifespan approach, we review trials including participants ranging from children to elderly adults, and show that critical components of effective interventions include targeting self-regulation and self-efficacy through strategies such as self-monitoring, receiving feedback, developing action plans, and utilizing effective goal setting strategies. Although limited research exists on comparing the effectiveness of integrating behavioral health experts into the integrated care team, the effects of traditional randomized trials show the consistent effectiveness of implementing behavioral interventions with a high fidelity of delivery. Furthermore, there is a growing literature that supports the cost-effectiveness of behavioral interventions on reducing hospital utilization and medication usage. Thus, the field of behavioral medicine has the potential to play a fundamental role in reducing healthcare utilization and costs by improving lifestyle habits that have been related to the prevention of chronic diseases.