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Family-Based Treatment May Be Effective in Severe Pediatric Obesity


Family-Based Treatment May Be Effective in Severe Pediatric Obesity

October 13, 2009 — Family-based treatment may be effective in severe pediatric obesity, according to the results of a study reported in the October issue of Pediatrics.

"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," write Melissa A. Kalarchian, PhD, from the University of Pittsburgh School of Medicine in Pennsylvania, and colleagues. "We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity."

Families of 192 severely obese children aged 8.0 to 12.0 years were randomly assigned to the intervention or to usual care, and evaluations were performed at baseline and at 6, 12, and 18 months. Mean age was 10.2 ± 1.2 years, and average body mass index (BMI) percentile for age and sex was 99.18 ± 0.72.

Percent overweight (percent over the median BMI for age and sex) was the main study endpoint, and other outcome measures were changes in blood pressure, body composition, waist circumference, and health-related quality of life. Session attendance and other factors associated with changes in child percent overweight were also assessed.

Compared with usual care, the intervention was associated with significant decreases in child percent overweight at 6 months. The intervention was associated with a 7.58% decrease in child percent overweight at 6 months vs a 0.66% decrease with usual care, based on intent-to-treat analyses. However, these between-group differences were not significant at 12 or 18 months. At 6 and 12 months, there were small but significant improvements in medical outcomes.

Children who attended at least 75% of the intervention sessions maintained their decreases in percent overweight through 18 months. Other factors associated with significantly greater reductions in child percent overweight at 6 months among intervention participants were lower baseline percent overweight, better attendance, higher income, and greater reduction in parental BMI.

"Intervention was associated with significant short-term reductions in obesity and improvements in medical parameters and conferred longer-term weight change benefits for children who attended ? 75% of sessions," the study authors write. "Although future work is needed to understand the relationship between attendance and weight control, the present findings suggest the potential importance of strategies to promote and to facilitate program adherence."

Limitations of this study include inability to attribute outcomes to the specific components of the family-based intervention; lack of generalizability to Hispanics or to those not participating in university-based, research programs; and missing data in intent-to-treat analyses.

"A 6-month, family-based, behavioral weight management program was associated with significant decreases in percent overweight and improvements in medical risk factors in severely obese, school-aged children," the study authors conclude. "Although the changes in percent overweight were modest, given the severity of obesity, the significant health benefits of the intervention suggest that further efforts to optimize the outcomes of family-based intervention programs are warranted."

The National Institutes of Health, the University of Pittsburgh Obesity and Nutrition Research Center, Children's Hospital of Pittsburgh General Clinical Research Center, and the University of Pittsburgh Clinical and Translational Science Institute supported this study. The study authors have disclosed no relevant financial relationships.

Pediatrics. 2009;124:1060-1068.

Clinical Context

In the United States, the greatest increases in prevalence of severe obesity have occurred among the heaviest children, with up to 4% of US children having a BMI at the 99th percentile or greater for age and sex. Obesity at this level is linked to multiple medical risk factors and severe adult obesity.

First-line treatment of severe pediatric obesity should include conservative measures such as family-based, behavioral weight management. Several previous studies have shown that family-based, behavioral weight management programs have led to modest weight loss in moderately overweight youths, but the efficacy of such programs has not been previously tested in severe pediatric obesity.

Study Highlights

  • The hypothesis tested by this randomized controlled trial was that compared with usual care, a family-based intervention would be associated with favorable changes in BMI and medical risk factors.

  • The intervention consisted of 20 group meetings (60 minutes each) during months 0 to 6, with separate meetings using complementary materials for adult and child groups.

  • Immediately before or after group meetings, the adult and child met together with a lifestyle coach to review self-monitoring records and to set weekly goals.

  • Between month 6 and month 12, there were 6 booster sessions (3 group sessions and 3 telephone calls), but there was no contact between the 12-month and 18-month evaluations.

  • The study sample consisted of 192 severely obese children and their families.

  • Age range was 8.0 to 12.0 years (mean age, 10.2 ± 1.2 years).

  • Average BMI percentile for age and sex was 99.18 ± 0.72.

  • The study sample contained white and black boys and girls, but no Hispanic children.

  • Participants were assessed at baseline and at 6, 12, and 18 months.

  • The main study endpoint was percent overweight (percent over the median BMI for age and sex).

  • Other outcomes were changes in blood pressure, body composition, waist circumference, and health-related quality of life.

  • The investigators also looked at session attendance and other factors linked to changes in child percent overweight.

  • The study design did not control for time and attention, preventing determination of the causal association between outcomes and specific components of the family-based intervention.

  • At 6 months, the intervention was associated with significant decreases in child percent overweight vs usual care.

  • Intent-to-treat analyses showed a 7.58% decrease in child percent overweight at 6 months for the intervention vs a 0.66% decrease with usual care.

  • Between-group differences were not significant at 12 or 18 months.

  • Small but significant improvements in medical outcomes were seen at 6 and 12 months.

  • Children who attended 75% or more of the intervention sessions maintained decreases in percent overweight through 18 months.

  • Among intervention participants, lower baseline percent overweight, better attendance, higher income, and greater reduction in parental BMI were linked to significantly greater reductions in child percent overweight at 6 months.

  • The investigators concluded that the intervention was associated with significant short-term reductions in obesity and improved medical parameters, as well as longer-term weight change benefits for children who attended 75% or more of the sessions.

  • They recommended additional research to understand the relationship between attendance and weight control and to optimize the outcomes of family-based intervention programs.

  • Limitations of the study include inability to determine the effect of specific components of the family-based intervention, limited generalizability, and missing data in intent-to-treat analyses.

Clinical Implications

  • Compared with usual care, a family-based intervention for children with severe obesity was associated with significant decreases in child percent overweight at 6 months, but these between-group differences were not significant at 12 or 18 months. At 6 and 12 months, there were small but significant improvements in medical outcomes.

  • Children who attended at least 75% of the intervention sessions maintained their decreases in percent overweight through 18 months. Other factors associated with significantly greater reductions in child percent overweight at 6 months were lower baseline percent overweight, better attendance, higher income, and greater reduction in parental BMI.

  •  http://cme.medscape.com/viewarticle/710414?src=cmemp&uac=120873FG