Treatment of Childhood Obesity Can Be Focused on Parent(s) -Children Do Not Need to Attend

From JAMA Pediatrics Full Text: Effect of Attendance of Child on Obesity Treatment

(Thanks to NASPGHAN twitter feed for this reference) KN Boutelle et al. JAMA Pediatr. Published online May 30, 2017. doi:10.1001/jamapediatrics.2017.0651

From 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.

My take: This study indicates that parental instruction is likely the key element in improving outcomes in childhood obesity.  In many cases, counseling parents without the presence of the child (patient) could improve ease of scheduling.  In other cases, parents may prefer for direct childhood involvement.  On a tangential note, the absence of the child may make billing issues (often a problem regardless) more complicated.

I’ve recently noted the popularity of these fidget spinners. I have yet to remove one with endoscopy

 

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