The Effect of Play Therapy Package Based on Temporal Self-regulation Theory on Body  Mass  Index  of  Obese  Children

Rezai, Aryan; Dehghani, Akram; Haghayegh, Sayed Abbas

doi:10.30473/hpj.2025.68972.5883

Document Type : Scientific Research

Authors

¹ Ph.D. Student, Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran.

² Assistant Prof, Department of Psychology, Najafabad Branch, Islamic Azad University, Najafabad, Iran.

10.30473/hpj.2025.68972.5883

Abstract

Objective: Weight loss and its maintenance were one of the most important goals of therapists in the field of treating chronic obesity in children due to the inadequacies of current treatments. Thus, the researchers of this study decided to test the effect of their play therapy package based on Hall and Fong's temporal self-regulation theory in this regard. Method: By implementing a semi-experimental research design with pre-test, post-test and follow-up at 2-month intervals on a convenience sample from the population of the Iranian Health Centers-Isfahan City, including 45 parent-obese child pairs randomly assigned to two experimental and control groups, at the same time as conducting family-based behavioral intervention on both groups, members of the experimental group also received play therapy package training. Results: By analyzing the data of children's body mass index (measured by dividing the weight measured in kilograms on a scale by the square of the height measured in meters with a stadiometer) in three sections in the form of pre-test, post-test and follow-up by one-way covariance method, significant difference between the experimental group (combined play therapy method with family-based behavioral intervention method) and the control group (only family-based behavioral intervention method) in both post-test stages (F(42,1)=2188.34, P<0.001, ŋ2=0.98) and follow-up (F(42,1)=1036.61, P<0.001, ŋ2=0.96) was observed which according to the observed strong size effect indicates the effectiveness of the combined method was much better than using the family-based behavioral intervention method alone on weight loss and maintenance. Conclusion: The interpretation of the results indicates the effectiveness of adding the training package designed based on Hall and Fong's temporal self-regulation theory to strengthen the three executive functions of working memory,response inhibition, and cognitive flexibility to the usual family-based behavioral intervention as the best method available in the field of reducing and maintaining weight of children. In such a way that this combined method according to restrictions set in the field of using medical treatments (including drug therapy and surgery) for children under 12 years of age, could be considered as a step in the field of designing complementary methods, which by addressing other causes of chronic obesity including the neurological causes and the psychological structures attributed to it, including the executive functions, has been able to be effective with minimal side effects on the process of treating chronic obesity. The primary step that taking other steps in the direction of improvement and expansion of the designed play therapy package was subject to its retesting and application in other societies, and in comparison, with other methods by interested researchers.

Keywords

References

Adise, S., Allgaier, N., Laurent, J., Hahn, S., Chaarani, B., Owens, M., Yuan, D-K., Nyugen P., Mackey, S., Potter, A. & Garavan, H. P. (2021). Multimodal brain predictors of current weight and weight gain in children enrolled in the ABCD study. Developmental Cognitive Neuroscience, (49): 100948.

Akbari, H. & Mohammadi, M. (2022). The Prevalence of Obesity in Iranian Children: A Systematic Review and Meta-analysis. Journal of Pediatrics Review. 10(2): 93-102.

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Retrieved from http://www.apa.org/ethics/code/index.aspx. 10 June 2021.

Blair, C., Kuzawa, C. W. & Willoughby, M. T. (2020). The development of executive function in early childhood is inversely related to change in body mass index: Evidence for an energetic tradeoff? Developmental science, 23(1): e12860.

Carretero Gómez, J., Ena, J., Arévalo Lorido, J. C., Seguí Ripoll, J. M., Carrasco-Sánchez, F. J., Gómez-Huelgas, R., Pérez Soto, M. I., Delgado Lista, J. & Pérez Martínez, P. (2021). Obesity is a chronic disease. Positioning statement ofthe Diabetes, Obesity and Nutrition Workgroup of theSpanish Society of Internal Medicine (SEMI) for anapproach centred on individuals with obesity. Rev Clin Esp, (English Edition), 221(9): 509-516.

Doak, C., Doak, L. & Root, J. (1996). Teaching patients with low literacy skills (Vol. 2). Philadelphia, PA: Lippincott-Raven.

Epstein, L. H., Schechtman, K. B., Kilanowski, C., Ramel, M., Moursi, N. A., Quattrin, T., Cook, S. R., Eneli, I. U., Pratt, C., Geller, N., Campo, R., Lew, D. & Wilfley, D. E. (2021). Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study. Contemporary Clinical Trials, 109: 106497.

Farrokhnia, M., Fathi-Ashtiani, A., Ashrafi, E. & Abtahei, F. (2022). Effectiveness of Parent-Focused Interventions in the Treatment of Childhood and Adolescent Obesity: A Systematic Review Article. Quarterly Journal of Health Psychology, 11(2): 45-66. (in persian).

Gettens, K. M. & Gorin, A. A. (2017). Executive function in weight loss and weight loss maintenance: a conceptual review and novel neuropsychological model of weight control. J Behav Med, 40: 687–701.

Gioia, G., Isquith, P., Guy, S. & Kenworthy, L. (1996). Behavior rating inventory of executive function. Lutz, FL: Psychological Assessment Resources.

