Nutritional Disorders Telehealth Network Project

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Stimulus Control Strategies

Stimulus control strategies are a type of behavioral interventions for weight management that are supported by research as being efficacious. Stimulus control strategies involve identification and modification of environmental factors that influence eating patterns. The goal of stimulus control strategies is to reduce environmental characteristics or situations that serve to trigger maladaptive eating behaviors, such as excessive oral caloric intake. 
Background Education for Providers
Excessive oral caloric intake in children who are overweight and obese may result, in part, from lack of attention to satiety cues (i.e., feelings of fullness), eating portion sizes that are too large, or failing to eat meals and snacks at appropriate intervals (i.e., every 4-5 hours). Another possible trigger for overeating is patterns of interaction between the child and caregiver. 
Each of the above issues can be addressed through techniques to modify the environment to create more structure around eating and to reduce cues that may be associated with overeating. 
Children may lack attention to satiety cues (i.e., feelings of fullness) because they are paying more attention to other things in the environment (e.g., television, computer, etc) than they are paying to the food that they are eating. By removing such distractions, it helps the child to attend more to their internal feelings of hunger and fullness.
Children may consume portion sizes that are too large because of availability of more food than in necessary during the meal time. By limiting the food present to the appropriate amount that the child should eat, this can help to reduce excessive caloric intake.
Finally, children may consume too many calories because of a lack of structure in their eating schedule. Children should eat a meal or snack every 4-5 hours. 
Instructions for Provider
For children who fail to pay attention to satiety cues, it is recommended that the primary care provider talk with the family about implementing the following things at home: 
1.   Eating all meals at a table or counter.
2.   Eating all meals in the same place.
3.   Treating all eating like a meal (including snacks like meals) and thereby eating these in the same place meals are eaten.
4.   All eating is treated like a meal by using plate/bowl and utensils (avoid eating out of packages or bags)
5.   Implementing a family rule so that all “screens” (i.e., TVs, computers, videogame systems, etc) are turned off during meal times.
For children who consume portion sizes that are too large, it is recommended that the primary care provider encourage the family to implement the following strategies. If primary interventions are not sufficient to lead to a reduction in portion sizes, then secondary interventions can be implemented. 
Primary Interventions:
  1. Caregiver plates all of the child’s food in the kitchen
  2. Caregiver puts extra food away immediately after meal time
  3. Second helpings are limited to only fruits and vegetables
Secondary Interventions:
  1. The plate method is used as a strategy for guiding the family in balancing the food groups at each meal.
  2. Use smaller plates and bowls to give the perception that the child has a larger portion size
  3. Use the 20 minute rule (described below)
For children who have a lack of structure in their eating schedule, the following is recommended as interventions to discuss with the family:
1.      Eat 3 meals per day
2.      Meals and snacks should be scheduled every 4-5 hours


Supplemental Materials
© 2015 Medical College of Wisconsin
Page Updated 04/15/2014