Family-Based Treatment of Severe Pediatric Obesity: Randomized, Controlled Trial

Abstract

WHAT'S KNOWN ON THIS SUBJECT:Family-based, behavioral weight management programs are associated with moderate weight losses and health benefits for school-aged children, but few studies have focused on severely obese children. WHAT THIS STUDY ADDS:Intervention was associated with short-term reductions in obesity and improvements in medical parameters. Sustained decreases in overweight were observed only among children with better session attendance. Chronic care models are indicated to optimize health outcomes for severely obese children.abstract OBJECTIVE: We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity. METHODS:Participants were 192 children 8.0 to 12.0 years of age (mean Ϯ SD: 10.2 Ϯ 1.2 years). The average BMI percentile for age and gender was 99.18 (SD: 0.72). Families were assigned randomly to the intervention or usual care. Assessments were conducted at baseline, 6 months, 12 months, and 18 months. The primary outcome was percent overweight (percent over the median BMI for age and gender). Changes in blood pressure, body composition, waist circumference, and health-related quality of life also were evaluated. Finally, we examined factors associated with changes in child percent overweight, particularly session attendance. RESULTS:Intervention was associated with significant decreases in child percent overweight, relative to usual care, at 6 months. Intent-totreat analyses documented that intervention was associated with a 7.58% decrease in child percent overweight at 6 months, compared with a 0.66% decrease with usual care, but differences were not significant at 12 or 18 months. Small significant improvements in medical outcomes were observed at 6 and 12 months. Children who attended Ն75% of intervention sessions maintained decreases in percent overweight through 18 months. Lower baseline percent overweight, better attendance, higher income, and greater parent BMI reduction were associated with significantly greater reductions in child percent overweight at 6 months among intervention participants. CONCLUSIONS:Intervention was associated with significant shortterm reductions in obesity and improvements in medical parameters and conferred longer-term weight change benefits for children who attended Ն75% of sessions.

Economic evaluation of lifestyle interventions to treat overweight or obesity in children

“…25) to À0.60, 29 although the reduction in BMI SDS was only statistically significant, at the conventional 5% level, in three studies. 27,29,31 The 'Sea Lion Club' intervention evaluated by Weigel et al 29 had the largest effect size and was a clear outlier. The smallest favourable effect size observed was À0.03.…”

“…The interventions to treat obesity could broadly be categorized into three groups: interventions aimed at modifying behaviour, diet and/or physical activity delivered to groups of children and/or parents 24,26,29,31,33 or delivered to individual families; 25,27,30 and technology-based interventions used in the home or community aimed at promoting physical activity or reducing sedentary activities. 28,32 For the group-based interventions, planned contact time with professionals ranged from 10 (ref.…”

Long-term efficacy of group-based treatment for childhood obesity compared with routinely given individual counselling

“…Maintaining the attained weight loss after the intervention was a major challenge, as also seen in other studies. 8 However, some randomised 9,10 and non-randomised studies 11 have suggested long-lasting beneficial impacts. Several approaches have been suggested for improving the long-term results of obesity management.…”

A Tailored Family-Based Obesity Intervention: A Randomized Trial

“…[4][5][6] However, virtually all interventions are only 6 to 12 months in duration, [4][5][6] with few exceptions. 7,8 Whether long-term changes to weight and the behavioral practices underpinning them are sustained has rarely been examined, 9,10 but this is important given that shorter studies report greater BMI differences than longer studies. 4 Typically, obesity interventions in children include treatment-seeking families or recruit via advertisement or referrals.…”