Prevention of Progression to Severe Obesity in a Group of Obese Schoolchildren Treated With Family Therapy

Abstract

Study objective. To evaluate the effect of family therapy on childhood obesity. Design. Clinical trial. One year follow-up. Setting. Referral from school after screening. Participants. Of 1774 children (aged 10 to 11), screened for obesity, 44 obese children were divided into two treatment groups. In an untreated control group of 50 obese children, screened in the same manner, body mass index (BMI) values were recorded twice, at 10 to 11 and at 14 years of age. Intervention. Both treatment groups received comparable dietary counseling and medical checkups for a period of 14 to 18 months, while one of the groups also received family therapy. Results. At the 1-year follow-up, when the children were 14 years of age, intention-to-treat analyses were made of the weight and height data for 39 of 44 children in the two treatment groups and for 48 of the 50 control children. The increase of BMI in the family therapy group was less than in the conventional treatment group at the end of treatment, and less than in the control group (P = .04 and P = .02, respectively). Moreover, mean BMI was significantly lower in the family therapy group than in the control group (P < .05), and the family therapy group also had fewer children with BMI > 30 than the control group (P = .02). The reduction of triceps, subscapular, and suprailiac skinfold thicknesses, expressed as percentages of the initial values, was significantly greater in the family therapy group than in the conventional treatment group (P = .03, P = .005 and P = .002, respectively), and their physical fitness was significantly better (P < .05). Conclusions. Family therapy seems to be effective in preventing progression to severe obesity during adolescence if the treatment starts at 10 to 11 years of age.

Family-based interventions for pediatric obesity: Methodological and conceptual challenges from family psychology.

“…In programs developed by Golan, Weizman, Apter, and Fainaru (1998), parents were viewed as the “exclusive agents of change.” This focus on parents highlights parenting skill as the target of intervention: “Approaching parents exclusively shifts the focus of the group from weight issues to parenting issues” (Golan & Crow, 2004a, p. 45). Finally, family therapy was used by Flodmark, Ohlsson, Ryden, and Sveger (1993) to strengthen hierarchies, reduce blurred boundaries and coalitions, and reinforce resources for coping in families of obese children…”

“…In traditional family-based behavior modification programs, there was no benefit associated with adding a parent training component (Aragona et al, 1975; Israel et al, 1994). Golan, Weizman, et al (1998) found clear advantages when parents were made the exclusive agents of change (relative to treatment in which the child was the exclusive agent of change), and Flodmark et al (1993) found significant advantages associ- ated with family therapy (relative to dietary counseling and pediatrician visits).…”

Parents’ integration in the treatment of adolescents with obesity: A qualitative study.

“…The program also included 90 min of physical activity twice a week for the adolescents. The parents' program consisted of nutrition-related topics and systemic interventions to facilitate family functioning by reinforcing family resources and improv-ing the emotional climate for adolescents with obesity (Flodmark et al, 1993).…”

“…Guidelines for obesity interventions in children and adolescents recommend comprehensive treatments combining dietary intervention, behavioral approaches, and physical activities, which have shown to have beneficial effects on adiposity (Hoelscher, Kirk, Ritchie, & Cunningham-Sabo, 2013; Luttikhuis et al, 2009; Whitlock, O’Connor, Williams, Beil, & Lutz, 2010). Targeting parents is also an important component of the treatment and family-based programs have been widely developed (Epstein, Valoski, Koeske, & Wing, 1986; Epstein, Valoski, Wing, & McCurley, 1994; Flodmark, Ohlsson, Rydén, & Sveger, 1993; Golan, Weizman, Apter, & Fainaru, 1998; Golley, Magarey, Baur, Steinbeck, & Daniels, 2007; Ho et al, 2012; Kitzmann et al, 2010; Sung-Chan, Sung, Zhao, & Brownson, 2013; Tanas, Marcolongo, Pedretti, & Gilli, 2007). Most of these programs have involved work on improving parental modeling and positive parenting styles, such as child-management strategies and authoritative parenting.…”

Integrating pediatric obesity treatment into clinical practice.

“…The latter may include a past or current eating disorder or difficulty with attachment and nurturing. The application of family systems theory to understanding obesity in childhood is a promising but largely unexplored research and clinical area (Flodmark, Ohlsson, Ryden, & Sveger, 1993). The basic premise, that obesity occurs within the context of specific family structures and patterns and can serve both homeostatic and conflict avoidance purposes, is ripe for investigation.…”