DEPARTMENT OF PSYCHOLOGY

CASE WORK
ON
OBESITY

SUBMITTED TO:
PROF.HARPRIT KAUR
SUBMITTED BY:-
AMANDEEP KAUR
PGDCDC
20361214
 TITLE
OBESITY
CLIENT'S PROFILE

 NAME -

 AGE - 13

 GENDER - Female

 SCHOOL - Sunflower model high school

 PARENTS OCCUPATION - Private job

 NO. OF SIBLINGS - Only child

 FAMILY TYPE - NUCLEAR FAMILY

SESSION 1

CASE AND ASSESSMENT TO IDENTIFY SPECIFIC

GOALS OF COUNSELLING
The first session starts with Rapport

building and the counsellor make the atmosphere of the room such that the client
would not feel any discomfort. It should be kept in mind that there should be no

disturbance. Then the counsellor asks the client How are you ?. The client told her

she was fine. Then the counsellor introduce herself and told her why she came

here. After some interaction and knowing about her family, the counsellor said to

the client that as u know mother-child relationship is of great significance for a

child's health. I came here to know about your knowledge about nutrition, your

feeding style, your child eating behaviour and behavioural problems. The client

said that my child eats food the whole day, she wants always eatable things near

her even when she studies, watching tv, playing games. When she wakes up in the

morning every day she eats one packet of creamy biscuits with tea if the biscuits

were not present at home she started crying and after having her breakfast she

usually eats chips and this process will continue throughout the day. She prefers to

eat junk and oily food. Every day she demands new eatable things and her father

never say no to her. The counsellor said is it okay for u if your child eats the whole

day. The client said no not at all if I said to her not to eat too much but her father

always defends her and said that don't stop the child to eat. Then the counsellor

asked the client what about eating manners or behaviour of your child when she

eats. The client said she always eat properly sometimes on the table and

sometimes on the bed and finishes all food that I serve to her. She sometimes rolls

chapati and eats it while walking here and there. If she does this behaviour I

punished her and hide all her chips and cold drinks. The client said in the lockdown

she concentrate on food and every day think today Mumma make a new dish. She
doesn't care about her body that how fatty she is. I always said her to do some

exercise but she never hears. She always lying on her bed and use her mobile

phone and eat. Then the counsellor asked the client did his child suffering from

any kind of problem. The client said I don't think so. She said she loves her child

and don't want that her child is sad because of food that's why we never

pressurize her. The counsellor said but you have to care about your child health

and we discuss healthy tips in the next sessions. Now I introduce questionnaires to

you and you have to fill it.

ADMINISTRATION OF SCALES:

The first scale administered to the client

is the Parental Feeding Style Questionnaire (PFSQ) developed in the
United Kingdom by Wardle et al. (2002). The questionnaire consists of
27 items organized into four subscales, including emotional feeding
(five items), instrumental feeding (four items), prompting/
encouragement to eat (eight items), and control over eating (ten
items). Five items in control overeating are reversed. It is answered on
a 5-point rating scale ranging from 1 (never) to 5 (always), meaning
that a higher score corresponds to a higher tendency for the adoption
of a specific style.
The second scale administers to the client is Child
Eating Behaviour Questionnaire (CEBQ) developed by Wardle, Guthrie,
Sanderson, & Rapoport. The Child Eating Behaviour Questionnaire
(CEBQ) was designed to assess children's eating scale styles. It is a
parent-report measure comprised of 35 items, each rated on a five-
point Likert scale that ranges from never to always. It is made up of
eight scales: Food responsiveness, Emotional over-eating, Enjoyment of
food, Desire to drink, Satiety responsiveness, Slowness in eating,
Emotional under-eating, and Food fussiness.
 The third scale administered to the client
is the Eyberg Child Behaviour Inventory The ECBI provides a list of 36
problem behaviours commonly reported by parents of children with
conduct problems. The inventory assesses behaviour on two
dimensions, the intensity of the behaviour and its identification as a
problem. The intensity range from 1 (never) to 7 (always), and are
summed to yield an overall problem behaviour Intensity score ranging
from 36 to 252. The problem identification measure requires the parent
to circle "yes" or "no" in response to the question "Is this behaviour a
problem for you?" The total Problem Score (between 0 and 36) is
calculated by summing the number of problems indicated.

