prospective designs must include repeated objective assessment of compliance to eating and exercise behavior, as well as use of behavioral techniques. The current studies suggest that a variety of treatment variables are important to outcome, such as self-monitoring and changes in eating behaviors. In addition, family factors such as parent praise and changes in weight of other family members may be important in arranging an environment that promotes compliance to recommended changes. There are a variety of other factors that could influence outcome that should be evaluated, particularly in regard to behavioral factors that may be operative in family-based treatments. For example, child food and exercise perceptions ( Epstein, Valoski, Wing, Perkins, Fernstrom, Marks, & Mc- Curley, 1989), parent eating and exercise behavior patterns ( Sallis, Patterson, McKenzie, & Nader, 1988), or parental perceptual biases ( Wahler & Dumas, 1989) may be responsive to family-based treatment and compliance enhancing interventions and thus related to outcome.
Appreciation is expressed to Rena R. Wing, Alice Valoski, and Joel Greenhouse for suggestions on design and analysis. The childhood obesity research presented was supported in part by grants HD MH 12520, HD 16411, HD 19532, and preparation of this chapter was supported by grant HD 20829, each of which was awarded to Dr. Epstein.
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