Family Based Treatment for Obese Children

Obesity is a trait that runs through families. This finding is at the heart of an intensive, behavioral, family-based treatment developed by University at Buffalo researchers for obese children and their parents.

Previously exclusively available in specialist clinics, this evidence-based treatment has now been deployed for the first time in a multicenter study conducted in four U.S. cities in children ages 6 to 12 in the primary care setting, where the vast majority of children receive care.

The study, which was published online June 13 in the Journal of the American Medical Association (JAMA), shows that family-based obesity therapy at the pediatrician’s office leads to better weight-loss outcomes for the treated kid and parent, as well as untreated siblings.

“This research shows that the healthy behaviors the treatment promotes extend beyond the parent and child being treated to potentially make the whole family healthier,” says David C. Goff Jr., MD, Ph.D., director, Division of Cardiovascular Sciences, NHLBI. “What’s more, the fact that this weight-loss study was implemented during the COVID-19 pandemic, when many adults and children gained weight, is noteworthy.”

The study discovered that three times as many children in the therapy group (27%) as in the usual care group (9%) experienced a clinically relevant reduction in BMI linked with improved cardiometabolic outcomes such as blood pressure, lipids, and glucose regulation.

Family Plays a Vital Role

“Our study is the first to test family-based treatment in primary care for children 6–12 years old and it worked for the child, for parents and even for their untreated siblings,” says Leonard H. Epstein, Ph.D., senior author, SUNY Distinguished Professor and chief of the Division of Behavioral Medicine in the Department of Pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB.

Epstein is widely regarded as the father of this behavioral, evidence-based, family-centered approach to pediatric obesity.

“The success of this novel and powerful family-based treatment of childhood obesity, which Dr. Epstein and his colleagues have developed, helps ensure the health of these children,” says Allison Brashear, MD, vice president for health sciences and dean of the Jacobs School. “It will not only impact them today but going forward as they adopt healthy practices for the rest of their lives.”

The present study expands on Epstein and colleagues’ previous work in the primary care setting, which was conducted by Teresa Quattrin, MD, UB Distinguished Professor in the Department of Pediatrics and senior assistant dean for research integration at the Jacobs School.

Quattrin, who was also a co-author on the JAMA paper, had successfully adapted this treatment for preschool obese children and parents in the primary care setting, demonstrating that outcomes for preschool-aged children who are overweight improve when both the parent and the child are treated, as opposed to only the child.

Multiple people Benefits

“Many families with obesity have multiple obese children, as well as parents with obesity,” says Epstein, “but traditional treatment for childhood obesity only focuses on the child; it may provide ideas about healthier foods and the recommendation to be more active, but the parent is never an active target for intervention, nor is the parent taught positive parenting.”

The standard treatment also does not focus on modifying behaviors and is not provided by specialists trained in behavior therapy.

In the JAMA trial, the family-based treatment comprised diet and activity plans, parenting and behavioral methods teaching, and facilitation of support for positive behavior changes in both family and peer environments. Individualized sessions for parent and child included assessments of self-monitored food and activity levels, study of treatment manuals and handouts, and discussions about weight and behavior goal-setting.

For the first four months, families met weekly to learn the program, then bi-weekly, and finally monthly. The majority of therapy providers had prior experience dealing with families and a master’s degree in psychology, counseling, social work, or dietetics.

The study involved 452 children ages 6 to 12 years old with one parent in primary care clinics in Buffalo and Rochester, New York, Columbus, Ohio, and St. Louis, Missouri. Half of the children were randomly assigned to family-based treatment, while the other half received standard care; 27.2% were Black, 8.8% were Latinx, and 57.1% were white.

Children enrolled in the family-based treatment had a 6.48% difference in percent above median BMI compared to those receiving conventional care, while their parents had a 3.97% reduction and their untreated siblings who were overweight had a 5.38% reduction. The increases in percent above the median BMI among family members were connected, implying that the treatment results in modeling healthy habits as well as real change in the shared family environment.

“Family-based therapy is unique in using up-to-date behavioral treatments to teach parents and children methods to eat healthier and be more physically active, and in the process teach positive parenting,” says Epstein.

Primary care’coaches’

The current study’s success of behavioral interventions highlights what the authors see as an increasing demand for behavioral treatments in pediatric primary care in general.

The results of the study underscore the need for ‘coaches’ in the primary care setting who can help with obesity treatment as well as many other behavioral problems, such as anxiety, depression, eating disorders and a host of other issues which require psychological support and behavior modification,” says Quattrin, also a pediatric endocrinologist with UBMD Pediatrics.

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