Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care

Abstract

ImportanceIntensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings.ObjectiveTo evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings.Design, Setting, and ParticipantsThis randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. 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 through August 2021.InterventionsFamily-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress.Main Outcomes and MeasuresThe primary outcome was the child’s change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents.ResultsAmong 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. 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 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, −2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; −1.05% [95% CI, −3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, −3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings).Conclusions and RelevanceFamily-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families withmultiple children.Trial RegistrationClinicalTrials.gov Identifier: NCT02873715

Promoting Health in Pediatric Obesity: A Decade\'s Research of Physical Activity\'s Influence on Cardiometabolic Parameters

“…Participation in organized team and individual physical activity plays an important role, primarily in supporting vigorous physical activity, but also in community-wide physical activity among children. The negative effects of pandemics should be mitigated by increasing the participation of young people in various forms of organized physical activity, with an emphasis on structured individual physical activity [ 94 ], revitalizing supportive peer relationships, increasing motivation for physical activity through its attractiveness, flexibility regarding place and time of implementation, and increasing recreational infrastructure in the immediate environment [ 95 ], or implementing the use of family-based behavioral interventions [ 96 ].…”

Validation of remote child weight and height measurements within a weight management trial

“…Children stood with their arms naturally at their sides while looking straight ahead in the Frankfort plane. Height measurements were collected twice, with a third measurement obtained if a difference >0.3 cm was found between the first two [12].…”

“…This measurement was completed twice, with a third measurement taken if a difference >0.1 kg was obtained between the first two [12].…”

Anthropometric Indices in Predicting the Risks of Occurrence and Outcomes of Diseases at Present Stage

“…В целом, наиболее эффективной стратегией почти для всех результатов было сочетание ограничения калорийности с нагрузочными тренировками или смешанными упражнениями, сопровождаемые приемом пищи с высоким содержанием белка. Следует понимать, что диета с ограничением калорий сама по себе может способствовать саркопеническому ожирению у лиц предпенсионного возраста [14].…”