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Table 3 Modules description regarding relevant BABELUGA lifestyle monitoring map, learning target, methods and instruments

From: Hormonal regulatory mechanisms in obese children and adolescents after previous weight reduction with a lifestyle intervention: maintain - paediatric part - a RCT from 2009–15

Module and title BABELUGA lifestyle monitoring item Learning targets Methods and instruments
1.“How to do your shopping”: Food- and drink selection in the supermarket “Food choice” and “Beverage selection” Participants know how a healthy and balanced diet can be realised with the right selection of food, drinks and meal-composition.
Parents are encouraged to buy more fruits and vegetables and generally replace highly processed food by natural alternatives.
Participants are encouraged to try new food and experience the taste of natural food.
Participants know how where to find, how to read and how to understand food labelling and declarations.
Awareness is raised for hidden sources of sugar and fat by examining the ingredients list.
Health claims on certain products can be analysed on their substance.
Foods and beverages can be categorised correctly within the OptimiX food groups, according to their fat or sugar content.
Participants are encouraged to plan their food-shopping more precisely to avoid the purchase of inadequate foods.
Introducing lecture on food labelling, declarations, health claims, listing of ingredients and processed vs. natural foods.
Food and drink packing material is examined and the labelling is analysed.
Quiz-questions are distributed, which are supposed to be answered by examining food products in the supermarket.
In small working groups participants complete the task accompanied by supervisors and return to present their findings.
2. “Fast Lunch: quick and easy recipes to cook for yourself” “Food choice”, “Portion size and food intake”, “Meals and In-Between-eating” Participants clearly understand the advantages of regular mealtimes and commonly shares at least one regular meal daily, where new strategies, such as trying new foods or cooking smaller portions, are realised.
Participants learn about factors that influence the feeling of satiety, such as watching TV during the meal or drinking water before eating.
Children are encouraged to cook for themselves, rather than to eat fast food, sweets or ready meals.
Parents are encouraged to cook for their family instead of using ready meals.
After a short introduction about food preparation, suitable serving size, right choice of ingredients considering energy intake, as well as time management and a lecture on how to integrate the preparation and the consumption of a warm meal for lunch into the day, parents and children are separated in groups.
Parents prepare small side dishes together and are encouraged by a trainer to discuss and share relevant issues concerning their children and demands of daily life. Thus experience, problems and knowledge can be exchanged.
Children are separated into smaller groups of 4 to 5 persons and prepare several dishes. Recipes and food components are provided y the study team. Even though trainers are present to support the children with food preparation, the cooking is a fairly independent process that enables the children to develop or strengthen new abilities. The dishes will be shared by the whole group and results are discussed.
3. “Family: Thrilling teamwork” “Moods and feelings” Participants accept and understand that child obesity is a family issue, which can only be approached successfully if the whole family cooperates.
Parents and children are equally encouraged to find positive ways of interaction and to concentrate on the strengths instead of the weaknesses of each other.
Participants learn to work as a team and understand the advantages of having the opportunity of relying on a supportive team as well as supporting someone to reach an achievement.
Parents and children are separated and each participant obtains a work sheet with “Power-questions” referring to positive aspects of life in general and specifically of family life. Parents, for example, are asked, what fills them with pride about their child and children are asked what makes them feel content about their parents. The task is completed individually and will not be discussed in the group.
Small groups of children and parents are formed and different family rules and regimes are discussed. Results are presented.
Teamwork: Tasks that require teamwork are given and participants (children and parents) complete the tasks in teamwork.
4. “No food all day, until facing the fridge in the afternoon alone”: Meal-distribution and planning. Recipes for healthy snacks and spreads. “Food choice”, “Beverage selection”, “Portion size and food intake”, “Meals and In-between eating”, “Sweets, Fast Food and Snacks” Participants are familiar with the concept of performance curves and know how to optimise their daily activity level by planning meal intake accordingly.
Participants are able to reflect on their daily routine specifically on meal-times and learn to consciously plan common meal-times (with the family) according to their agenda (see also module 2).
Participants know the difference between snacks and meals, and know which food is suitable for each kind of meal.
Timeline: each participant reflects on his or her own scheduling of daily meals and marks times and type of meal on a timeline
Performance curve: an optimised schedule of meal times and appropriate types of meals at each time point are presented and compared with the individual results on the timeline. Possible corrections are discussed.
Recipes for healthy snacks are distributed and participants (children) are separated into small groups and prepare them.
Parents form a separate group and discuss the issue of planning and arranging mealtimes in daily routine supported by a supervisor.
5. “How to REALLY ENJOY YOUR MEAL and how to deal with cravings”: Training joyful eating and development of strategies to deal with cravings effectively “Food choice”, “Beverage selection”, “Portion size and food intake”, “Meals and In-between eating”, “Sweets, Fast Food and Snacks” Feelings of hunger, appetite and satiety can be appropriately differentiated by participants.
