Family-based treatment of severe pediatric obesity: randomized, controlled trial.
OBJECTIVE
We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity.


METHODS
Participants were 192 children 8.0 to 12.0 years of age (mean +/- SD: 10.2 +/- 1.2 years). The average BMI percentile for age and gender was 99.18 (SD: 0.72). Families were assigned randomly to the intervention or usual care. Assessments were conducted at baseline, 6 months, 12 months, and 18 months. The primary outcome was percent overweight (percent over the median BMI for age and gender). Changes in blood pressure, body composition, waist circumference, and health-related quality of life also were evaluated. Finally, we examined factors associated with changes in child percent overweight, particularly session attendance.


RESULTS
Intervention was associated with significant decreases in child percent overweight, relative to usual care, at 6 months. Intent-to-treat analyses documented that intervention was associated with a 7.58% decrease in child percent overweight at 6 months, compared with a 0.66% decrease with usual care, but differences were not significant at 12 or 18 months. Small significant improvements in medical outcomes were observed at 6 and 12 months. Children who attended > or =75% of intervention sessions maintained decreases in percent overweight through 18 months. Lower baseline percent overweight, better attendance, higher income, and greater parent BMI reduction were associated with significantly greater reductions in child percent overweight at 6 months among intervention participants.


CONCLUSIONS
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 > or =75% of sessions.
Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
Melissa A
MA
Kalarchian
Michele D
MD
Levine
Silva A
SA
Arslanian
Linda J
LJ
Ewing
Patricia R
PR
Houck
Yu
Y
Cheng
Rebecca M
RM
Ringham
Carrie A
CA
Sheets
Marsha D
MD
Marcus
D000367:Age Factors; D001521:Behavior Therapy / Q000379:methods*; D001823:Body Composition; D015992:Body Mass Index; D002648:Child; D005195:Family Relations; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009765:Obesity / Q000517:prevention & control / Q000628:therapy*; D009767:Obesity, Morbid / Q000517:prevention & control / Q000628:therapy; D010287:Parent-Child Relations; D010349:Patient Compliance; D011336:Probability; D012016:Reference Values; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D015431:Weight Loss