title: Childhood obesity and co-morbid problems: effects of Epstein's family-based behavioural treatment in an Icelandic sample.
abstract: OBJECTIVE
  This study assessed the effects of Epstein's family-based behavioural treatment in a clinical sample of obese children in Iceland. Also, it explored whether co-morbid concerns affect treatment outcome.
  
  
  METHODS
  Eighty-four obese children [mean body-mass-index standard-deviation-scores (BMI-SDS) = 3.11, aged 7.5-13.6 years] and a participating parent initiated treatment in response to a school-based screening. Sixty-one families completed treatment and were followed for 1 year post treatment. Measurements included height, weight, reports of psychological well-being (Strengths and Difficulties Questionnaire, Multidimensional Anxiety Scale for Children, Children's Depression Inventory, Piers-Harris Self Concept Scale, Social Skills Rating System) and academic competencies.
  
  
  RESULTS
  Among treatment completers a large effect size was obtained for change in BMI-SDS during treatment (mean difference = -0.40, SD = 0.29). Psychological well-being improved and treatment effects were maintained at 1-year follow-up. At baseline, 69% of the children presented with one or more co-morbid concerns. Children who scored above cut-off for concern on parent-reported hyperactivity (Strengths and Difficulties Questionnaire subscale T-score ≥ 65) reduced their BMI-SDS less during treatment than children with lower hyperactivity scores whereas children who scored in the clinical range for social anxiety (Multidimensional Anxiety Scale for Children subscale T-score ≥ 65) reduced their BMI-SDS significantly more than children with lower social anxiety scores. The social anxiety effect was still present at 1-year follow-up, but not the hyperactivity effect (P > 0.05). No differential response was shown for children with higher depression scores, lower self-concept or low academic competencies.
  
  
  CONCLUSIONS
  Epstein's family-based behavioural treatment produced promising effects in both the short and the longer term in a clinical sample of Icelandic children with substantial rates of co-morbid concerns. Co-morbid problems affect outcome and tailoring treatment to address co-morbid concerns might improve outcomes for certain subgroups.
authors.affiliation: University of Iceland, Centre of Public Health, Reykjavik, Iceland. thrudur@hi.is
authors.forename: Thrudur
authors.initials: T
authors.lastname: Gunnarsdottir
authors.forename: Urdur
authors.initials: U
authors.lastname: Njardvik
authors.forename: Anna S
authors.initials: AS
authors.lastname: Olafsdottir
authors.forename: Linda
authors.initials: L
authors.lastname: Craighead
authors.forename: Ragnar
authors.initials: R
authors.lastname: Bjarnason
mesh_terms: D000293:Adolescent; D001521:Behavior Therapy; D016009:Chi-Square Distribution; D002648:Child; D015897:Comorbidity; D005196:Family Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007055:Iceland / Q000453:epidemiology; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D016896:Treatment Outcome