Overweight and obese children do not necessarily need to attend weight loss treatment programs with their parents, a new study has found.
“[C]hildren in both [parent-based weight loss treatment (PBT)] and [family-based treatment (FBT)] experienced similar decreases in [BMI z-score (BMIz)] by the end of the treatment period that [were] largely sustained through the 18-month assessment,” write Kerri N. Boutelle, PhD, from the Department of Pediatrics and the Department of Psychiatry, University of California, San Diego, and colleagues.
“[FBT] is considered the most effective model for the treatment of children with obesity in the short term and long term…. However, FBT is provided mainly in academic medical centers and can be challenging to attend for busy families because it requires attendance by both parent and child at specific group times,” the authors explain in an article published online May 30 in JAMA Pediatrics.
The randomized noninferiority trial included 150 overweight and obese children aged 8 to 12 years and their parents. During the first 6 months of the 24-month trial, parents in both groups attended 20 group meetings, each lasting 1 hour, and children in the FBT group attended hour-long child group meetings simultaneously with their parents. Children in the PBT group did not attend meetings. Parents and children in the FBT group and parents in the PBT group also participated in 30-minute individual meetings with a behavioral coach.
The researchers found no difference in the amount of weight lost by children in the two groups, which was the primary outcome measure. The mean baseline BMIz was 2.02 in the PBT group and 1.98 in the FBT group. At the end of the study, the mean BMIz for both groups was just over 1.8.
The difference in BMIz between the two groups over assessments was 0.001 (90% confidence interval, −0.05 to 0.05), which was well within the predetermined noninferiority margin of −0.13 to −0.065. Thus, the findings support noninferiority, the authors explain.
Secondary outcomes (parent weight loss, child and parent energy intake, child and parent physical activity, and parenting) were also similar between the treatment groups.
“Consistent with previous evidence, the PBT program was noninferior to FBT on child weight outcomes, child and parent energy intake, child and parent physical activity, and parenting measures at the 6-month, 12-month, and 18-month follow-ups,” the researchers write. “The PBT program was noninferior to FBT on parent weight outcomes at the 6-month follow-up; however, PBT parents gained more weight over time. Additionally, there [were] greater attrition and lower acceptability ratings in the PBT compared with the FBT group,” they add.
“It is possible that child motivation to attend group sessions could influence family attendance and attrition,” Li Ming Wen, MD, MMed, PhD, from School of Public Health, Sydney Medical School at the University of Sydney in Australia, writes in an accompanying editorial.
Although the results for both types of treatment are encouraging, a single treatment program will not slow the rise of obesity, Dr Wen says.
“Addressing childhood and adolescent obesity requires a life-course approach including preconception and pregnancy, infancy and early childhood, and older childhood and adolescence. In addition, it is important to treat children who are already obese for their own well-being and that of their children. Providing parents with evidence-based advice and recommendations can improve parental knowledge and practice regarding obesity prevention and treatment,” Dr Wen explains.
In addition, clinicians need to address the reasons families may have difficulty participating in education programs like this one, Dr Wen continues.
“It may be worth considering whether home visits could be applied to engage parents for obesity treatment of school-aged children and, in particular, for those families of low socioeconomic status who are less likely to participate in group education programs.”
Dr Wen concludes, “School-based intervention toward healthy eating habits and physical activity is another key strategy in the prevention of obesity. It is likely that a multistrategic approach involving parents, children, schools, and communities as well as local governments will be more effective for childhood obesity prevention and treatment.”
The authors and Dr Wen have disclosed no relevant financial relationships.
JAMA Pediatrics. Published online May 30, 2017. Article full text, Editorial full text
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