Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study

Epstein, Leonard H.; Schechtman, Kenneth B.; Kilanowski, Colleen; Ramel, Melissa; Moursi, Nasreen A.; Quattrin, Teresa; Cook, Stephen J.; Eneli, Ihuoma; Pratt, Charlotte; Geller, Nancy; Campo, Rebecca; Lew, Daphne; Wilfley, Denise E.

doi:10.1016/j.cct.2021.106497

Cited by 15 publications

(31 citation statements)

References 73 publications

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“…format to an individual family format. 15 In the present study, significantly more participants in the FBSFT group achieved a BMI SDS reduction of ≥0.25 (31.5% in FBSFT group compared to 13% in TAU group). Individual treatment response is an important outcome measure, in addition to mean changes.…”

Section: Discussionsupporting

confidence: 47%

“…FBSFT also includes elements of interpersonal therapy for eating disorders aimed at tackling emotions and interpersonal conflicts that affect eating habits. Health behaviours in terms of diet, physical activity, sedentary behaviour, and sleep are targeted in both children and their parents applying the Traffic Light Eating Plan and activity programme 15 . Pretreatment measures of the mentioned lifestyle behaviours were used to form the basis for the planning of healthy changes.…”

Section: Methodsmentioning

confidence: 99%

“…Health behaviours in terms of diet, physical activity, sedentary behaviour, and sleep are targeted in both children and their parents applying the Traffic Light Eating Plan and activity programme. 15 Pretreatment measures of the mentioned lifestyle behaviours were used to form the basis for the planning of healthy changes. Progress was monitored from session‐to‐session using specific weight goals and relevant lifestyle behaviours adjusted thereafter.…”

Section: Methodsmentioning

confidence: 99%

“…Treatment programmes targeting multiple lifestyle behaviours whilst applying behavioural techniques in a family‐based approach have shown the most promise and are considered best practise in obesity treatment for children aged 6–17 years 10,12,13 . However, evidence is mostly derived from efficacy trials in research clinics, with strict control of internal validity and participant selection 14,15 . An important next step is to conduct effectiveness trials focusing on treatment delivery in public healthcare settings with less stringent participant selection criteria 9,11 .…”

Section: Introductionmentioning

confidence: 99%

“… 10 , 12 , 13 However, evidence is mostly derived from efficacy trials in research clinics, with strict control of internal validity and participant selection. 14 , 15 An important next step is to conduct effectiveness trials focusing on treatment delivery in public healthcare settings with less stringent participant selection criteria. 9 , 11 Evidence for the effectiveness of such treatment programmes that can be extrapolated to different healthcare settings is sparse, 16 , 17 and sought by national health authorities.…”

Section: Introductionmentioning

confidence: 99%

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Family‐based treatment of children with severe obesity in a public healthcare setting: Results from a randomized controlled trial

et al. 2022

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To compare the effectiveness of family-based behavioural social facilitation treatment (FBSFT) versus treatment as usual (TAU) in children with severe obesity. Parallel-design, nonblinded, randomized controlled trial conducted at a Norwegian obesity outpatient clinic. Children aged 6-18 years referred to the clinic between 2014 and 2018 were invited to participate. Participants were randomly allocated using sequentially numbered, opaqued, sealed envelopes. FBSFT (n = 59) entailed 17 sessions of structured cognitive behavioural treatment, TAU (n = 55) entailed standard lifestyle counselling sessions every third month for 1 year. Primary outcomes included changes in body mass index standard deviation score (BMI SDS) and percentage above the International Obesity Task Force cut-off for overweight (%IOTF-25). Secondary outcomes included changes in sleep, physical activity, andeating behaviour. From pre-to posttreatment there was a statistically significant difference in change in both BMI SDS (0.19 units, 95% confidence interval [CI]: 0.10-0.28, p < .001) and p < .001) between FBSFT and TAU groups. FBSFT participants achieved significant reductions in mean BMI SDS (0.16 units, (95%CI: À0.22 to À0.10, p < .001) and %IOTF-25 (6.53%, 95% CI: À8.45 to À4.60, p < .001), whereas in TAU nonsignificant changes were observed in BMI SDS (0.03 units, 95% CI: À0.03 to 0.09, p = .30) and %IOTF-25 (À1.04%, 95% CI: À2.99 to À0.90, p = .29). More FBSFT participants (31.5%) had clinically meaningful BMI SDS reductions of ≥0.25 from pre-to posttreatment than in TAU (13.0%, p = .021). Regarding secondary outcomes, only changes in sleep timing differed significantly between groups. FBSFT improved weight-related outcomes compared to TAU. Yngvild S. Danielsen and Petur B. Juliusson are joint senior authors.

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Section: Discussionsupporting

confidence: 47%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Family‐based treatment of children with severe obesity in a public healthcare setting: Results from a randomized controlled trial

et al. 2022

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Behavioral Interventions for Treating Childhood Obesity

Heerman

Paul

Staiano

2023

JAMA

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

Epstein

Wilfley

Kilanowski

et al. 2023

JAMA

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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

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Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study

Cited by 15 publications

References 73 publications

Family‐based treatment of children with severe obesity in a public healthcare setting: Results from a randomized controlled trial

Family‐based treatment of children with severe obesity in a public healthcare setting: Results from a randomized controlled trial

Behavioral Interventions for Treating Childhood Obesity

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

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