Family-based treatment aids weight loss in children and parents: JAMA

In the randomized trial with 24 months of follow-up in 4 US settings, children, siblings, and parents with obesity or weight assigned to undergo family-based treatment they had significantly better weight loss outcomes, measured by percentage above the median BMI (body mass index) for their sex and age, compared to those undergoing usual care.

National guidelines recommend intensive behavioural interventions for childhood obesity and overweight but are offered primarily in speciality clinics. There is no evidence of their effectiveness in pediatric primary care settings. Leonard H. Epstein, Washington University in St Louis School of Medicine, St Louis, Missouri, and colleagues aimed to assess the effects of family-based treatment for obesity or overweight implemented in pediatric primary care on children and their parents and siblings.

The randomized clinical trial enrolled 452 children ages 6 to 12 with obesity or weight, 106 siblings, and their parents. Participants were allocated to undergo family-based treatment (n=226) or usual care (n=226) and were followed for 24 months. The trial was conducted from 2017 to 2021. The child's mean age was 9.8 years; 53% were female; the mean percentage above median BMI was 59.4% [n = 27.0]. One hundred six siblings were included.

The family-based intervention used various behavioural techniques to develop physical activity, healthy eating, and parenting behaviours with families. The treatment goal was 26 sessions for 24 months with a coach trained in behaviour change methods; the sessions were individualized based on family progress.

The study's primary outcome was a change in the child's percentage above the median BMI from baseline to 24 months in the general US population normalized for sex and age. Secondary outcomes were the changes in this measure for siblings and in BMI for parents.

The authors reported the following findings:

• 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%).
• Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at six 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% versus 6.48% for children; −1.05% versus 2.92% for parents; and 0.03% versus 5.35% for siblings).

"We found that family-based treatment for childhood obesity and overweight was successfully implemented in pediatric primary care settings and improved weight outcomes over 24 months for children and parents," the authors wrote.

"Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families with multiple children," they concluded.

Reference:

Epstein LH, Wilfley DE, Kilanowski C, et al. Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care: A Randomized Clinical Trial. JAMA. 2023;329(22):1947–1956. doi:10.1001/jama.2023.8061