Add-on Family-Based Behavioral Therapy to ESOC Improves Childhood Obesity Outcomes: JAMA
USA: A multicenter randomized clinical trial involving 730 children aged 6–15 years found that family-based behavioral treatment (FBT) combined with enhanced standard of care (ESOC) was more effective than ESOC alone in reducing childhood obesity. Nearly half of the children receiving FBT achieved clinically meaningful weight loss, demonstrating that integrating family-based interventions into primary care is a feasible and effective strategy across diverse populations.
The findings are from the TEAM UP randomized clinical trial, published in JAMA Pediatrics. The study was led by Amanda E. Staiano of the Pennington Biomedical Research Center, Baton Rouge, Louisiana, and colleagues. The researchers evaluated whether adding family-based behavioral treatment to enhanced standard obesity care could improve weight outcomes in children and adolescents with obesity.
The pragmatic trial was conducted between 2019 and 2024 across 41 primary care practices in Louisiana, New York, Missouri, and Illinois. Children aged 6 to 15 years with obesity were referred by their primary care physicians or enrolled directly with a participating parent. Participants were randomly assigned to receive either ESOC alone or ESOC plus FBT for 12 months, with follow-up extending to 18 months.
Enhanced standard care was delivered by primary care physicians and intensified according to each child's response. The FBT program included structured sessions with trained interventionists focusing on healthy eating, physical activity, positive parenting techniques, and strategies to modify home and environmental factors that influence health behaviors.
A total of 730 children were enrolled, with a mean age of 10.8 years. More than half were girls, nearly half were covered by Medicaid, and over one-fifth experienced food insecurity.
Key findings from the study include:
- Children receiving ESOC plus family-based behavioral treatment experienced significantly greater reductions in median percent BMI than those receiving ESOC alone.
- Nearly half of the children in the ESOC+FBT group achieved clinically meaningful weight reduction.
- Both treatment groups showed improvements in body weight, but the reduction was significantly greater with FBT.
- Overall quality of life improved in both groups at 12 and 18 months.
- Weight-related quality of life improved in both groups, with greater gains among children receiving ESOC+FBT.
- No adverse events related to trial participation were reported.
The researchers noted that the COVID-19 pandemic disrupted enrollment and treatment delivery, while lower FBT attendance among African American families, Medicaid recipients, and food-insecure households highlighted ongoing access barriers. They called for more flexible delivery models, including telehealth, to improve participation.
Overall, the findings show that adding family-based behavioral treatment to primary care is more effective than enhanced standard care alone for reducing childhood obesity. The researchers said the approach is feasible across diverse populations and supports broader implementation in routine pediatric care.
Reference:
Staiano AE, Cook SR, Stein RI, et al. Family-Centered Child Obesity Treatment: The TEAM UP Randomized Clinical Trial. JAMA Pediatr. Published online July 27, 2026. doi:10.1001/jamapediatrics.2026.3067
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