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Family-Based Primary Care Treatment Shows Stronger Weight Loss Outcomes
Family-based treatment for childhood overweight and obesity was found to be successful in pediatric primary care settings and showed improved weight outcomes, according to a randomized clinical trial published in JAMA.
“These findings may suggest a way for more clinical groups to implement national recommendations by the American Academy of Pediatrics and the US Preventive Services Task Force to offer intensive behavioral interventions for childhood overweight and obesity,” authors noted. “Embedding behaviorally trained interventionists within primary care practices could be tested for other common behavioral issues that may benefit from improving parenting practices.”
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Researchers enrolled 452 children 6-12 years old clinically considered overweight or obese, along with their parents and 106 siblings, across 4 US settings. The participants were randomly assigned to undergo family-based treatment over 26 sessions or receive usual care and were followed up for 24 months between November 2017 and August 2021. The family-based treatment approach used behavioral techniques and materials like Traffic Light Eating, parenting and behavioral techniques, and facilitation of support in family and peer environments.
Researchers measured the child's percentage above the median body mass index (BMI) in the general US population, normalized for age and sex, from baseline to 24 months as the primary outcome. Secondary outcomes included BMI changes for siblings and parents.
Of the 452 enrolled children, 226 were randomly assigned family-based treatment and 226 were randomly assigned usual care. At the end of the 24 months, children who received family-based treatment showed better weight outcomes compared to those who received usual care. The difference in the change in percentage above median BMI was -6.21% for the family-based treatment group. Longitudinal growth models revealed that children, parents, and siblings undergoing family-based treatment consistently had better outcomes compared to those receiving usual care. These outcomes were observed at 6 months and maintained through 24 months.
Researchers indicated several limitations.
First, the intensity of the family-based treatment approach evaluated in this study may be difficult in many primary care settings due to the time and expertise required.
Second, the study had a smaller sample of siblings than index children since sibling participation was not required, meaning selection bias may have been present towards families who included siblings.
Third, a significant percentage of parents were lost to follow-up, which may limit the ability to generalize parental outcomes to the broader population. Lastly, this study was conducted during the COVID-19 pandemic, which negatively influenced the magnitude of change in weight outcomes.
