Family-Based Treatment May Be Effective in Severe Pediatric Obesity
By Laurie Barclay, MD
Medscape Medical News
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.