INTERPRETATION OF SCORES :
After administering the scales the scores
were interpreted. The first scale administered to the client is the
Parental Feeding Style Questionnaire (PFSQ) in which the client score as
shown in the table :
SUBSCALES SCORES
INSTRUMENTAL FEEDING (I) 17
CONTROL (C) 22
EMOTIONAL FEEDING (EM) 20
ENCOURAGEMENT (EN) 37
TOTAL 96

The second scale administer to the client is Child

Eating Behaviour Questionnaire (CEBQ) in which the client score as
shown in the table:
SUBSCALES SCORES
FOOD RESPONSIVENESS 21
EMOTIONAL OVEREATING 17
ENJOYMENT OF FOOD 19
DESIRE TO DRINK 10
 SATIETY RESPONSIVENESS 11
SLOWNESS IN EATING 10
EMOTIONAL UNDER EATING 13
FOOD FUSSINESS 16
TOTAL 117

The third scale administer to the client is the Eyberg

Child Behaviour Inventory in which the client score as shown in the
table :
INTENSITY OF BEHAVIOUR 139
PROBLEM 14
From these scores we came to know that on intensity scale the client
score higher that's mean it is serious problem and on problem scale the
parents are mild distressed.

BMI OF THE CLIENT :

SESSION 2 :
BMI CONCEPT EXPLANATION :
Before explaining the concept of BMI
the counsellor discuss about her child”s BMI , the counsellor said to the
client that as you know your child is in the range of obese children. Now
I told you about what is BMI how It is calculated and many other things
so that u may take care of your children and after one month check her
weight and BMI. The client said that's great I feel grateful and am also
interested in knowing new things. So now I tell you
 WHAT IS BMI?
BMI is a measurement that takes into account your age,
sex, height, and weight to produce a calculation. This
calculation is a measurement of your body size and can be
used to determine how your body weight is related to
your height. It offers an inexpensive and simple method of
categorising people according to their BMI value so that
we can screen people’s weight category and indicate their
potential risk for health conditions.

HOW BMI IS MEASURED?

Body mass index (BMI) is one of the most

popular ways to measure body composition as it pertains to health.
BMI, or body mass index, is a calculation that estimates a person's body
fat by dividing their weight in kilograms by their height in meters
squared (BMI = kg/m2). The results are broken down into
four categories: 

 Underweight ( < 18.5)

 Normal (18.5 – 24.9)
 Overweight (25 – 29.9)
 Obese (> 30)

Doctors may use BMI measurements as a screening tool to indicate

which category you fall into and whether you have an increased risk for
certain health conditions, such as heart disease or diabetes, based on
your results. 

o HEALTHY EATING :
 After the explanation of the BMI concept, the
counsellor explains some healthy eating habits to the client. The
counsellor said as I know you love your child very much but it is also
important to take care of your child and I recommend you to apply
healthy eating habits to your child as I further explain to you and also
told her father about this.
So Be a good role model. Consume healthy foods and
drinks, and choose active pastimes. Children are good learners, and
they often copy what they see. Talk with your child about what it
means to be healthy and how to make healthy decisions. Discuss how
physical activities and certain foods and drinks may help their bodies
get strong and stay healthy.
 Eat the rainbow. Serve and encourage consumption of a wide
variety of fruits and vegetables. This should include red
(beets, tomatoes), orange (carrots, squash), yellow (potatoes,
bananas), green (lettuce, broccoli) and so on—just like eating
a rainbow.
 Look for hidden sugar. Reducing the amount of candy and
desserts you and your child eat is only part of the battle.
Sugar is also hidden in foods as diverse as bread, canned
soups, pasta sauce, instant mashed potatoes, frozen dinners,
low-fat meals, fast food, and ketchup. The body gets all it
needs from sugar naturally occurring in food—so anything
added amounts to nothing but a lot of empty calories. Check
labels and opt for low sugar products and use fresh or frozen
ingredients instead of canned goods.
 Schedule regular meal times. The majority of children like
routine. If your kids know they will only get food at certain
times, they will be more likely to eat what they get when they
get it.
 Limit dining out. If you must eat out, try to avoid fast food.
 Learn what a regular portion size looks like. The portion sizes
that you and your family are used to eating may be equal to
 two or three true servings. To keep calories in check, try to
limit portions to the size of your fist. Portions will look bigger
and child eat less when you use small bowls or plates.
 Stop eating in front of the TV. Limit your child’s calorie intake
by limiting time spent eating in front of the tube. Tell your
child that, starting now, your family does all their eating at
the table.
In the end of this session the counsellor told client
to start apply this techniques in your daily routine and meet u in
the next session.

