title: The challenge of identifying behavioral alternatives to food: clinic and field studies.
abstract: BACKGROUND
  One of the basic principles of behavioral economics interventions is identification of alternative behaviors to compete with the reinforcing value of a highly rewarding commodity.
  
  
  OBJECTIVE
  Two experiments that attempt to increase alternatives to eating in obese youth are presented.
  
  
  METHODS
  A randomized, controlled trial was used in Study 1 to compare a comprehensive family-based behavioral treatment program or an experimental treatment that incorporated reinforcing children for engaging in alternative behaviors to eating for 41 overweight 8- to 12-year-old children. Study 2 used a within-subject design with baseline, enriched environment and a second baseline phase to determine the influence of providing activities that compete with eating for 13 overweight 8- to 12-year-old children. Measurements included body mass index (BMI) change, alternatives to eating, eating, and physical activity.
  
  
  RESULTS
  In Study 1 both treatments were associated with significant (p < .05) and maintained reductions in z-BMI over the 24 months of observation. The experimental group showed a significantly (p < .05) greater increase in alternatives to eating, and both groups showed significant (p < .05) increases in physical activity. In Study 2 alternative behaviors to eating were increased by almost 1 hr/day (p < .001) but were not associated with significant changes in energy intake or physical activity.
  
  
  CONCLUSIONS
  These results suggest that using the methods studied, increasing behaviors that could compete with eating did not influence relative weight in a clinical outcome study or energy intake in a controlled field study.
authors.affiliation: Department of Pediatrics, University at Buffalo, NY 14214, USA. LHENET@ACSU.BUFFALO.EDU
authors.forename: Leonard H
authors.initials: LH
authors.lastname: Epstein
authors.forename: James N
authors.initials: JN
authors.lastname: Roemmich
authors.forename: Richard I
authors.initials: RI
authors.lastname: Stein
authors.forename: Rocco A
authors.initials: RA
authors.lastname: Paluch
authors.forename: Colleen K
authors.initials: CK
authors.lastname: Kilanowski
mesh_terms: D000704:Analysis of Variance; D001521:Behavior Therapy / Q000379:methods*; D015992:Body Mass Index; D002648:Child; D015444:Exercise; D005196:Family Therapy / Q000379:methods*; D005247:Feeding Behavior; D005260:Female; D015438:Health Behavior; D006801:Humans; D007899:Leisure Activities; D008297:Male; D009765:Obesity / Q000534:rehabilitation*; D012054:Reinforcement, Psychology