Effects of family-based behavioral treatment on obese 5-to-8-year-old children

Epstein, Leonard H.; Wing, Rena R.; Woodall, Karen L.; Penner, Barbara C.; Kress, Mary Jeanne; Koeske, Randi

doi:10.1016/s0005-7894(85)80046-0

Cited by 73 publications

(52 citation statements)

References 11 publications

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“…[238][239][240][241] A number of behavioral therapy techniques, including environmental control approaches (such as parental modeling of healthful eating and physical activity), as well as monitoring, goalsetting, and contingency management, can facilitate recommended changes in children's diet and physical activity. 225 A nonrandomized trial conducted in Israel by Eliakim et al 242 demonstrated that children and adolescents who completed a 12-week program that included behavioral therapy sessions with a psychologist reduced their BMI more than did untreated control subjects.…”

Section: Evidence For Efficacy Of Behavioral Therapy Componentsmentioning

confidence: 99%

Recommendations for Treatment of Child and Adolescent Overweight and Obesity

et al. 2007

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In this article, we review evidence about the treatment of obesity that may have applications in primary care, community, and tertiary care settings. We examine current information about eating behaviors, physical activity behaviors, and sedentary behaviors that may affect weight in children and adolescents. We also review studies of multidisciplinary behavior-based obesity treatment programs and information about more aggressive forms of treatment. The writing group has drawn from the available evidence to propose a comprehensive 4-step or stagedcare approach for weight management that includes the following stages: (1) Prevention Plus; (2) structured weight management; (3) comprehensive multidisciplinary intervention; and (4) tertiary care intervention. We suggest that providers encourage healthy behaviors while using techniques to motivate patients and families, and interventions should be tailored to the individual child and family. Although more intense treatment stages will generally occur outside the typical office setting, offices can implement less intense intervention strategies. We not ony address specific patient behavior goals but also encourage practices to modify office systems to streamline office-based care and to prepare to coordinate with professionals and programs outside the office for more intensive interventions. S254SPEAR et al by guest on August 28, 2018 www.aappublications.org/news Downloaded from T REATMENT FOR CHILDREN who are overweight or obese seems easy, that is, just counsel children and their families to eat less and to exercise more. In practice, however, treatment of childhood obesity is time-consuming, frustrating, difficult, and expensive. In fact, choosing the most effective methods for treating overweight and obesity in children is complex at best. This is especially true for primary care providers, who have limited resources to offer interventions within their offices or programs and few providers to whom they can refer patients.The need for evidence-based treatment recommendations is a critical health care issue, because obese children and adolescents are at risk for developing many of the comorbidities seen in obese adults. Studies demonstrated that fasting serum glucose, insulin, and triglyceride levels and the prevalence of impaired glucose tolerance and systolic hypertension increase significantly as children become obese (BMI of Ն95th percentile). 1 Even children and adolescents who are overweight (BMI of 85th to 94th percentile) are at risk for comorbidities. Therefore, interventions using dietary modifications, increased physical activity, and behavioral therapy may be beneficial for overweight children and adolescents, with more-aggressive intervention directed toward obese children and adolescents. 2 Health care professionals, however, may find it difficult to determine which interventions will be most efficacious for their patients. To date, no clinical trials have determined whether specific dietary modifications alone (ie, without behavioral interven...

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Section: Evidence For Efficacy Of Behavioral Therapy Componentsmentioning

confidence: 99%

Recommendations for Treatment of Child and Adolescent Overweight and Obesity

et al. 2007

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“…Dietary modifications that have been associated with improved outcomes include caloric reduction through decreased intake of high-energy dense, low-nutrient foods and=or increased intake of low-energy dense, high-nutrient foods (e.g., Traffic Light Diet; Epstein et al, 1985;TODAY Study Group, 2010). Physical activity modifications include encouraging increased physical activity and decreased sedentary activity (Epstein, Paluch, Gordy, & Dorn, 2000;Epstein, Valoski, Vara, et al, 1995).…”

Section: Treatment Componentsmentioning

confidence: 99%

Evidence Update on the Treatment of Overweight and Obesity in Children and Adolescents

