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Childhood obesity

Obese children lose more weight when parent is treated

Dr Teresa A Quattrin (Credit: Image courtesy of University at Buffalo)
Children in the intervention group gained an average of 12lbs over 24 months compared to children in the control group who gained almost 16lbs
Parents in the intervention group lost an average of 14lbs, resulting in a BMI decrease of over 2 units while the weight of parents in the control group was essentially unchanged.

Primary care treatment of overweight and obese pre-schoolers works better when treatment targets both parent and child compared to when only the child is targeted, according to a study published in Pediatrics. The study results suggest that overweight or obese children and their parents can be successfully treated in the primary care setting with the assistance of practice enhancers.

"Our results show that the traditional approach to overweight prevention and treatment focusing only on the child is obsolete," said Dr Teresa A Quattrin, senior author and UB Distinguished Professor, chair of the Department of Pediatrics in the School of Medicine and Biomedical Sciences and pediatrician-in-chief at Women and Children's Hospital of Buffalo. "This study is important because while we know that it is critical to begin treating overweight or obese children early, there has been limited data on what works best in preschool-aged children.”

The researchers sought to test, in the primary care setting the short- and long-term, efficacy of a behavioural intervention that simultaneously targeted an overweight child and parent versus an information control (IC) targeting weight control only in the child.

Two- to 5-year-old children who had BMI ≥85th percentile and an overweight parent (BMI>25) were randomized to Intervention or IC, both receiving diet and activity education over 12 months (13 sessions) followed by 12-month follow-up (3 sessions). Parents in the Intervention group were also targeted for weight control and received behavioral intervention. Pediatricians in four practices enrolled their patients with the assistance of embedded recruiters (Practice Enhancement Assistants) who assisted with treatment too.

The research was part of Buffalo Healthy Tots, a novel family-based, weight control intervention in preschool children that Quattrin directed in urban and suburban paediatric practices in Western New York.

Results

A total of 96 of the 105 children randomised (Intervention n=46; IC n=50) started the programme and had data at baseline. Children who were treated concurrently with a parent experienced more appropriate weight gain while growing normally in height. Children in the intervention group gained an average of 12 pounds over 24 months compared to children in the control group who gained almost 16 pounds. This more appropriate weight accrual resulted in a decrease of 0.21 percent over BMI from baseline to 24 months.

Parents in the intervention group lost an average of 14 pounds, resulting in a BMI decrease of over 2 units while the weight of parents in the control group was essentially unchanged.

Quattrin notes that an important feature of the study was the use of practice enhancement assistants, trained in psychology, nutrition or exercise science. These assistants worked with the families both during treatment and education sessions and afterward by phone.

The intervention was delivered through the parents, who were instructed about the appropriate number of food servings for children and appropriate calorie values. They were taught to avoid ‘high-energy’ foods, such as those with high sugar content, more than 5g of fat per serving or artificial sweeteners.

Parents monitored the number of servings in each food category, using a simple diary to cross off icons pertaining to the food consumed or type of physical activity performed. Parents also were taught to record their own and their child's weight on a simple graph.

"Instead of the more traditional approach of referring these patients to a specialty clinic, the patient-centred medical home in the pediatrician's office may be an ideal setting for implementing these family-based treatments," said Quattrin. "We have entered a new era where students, trainees and specialists have to learn how to better interact with primary care providers and implement care coordination. This paper suggests that, indeed, family-based strategies for any chronic disorder, including obesity, can be successful in primary care. The pediatrician's office can become a 'family-centered medical home.”

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