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Original Investigation
Journal Club
July 2017

Effect of Attendance of the Child on Body Weight, Energy Intake, and Physical Activity in Childhood Obesity TreatmentA Randomized Clinical Trial

Journal Club PowerPoint Slide Download
Author Affiliations
  • 1Department of Pediatrics, University of California, San Diego
  • 2Department of Psychiatry, University of California, San Diego
  • 3Department of Psychology, Bowling Green University, Bowling Green, Ohio
  • 4Department of Family Medicine and Public Health, University of California, San Diego
  • 5Department of Psychology, Washington University at St Louis, St Louis, Missouri
  • 6Department of Pediatrics, State University of New York at Buffalo
  • 7Department of Psychiatry, University of Minnesota, Minneapolis
JAMA Pediatr. 2017;171(7):622-628. doi:10.1001/jamapediatrics.2017.0651
Key Points

Question  Do children need to come to childhood obesity treatment with their parent for it to be effective?

Findings  In this randomized clinical trial among 150 children and their parent, results showed that parent-based treatment (parent-only, without the child) was noninferior to a family-based treatment (parent and child) on child weight loss over 24 months.

Meaning  The child does not need to come to treatment to lose weight.

Abstract

Importance  Family-based weight loss treatment (FBT) is considered the gold-standard treatment for childhood obesity and is provided to the parent and child. However, parent-based treatment (PBT), which is provided to the parent without the child, could be similarly effective and easier to disseminate.

Objective  To determine whether PBT is similarly effective as FBT on child weight loss over 24 months. Secondary aims evaluated the effect of these 2 treatments on parent weight loss, child and parent dietary intake, child and parent physical activity, parenting style, and parent feeding behaviors.

Design, Setting, and Participants  Randomized 2-arm noninferiority trial conducted at an academic medical center, University of California, San Diego, between July 2011 and July 2015. Participants included 150 overweight and obese 8- to 12-year-old children and their parents.

Interventions  Both PBT and FBT were delivered in 20 one-hour group meetings with 30-minute individualized behavioral coaching sessions over 6 months. Treatments were similar in content; the only difference was the attendance of the child.

Main Outcomes and Measures  The primary outcome measure was child weight loss (body mass index [BMI] and BMI z score) at 6, 12, and 18 months post treatment. Secondary outcomes were parent weight loss (BMI), child and parent energy intake, child and parent physical activity (moderate to vigorous physical activity minutes), parenting style, and parent feeding behaviors.

Results  One hundred fifty children (mean BMI, 26.4; mean BMI z score, 2.0; mean age, 10.4 years; 66.4% girls) and their parent (mean BMI, 31.9; mean age, 42.9 years; 87.3% women; and 31% Hispanic, 49% non-Hispanic white, and 20% other race/ethnicity) were randomly assigned to either FBT or PBT. Child weight loss after 6 months was −0.25 BMI z scores in both PBT and FBT. Intention-to-treat analysis using mixed linear models showed that PBT was noninferior to FBT on all outcomes at 6-, 12-, and 18-month follow-up with a mean difference in child weight loss of 0.001 (95% CI, −0.06 to 0.06).

Conclusions and Relevance  Parent-based treatment was as effective on child weight loss and several secondary outcomes (parent weight loss, parent and child energy intake, and parent and child physical activity). Parent-based treatment is a viable model to provide weight loss treatment to children.

Trial Registration  Clinicaltrials.gov Identifier: NCT01197443

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