Altman

Wilfley²

2014

Journal of Clinical Child & Adolescent Psychology

140

149

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Childhood obesity is associated with increased medical and psychosocial consequences and mortality and effective interventions are urgently needed. Effective interventions are urgently needed. This article reviews the evidence for psychological treatments of overweight and obesity in child and adolescent populations. Studies were identified through searches of online databases and reference sections of relevant review articles and metaanalyses. Treatment efficacy was assessed using established criteria, and treatments were categorized as well-established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy. Well-established treatments included family-based behavioral treatment (FBT) and Parent-Only Behavioral Treatment for children. Possibly efficacious treatments include Parent-Only Behavioral Treatment for adolescents, FBT-Guided SelfHelp for children, and Behavioral Weight Loss treatment with family involvement for toddlers, children, and adolescents. Appetite awareness training and regulation of cues treatments are considered experimental. No treatments are considered probably efficacious, or of questionable efficacy. All treatments considered efficacious are multicomponent interventions that include dietary and physical activity modifications and utilize behavioral strategies. Treatment is optimized if family members are specifically targeted in treatment. Research supports the use of multicomponent lifestyle interventions, with FBT and Parent-Only Behavioral Treatment being the most widely supported treatment types. Additional research is needed to test a stepped care model for treatment and to establish the ideal dosage (i.e., number and length of sessions), duration, and intensity of treatments for long-term sustainability of healthy weight management. To improve access to care, the optimal methods to enhance the scalability and implementability of treatments into community and clinical settings need to be established.

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“…Considering other intermediate outcomes in addition to weight, more than one half (n ϭ 13) of fairor good-quality trials 86,[88][89][90][91][92][93][94]97,99,104,105,108 reported intermediate behavioral (n ϭ 11) or physiologic (n ϭ 7) measures (Table 5). Two good-quality trials 105,108 …”

Section: Behavioral Counseling Interventionsmentioning

confidence: 99%

“…Although one 108 indicated reduced total daily energy intake in the active treatment group, neither indicated changes in physical activity. One fair-quality study reported reductions in targeted dietary components (fat or glycemic load of diet), but not energy, 88 whereas other fair-quality studies [89][90][91][92][93][94]99,104 measured changes in eating behaviors, physical activity, and sedentary behaviors but did not provide a clear picture because of differences in subjects, interventions, and measures.…”

Section: E136mentioning

confidence: 99%

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

et al. 2005

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ABSTRACT. Background. Childhood and adolescent overweight and obesity are related to health risks, medical conditions, and increased risk of adult obesity, with its attendant effects on morbidity and mortality rates. The prevalence of childhood overweight and obesity has more than doubled in the past 25 years.Purpose. This evidence synthesis examines the evidence for the benefits and harms of screening and early treatment of overweight among children and adolescents in clinical settings.Methods. We developed an analytic framework and 7 key questions representing the logical evidence connecting screening and weight control interventions with changes in overweight and behavioral, physiologic, and health outcomes in childhood or adulthood. We searched Results. Although BMI is a measure of relative weight rather than adiposity, it is recommended widely for use among children and adolescents to determine overweight and is the currently preferred measure. The risk of adult overweight from childhood overweight provides the best available evidence to judge the clinical validity of BMI as an overweight criterion for children and adolescents. BMI measures in childhood track to adulthood moderately or very well, with stronger tracking seen for children with >1 obese parent and children who are more overweight or older. The probability of adult obesity (BMI of >30 kg/m 2 ) is >50% among children >13 years of age whose BMI percentiles meet or exceed the 95th percentile for age and gender. BMI-based overweight categorization for individuals, particularly for racial/ethnic minorities with differences in body composition, may have limited validity because BMI measures cannot differentiate between increased weight for height attributable to relatively greater fat-free mass (muscle, bone, and fluids) and that attributable to greater fat. No trials of screening programs to identify and to treat childhood overweight have been reported. Limited research is available on effective, generalizable interventions for overweight children and adolescents that can be conducted in primary care settings or through primary care referrals.Conclusions.

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Effects of family-based behavioral treatment on obese 5-to-8-year-old children

Cited by 73 publications

References 11 publications

Recommendations for Treatment of Child and Adolescent Overweight and Obesity

Recommendations for Treatment of Child and Adolescent Overweight and Obesity

Evidence Update on the Treatment of Overweight and Obesity in Children and Adolescents

Screening and Interventions for Childhood Overweight: A Summary of Evidence for the US Preventive Services Task Force

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