A Parent Treatment Program for Preschoolers With Obesity: A Randomized Controlled Trial

Abstract

BACKGROUND AND OBJECTIVES: Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST). METHODS: Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (20.5) was assessed with risk ratios. RESULTS: A total of 174 children (mean age: 5.3 years [SD 5 0.8]; BMI z score: 3.0 [SD 5 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n 5 44; No Booster, n 5 43; ST, n 5 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: 20.45 to 20.15) compared with ST (0.07; 95% CI: 20.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (20.54; 95% CI: 20.77 to 20.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of $0.5 of the BMI z score compared with ST. CONCLUSION A parent-only treatment with boosters outperformed standard care for obesity in preschoolers. WHAT'S KNOWN ON THIS SUBJECT: Although obesity among preschoolers is common and on the rise, few existing treatment programs, including standard care, have been properly evaluated. Early treatment should be directed to parents and be of high intensity to be effective. WHAT THIS STUDY ADDS: We show that parent-only obesity treatment, including parenting skills training with follow-up booster sessions (but not without), outperformed standard treatment regarding improvements in child weight status. Thus, for successful obesity treatment in preschoolers, only parents need to be involved.

The influence of preschoolers' emotional and behavioural problems on obesity treatment outcomes: Secondary findings from a randomized controlled trial

“…The sessions centred on evidence‐based parenting practices (eg, encouragement, monitoring, positive involvement, limit setting, and problem solving along with regulation of emotional expression), which were discussed and practiced through role playing. The sessions emphasized specific lifestyle components (eg, healthy eating and physical activity) to support a healthy home environment . Standard treatment was delivered to individual families by paediatricians (the first visit) and paediatric nurses (follow‐up visits) in outpatient paediatric clinics.…”

“…The present paper presents data on child emotional and behavioural problems at baseline and 12 months post baseline in relation to weight status. The primary outcomes of the RCT have been published elsewhere; these findings show that children whose families were randomized to the parent support group had a larger decrease in BMI z ‐score compared with standard treatment 12 months post baseline . The protocol for the study was registered with the Clinical Trials Registry, http://clinicaltrials.gov on February 14, 2013, (ID: NCT01792531).…”

“…Informed consent forms were signed by all participating parents. The ML study included children who were 4 to 6 years old, had obesity as defined by international age‐ and sex‐specific cut‐offs, were not diagnosed with any chronic disease or developmental problem, and whose parents were sufficiently proficient in Swedish to fill out questionnaires and participate in discussion‐centred treatment . The sample size was determined based on BMI z ‐score (primary outcome) adjusting for a 21% dropout rate…”

“…The present study reports on secondary outcomes of a randomized controlled trial (RCT) based in Stockholm County, Sweden, which assessed a new childhood obesity intervention for preschool‐aged children (defined as children between the ages of 4 and 6 years). The RCT evaluated a parent group program (whose main focus was evidence‐based parenting practices) in comparison with standard treatment (whose main focus was food and physical activity) . The RCT's primary outcome was changes in child weight status 12 months post baseline.…”

“…The RCT evaluated a parent group program (whose main focus was evidence-based parenting practices) in comparison with standard treatment (whose main focus was food and physical activity). 17,18 The RCT's primary outcome was changes in child weight status 12 months post baseline. Parents filled out questionnaires at baseline and after 12 months.…”