Participants know strategies to avoid ravenous hunger and craving.
Participants can estimate the appropriate serving size by simply using their hand size or the space on the plate as measurement.
Parents can estimate an appropriate food serving size for their child, according to its age.
Participants learn to experience and enjoy the food-intake consciously with all their senses.
Parents and children are separated in groups and each group works on finding “reasons to eat and drink”. Answers are collected and sorted into categories: physical requirements, psychological requirements. Differences are accentuated and discussed. The importance of avoiding ravenous hunger and craving is discussed and prevention methods are elaborated.
Children group: Visualising and estimating serving sizes: foods are weighed and portioned on plates.
Parents group: Convenience foods and their nutrient composition are discussed. Serving sizes and appropriate meal composition are revised.
Both groups: Different confectionary and sweet drinks are savoured slowly and consciously, in order to stimulate all senses and consciously experience the taste. Taste of different foods i.e. wholegrain vs. white bread are compared
6. “Eating on the way: How to prepare healthy Fast Food” “Food choice” “Beverage selection”, “Sweets, Fast Food and Snacks” Children and parents correctly recognise sweets, snacks and fast food.
Children and parents know how much of these foods they consume every day and learn to estimate appropriate serving sizes, according to their age and activity.
Awareness is raised for formerly unrecognised sweets or unconsciously eaten snacks and healthier alternatives are discovered.
Each participant presents his or her favourite fast food. In small groups participants collect preferred fast foods and then reflect on situations when these foods are eaten mostly.
Children and parents are separated. Children visit nearby kiosks and shops to research products and ingredients (shop owners are informed previously). Results are presented subsequently.
Parents receive information on fat content of fast food, possible alternatives and prepare salads.
Groups are united and together ways of optimising fast food or complementing it with healthy foods, i.e. frozen pizza is refined with vegetables and eaten with salad, are elaborated. Results are being discussed.
7. “Getting fitter with each step”: Exercise and recreation “Daily activity”, “Sports” “Moods and feelings” Children experience and accept sports and daily activity as part of daily routine.
Children learn new aspects of body perception and body image as well as composure and physical expression.
As a long-term goal, participants can integrate physical activity in their daily routine and develop a feeling of deficiency if insufficient or no physical activity was accomplished in a certain time period.
For psycho-social matters, it is a goal of this module to impart participants the positive experience of shared activities.
Based on the Evidence Based Guidelines for Adiposity Therapy for Children and Adolescents (AGA 2009) 60 to 90 minutes of daily activity and additional intensive activity two or three times a week are recommended.
Parents and children are separated and the parents group is given a lecture on the importance of activity concerning weight balance and the AGA-guidelines are introduced. Children complete an activity program with professional physiotherapists on body perception, body image, physical expression and group exercise.
8. “Need a holiday? Dealing with stress and preventing relapse. “Moods and feelings” Participants understand to what extent moods, emotions and psychosocial strains can influence eating- and physical behaviour.
Triggers for dysfunctional strategies of dealing with emotions, stress and problems are being uncovered and new effective alternatives are presented.
Individual and flexible strategies for self-control and self-efficacy are developed in the long term.
In small groups parents and children discuss difficult and stressful situations in which the risk of reviving old habits becomes apparent.
Parents and children are separated and children work on strategies of dealing successfully with difficult situation without relapsing: Group-work and individual work.
Parents prepare small dishes together and meanwhile share experience on how they experience emotional distress of their children and how children can be supported. Results are being discussed in the complete group.
9. “Don’t miss the fun: How to celebrate every party the right way” “Food choice”, “Beverage selection”, “Portion size and food intake” Participants learn to resist temptation in difficult situations such as celebrations and holidays, where daily routine is disrupted and acquired patters are put on hold.
Practical advice is given on how to deal with unusual and tempting situations. Strategies are developed.
Practical examples of tempting situations are discussed: Buffets, Parties
Appropriate serving size and healthy alternatives to party snacks are presented and strategies of dealing adequately with the offer are discussed.
Examples for healthy party snacks are given and prepared in groups.
10. “Creative Cooking: How to modify recipes, creating your own style” “Food choice”, “Beverage selection”, “Portion size and food intake” Participants know how to modify recipes, reducing amounts of sugar and fat as well as using alternatives, such as whole grain flour instead of white flour.
Participants get accustomed to vegetarian alternatives to meat and learn new recipes. Cooking skills are further developed.
An introductory lecture is given on healthy alternatives to meat and dishes containing a high amount of recommended foods are presented.
In small groups dishes are prepared and eaten altogether. Results are discussed.