SESSION 3 :
In this session, the counsellor told the client that I told more
about your child behaviour in context to food. So that you have to
pay more attention when your child is doing this behaviour.
 STOPPED STRESS EATING :
From the questionnaire, I
found that your child eats more when she is under stress.
Practice mindful eating that is Encourage your child to pay
attention to what they eat and notice when they feel
full. Identify triggers that Help your child avoid or manage
things that trigger her. Healthier ways to manage stress
include music, art, dance, writing, or talking to a friend
meditation, or taking a couple of deep breaths also can help
your child relax.
 PHYSICAL ACTIVITY :
It is difficult to reduce weight just by
modifying your child diet, It is also essential to do regular
exercise. Exercise keeps the body fresh and active. It helps
to reduce weight and builds resistance to fight against
diseases. Now the question is that what type of exercises
your children will do?
  Jogging, jumping, skipping, cycling, dancing, football,
tennis
Then the client said it is good but can we also
include physical activity in daily household work. The
counsellor said yes it's good you can add up exercise like :
 sweeping the house
 cleaning the table
 getting herself drinking water

 FAMILY MEAL TIME: This could become a family event

from the selection of the menu, preparing the food and
table, serving, eating together, and cleaning up. During
the meal, children and adolescents can be encouraged
to talk about what is interesting to them, and not
necessarily the usual topics like school and work.
 COGNITIVE BHEAVIOURAL THERAPY:
In this therapy
you help your child by told him this goals (i) achieve,
accept and maintain healthy weight loss; (ii) adopt a
lifestyle conducive to weight control; and (iii) develop a
stable “weight-control mindset”. This is usually
achieved by combining specific recommendations
about diet and exercise. It was originally based on
learning theory (i.e., behaviourism), and the idea that
education, and the recognition and modification of
environmental stimuli (antecedents) and
consequences of food intake (reinforcements), can
prompt patients to change their dietary and physical
activity habits with a view to reaching and maintaining
a healthy weight.

SESSION 4:
 PARENTING STYLE:
Consistency is one of the most
important and essential concepts when it comes to effective
parenting. In terms of parenting, consistency may be tied to how you
connect with your child emotionally When parents are consistent in
their reactions and consequences, children know what to expect.2

Your child will be able to predict how you will react to specific

situations, such as when they throw food or when it is time for bed.
This does not mean that your children won't push your buttons or try to
see if your reaction changes. But in time, your child will come to feel
safe through consistency. Children understand the world through
consistency. When kids can predict how their morning will go, they feel
more secure and in turn, make better choices.

 SPECIFIC GOALS: So now we discuss specific goals which

are related to your child's case. Now the first is :

UNCONTROLLED EATING: As I came to know in your

case your child has no control over her eating as u told me that
your child is eating one packet of creamy biscuits this
behaviour is uncontrollable. The client said yes I understand
that but what I do now. The counsellor said u may be told your
child firstly about the chemicals that go into making the
biscuits, how that harms the human body. Then talk about how
it would harm their health and looks and how eating such
things would prevent them from being successful in school,
sports and life in general. After this stop buying biscuits, do not
permit them in your home. Give them healthy alternatives to
biscuits.

INCONSISTENT PARENTING: As I told you above that

consistency in parenting style is very important. Inconsistent
 parenting is when a parent responds differently to a similar
situation.  If a child misbehaves, one day a parent might take
away the child's privileges to let him know that this behaviour
can not be tolerated but on the second day, the parent
forsakes the same behaviour. So you have to respond the same
in every situation that is related to your child.

FOOD IS NOT LOVE. Find better ways to say "I

love you." When foods are used to reward kids and show
affection, they may start using food to cope with stress or
other emotions. Offer hugs, praise, and attention instead of
food.

SESSION 5 :

CONSOLIDATION AND CLARIFICATION :

When all sessions were

completed the counsellor asks the client if you have any doubt related
to the sessions then tell me I clarify you again so that you can better
help your child to reduce obesity. The client said do you think that I
might consult a doctor related to my child obesity. The counsellor
advised her firstly you try to improve her feeding style and her child
behaviour if the weight will not reduce then consult to doctor so that
your child will not suffer from any health issues. Then the counsellor
asked anything else you want to discuss with me. The client said no all
sessions were clear if I have any doubt regarding this in future I contact
you.

In the last, the counsellor meets her children and

also told some things which were useful to the child in future like she
concentrates on her studies rather than eating, obey the rules that
 your parents told you. The child said okay whatever my mom told
me I'll do.

 COUNSELLOR REMARKS:

From all the sessions the counsellor observe

that the client is very nice and she listen to me very carefully. The
client promises to the counsellor that she take care of her child and
give proper diet. In last counsellor asked client is this information is
useful to you the client said yes i totally agree with you and thanks to
her for information.