Gowey, M., Redden, D., Lim, C., Janicke, D. & Dutton, G. (2020). Executive function phenotypes in pediatric obesity. Pediatric Obesity, 15(9): e12655.

Hall, P. A., Best, J. R., Danckert, J., Beaton, E. A. & Lee. J. A. (2021). Morphometry of the lateral orbitofrontal cortex is associated with eating dispositions in early adolescence: findings from a large population-based study. Social Cognitive and Affective Neuroscience, 18(1): nsab084.

Hall, P. A. & Fong, G. T.) 2013(. Temporal self-regulation theory: Integrating biological, psychological, and ecological determinants of health behavior performance. In: Hall, P. A. (Ed.), Social Neuroscience and Public Health (pp. 35–53). New York, NY: Springer.

Han, Y.-P., Tang, X., Han, M., Yang, J., Cardoso, M. A., Zhou, J. & Simó, R. (2021). Relationship between obesity and structural brain abnormality: Accumulated evidence from observational studies. Ageing Research Reviews, 71: 101445.

Jebeile, H., Kelly, A. S., O’Malley, G. & Baur, L. A. (2022). Obesity in children and adolescents: epidemiology, causes, assessment, and management. Lancet Diabetes Endocrinol, 10: 351–365.

Laurent, J. S., Watts, R., Adise, S., Allgaier, N., Chaarani, B., Garavan, H., Potter, A. & Mackey, S. (2020). Associations Among Body Mass Index, Cortical Thickness, and Executive Function in Children. JAMA Pediatr, 17(2): 170-177.

Likhitweerawong, N., Khorana, J., Boonchooduang, N., Phinyo, P., Patumanond, J. & Louthrenoo, O. (2022) Association between executive function and excess weight in pre-school children. PLoS ONE, 17(10): e0275711.

Lin, C. Y., Imani, V., Broström, A., Huus, K., Björk, M., Hodges, E. A. & Pakpour, A. H. (2020). Psychological distress and quality of life in Iranian adolescents with overweight/obesity: Mediating roles of weight bias internalization and insomnia. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 25(1): 1583-1592.

Moran, A. & Mullan, B. (2021). Exploring temporal self-regulation theory to predict sugar-sweetened beverage consumption. Psychology & Health, 36(3): 334-350.

Nuttall, F. Q. (2015). Body Mass Index. Nutrition Today, 50(3): 117-128.

Omer, T. (2020). The causes of obesity: an in-depth review. Adv Obes Weight Manag Control, 10(4): 90‒94.

Rezai, A., Dehghani, A. & Haghayegh, S. A. (2024). Designing the play therapy package based on executive functions for obese children and examining its effectiveness on body mass index, mental health, physical activity, and eating behaviors of them. [Dissertation]: Najafabad, Najafabad Branch, Islamic Azad University, Not Printed.

Ronan, L., Alexander-Bloch, A. & Fletcher, P. C. (2020). Childhood Obesity, Cortical Structure, and Executive Function in Healthy Children. Cerebral Cortex, 30(4): 2519-2528.

Sani, M. F. H., Dewi, Y. L. R. & Murti. B (2021). The Effect of Family-based Intervention on Overweight/Obesity in Children: Meta-Analysis. J Health Promote Behav. 06(01): 45-56.

Shalani, B. (2022). Analysis and Review of the Iranian Children’s Overuse in Virtual Space and Development of a Preparatory Program to Optimize Their Use of New Media [Dissertation]: Tehran, Tarbiat Modares University, Not Printed.

Smith, J. D., Fu, E. & Kobayashi, M. A. (2020). Prevention and Management of Childhood Obesity and Its Psychological and Health Comorbidities. Annu. Rev. Clin. Psychol, 16: 351-378.

Steinhart, A., Tsao, D. & Pratt, J. S. A. (2021). Pediatric Metabolic and Bariatric Surgery. Surg Clin N Am, 101(2): 199–212.

Tiregar, M., Golshani, F., Baghdasarians, A. & Emamipour, S. (2023). Modeling of Childhood Obesity Based on the Mediating Role of Maternal Feeding Style in the Relationship Between Maternal Body Mass Index and Parenting Stress with Child Body Mass Index. Quarterly Journal of Health Psychology, 11(4): 51-72. (in persian).

U.S. Public Health Service (2000). Report of the surgeon general’s conference on children’s mental health: A national action agenda. Retrieved from

http://www.surgeongeneral.gov/topics/cmh/cmhreport.pdf. 25 June 2020.

Verbeken, S., Braet, C., Goossens, L. & van der Oord, S. (2013). Executive function training with game elements for obese children: A novel treatment to enhance self-regulatory abilities for weight-control. Behaviour Research and Therapy, 51(6): 290–299.

Verbeken, S., Braet, C., Naets, T., Houben, K., Boendermaker, W. & Vzw, Zeepreventorium. (2018). Computer training of attention and inhibition for youngsters with obesity: A pilot study. Appetite, 123: 439-447.

The Effect of Play Therapy Package Based on Temporal Self-regulation Theory on Body Mass Index of Obese Children

References

References

Volume 13, Issue 52March 2025Pages 139-154

Volume 13, Issue 52
March 2025
Pages 139-154