Family-Based Behavioral Therapy Targeting Childhood Obesityin Pediatric Primary Care

National guidelines recommend intensive behavioral interventions for childhood overweight and obesity, typically provided in specialized clinics. However, there exists a lack of evidence regarding their effectiveness in pediatric primary care settings. 

A recent randomized clinical trial, conducted in four US settings from 2017-2021, selected 452 children aged 6-12 years with overweight or obesity, along with their parents and 106 siblings. Participants were randomly assigned to receive family-based treatment or usual care and were followed for 24 months.Family-based treatment aimed to instill healthy eating, physical activity, and parenting behaviors within families, with a goal of 26 sessions over 24 months. The primary outcome was the child's change in percentage above the median body mass index (BMI) for their age and sex. Secondary outcomes included changes in this measure for siblings and BMI changes for parents.

It was found that children receiving family-based treatment had better weight outcomes compared to those receiving usual care, with a significant difference in change in percentage above median BMI at 24 months. Longitudinal analysis showed that family-based treatment led to superior outcomes in children, parents, and siblings at 6 months, maintained through 24 months.

Thus, family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings. It resulted in improved weight outcomes over 24 months for children, parents, and even siblings who were not directly treated. This suggests a promising approach for families with multiple children facing weight-related challenges.

Source: Epstein LH, Wilfley DE, Kilanowski C, et al. JAMA. 2023 Jun 13;329(22):1947-56.