Help parents consistently reward specific behavior changes, but avoid material rewards. Encourage them to be observant: If a child comes home from school and does homework without turning on the TV, give specific praise for that immediately or as soon as possible. Besides praise, other effective rewards might be an activity together, or an activity related to the goal. Extra privileges or extra time with a parent can be a motivating goal. Any "thing" used as a reward should be related to the goals, he said.
When the child is in the early stages of changing a behavior, reward success frequently, but make the rewards less frequent as the behavior becomes more established so that it is not contingent upon rewards. Parents might also consider making contracts with their children around the goals, even reciprocal contracts in which the parents reward the child and the child rewards the parents.
See patients regularly when trying to make these changes, Dr. Robinson said, and expect relapses. Problem-solve with patients and families to plan ahead for difficult scenarios, especially birthdays and holidays.
As behaviors begin to change, support that change with more intensity, greater frequency, or longer duration.
"Obesity is less about knowledge than about behavior and setting up behavioral systems," he said.
Dr. Robinson reported having no relevant financial disclosures.