Family-based treatment for obesity conducted in the paediatrician’s office resulted in improved weight-loss outcomes for the treated child and parent, and even extended to untreated siblings, University of Buffalo (UB) researchers have reported. The study found that three times as many children in the treatment group (27%) as in the usual care group (9%) had a clinically meaningful reduction in median body mass index (BMI) associated with improved cardiometabolic outcomes, such as blood pressure, lipids and glucose regulation.
"Our study is the first to test family-based treatment in primary care for children 6–12 years old and it worked for the child, for parents and even for their untreated siblings," explained Dr Leonard H Epstein, senior author, SUNY Distinguished Professor and chief of the Division of Behavioral Medicine in the Department of Pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB. The findings were reported in the paper, ‘Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care’, published in the Journal of the American Medical Association (JAMA).
The findings are from a randomised clinical trial that evaluated the effects of family-based treatment for overweight or obesity implemented in paediatric primary care on children and their parents and siblings. Set in four US settings, the study enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents and 106 siblings. 27.2% of the children were Black, 8.8% were Latinx and 57.1% were white. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 to August 2021.
Family-based treatment used a variety of behavioural techniques to develop healthy eating, physical activity, and parenting behaviours within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behaviour change methods; the number of sessions was individualized based on family progress.
The primary outcome was the child’s change from baseline to 24 months in the percentage above the median BMI in the general US population normalised for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents. In total, 226 children were randomised to undergo family-based treatment and 226 to undergo usual care.
At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (−6.21% [95% CI, −10.14% to −2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at six months and maintained through 24 months.
Children enrolled in the family-based treatment had a difference in percent over median BMI versus those receiving the usual care of 6.48%, while their parents had a reduction of 3.97% and their untreated siblings who were overweight had a reduction of 5.38%. The changes in percent over median BMI among family members were related, suggesting that the treatment results in modelling healthy behaviours and in real change in the shared family environment.
"The success of this novel and powerful family-based treatment of childhood obesity, which Dr Epstein and his colleagues have developed, helps ensure the health of these children," added Dr Allison Brashear, vice president for health sciences and dean of the Jacobs School. "It will not only impact them today but going forward as they adopt healthy practices for the rest of their lives."
The current work builds on more than 40 years of work by Epstein and colleagues, including a previous study in the primary care setting led by Dr Teresa Quattrin, UB Distinguished Professor in the Department of Pediatrics and senior associate dean for research integration in the Jacobs School.
Quattrin, also co-author on the JAMA paper, had successfully adapted this treatment for preschool children and parents with obesity in the primary care setting, demonstrating that outcomes for preschool-aged children who are overweight improve when both parent and child are treated compared to when only the child is treated.
"This research shows that the healthy behaviours the treatment promotes extend beyond the parent and child being treated to potentially make the whole family healthier," said David C Goff Jr, director, Division of Cardiovascular Sciences, NHLBI. "What's more, the fact that this weight-loss study was implemented during the COVID-19 pandemic, when many adults and children gained weight, is noteworthy."
The usual treatment also does not focus on changing behaviours and is not administered by professionals with experience in behaviour therapy. By contrast, the family-based treatment in the JAMA study included eating and activity plans, education in parenting and behavioural techniques, and facilitation of support for positive behaviour changes in both family and peer environments. Parent and child were seen together in individualised sessions that included reviews of self-monitored eating and activity levels, review of treatment manuals and handouts, and discussions about goal-setting for weight and behaviours.
"Many families with obesity have multiple children with obesity, as well as parents with obesity," said Epstein. "But traditional treatment for childhood obesity only focuses on the child; it may provide ideas about healthier foods and the recommendation to be more active, but the parent is never an active target for intervention, nor is the parent taught positive parenting. Family-based therapy is unique in using up-to-date behavioural treatments to teach parents and children methods to eat healthier and be more physically active, and in the process teach positive parenting.”
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