Behavioral Treatment Of Obesity Research Articles

The Mood-Behavior Model: Assessing Mood-Related Mobilization of Self-Regulation of Weight-Loss Behaviors Within Community-Based Obesity Treatments

Increasing understanding of self-regulation processes within behavioral obesity treatments is required to improve consistently inadequate outcomes. The mood-behavior model proposes that, under conditions of goal striving and mood awareness, enhanced mood will mobilize self-regulation resources. That was tested within community-based obesity treatments where increased exercise might enhance mood, and increased self-regulation could improve weight-loss behaviors. Women with obesity participating in treatments focusing on either moderate exercise and self-regulation (Exercise/Self-Regulation [Exercise/SR] group, n = 42) or education on healthy eating and (to a lesser extent) exercise (Usual Care group, n = 48) were assessed on psychological and behavioral changes over 6 months. Significant overall improvements in negative mood, self-regulation for exercise and controlling eating, exercise, and fruit/vegetable intake were significantly greater in the Exercise/SR group. Using aggregated data ( N = 90), at baseline, negative mood did not significantly predict self-regulation. However, at months 3 and 6, negative mood significantly predicted both self-regulation for exercise and self-regulation for controlling eating. The addition of the group as a predictor significantly increased the explained variances. Increase in self-regulation for exercise significantly mediated the prediction of increased exercise via earlier reduction in negative mood. When group was entered into that model, it significantly moderated the mood-self-regulation and mood-exercise relationships. Increase in self-regulation for controlling eating significantly mediated the prediction of increase in fruit/vegetable intake via reduction in negative mood. Group marginally moderated the mood-self-regulation relationship only. Findings supported viability of the mood-behavior model in a field-based setting and suggested a need to facilitate improved mood to increase participants’ self-regulatory skill usage within obesity treatments.

Family-Based Interventions for Pediatric Obesity: A Comprehensive Systematic Review and Meta-Analysis of Their Effectiveness.

Genetics can influence obesity, and when it affects both parents and children, there is a high risk of developing cardiometabolic diseases. Studies have indicated that family-based treatment (FBT) is a cost-effective and successful option for achieving significant weight changes in both children and parents. While specialized clinics offer FBT, primary care settings, where most pediatric care takes place, may not have the necessary resources or expertise to provide intensive behavioral interventions for childhood obesity. Based on early findings, FBT could potentially have a positive impact on siblings as well, as when treated children and parents experience behavioral changes, it can also have a beneficial effect on their untreated siblings. Parents play a crucial role in shaping their children's behavior, and siblings often have a stronger influence on them than their parents or friends. For our meta-analysis, we utilized three graphical models created using RevMan 5.4, based on the selected articles. To develop our systematic review, we thoroughly analyzed a total of 10 articles. The subgroup analysis within these studies assessed the effectiveness of FBT for overweight children, revealing no significant differences between groups (p=0.77). This suggests that based on their BMI, FBT may not have a statistically significant impact on weight loss in overweight children. However, each study reviewed showed statistical significance (p<0.05). The findings of our meta-analysis underscore the need for more robust evidence and larger randomized controlled trials (RCTs) to enhance our understanding of FBT's benefits in pediatric obesity. This will be crucial for reducing the rising prevalence of obesity and maintaining lower incidence rates.

Obesity treatment-associated transfer of exercise-related self-regulation to eating-related self-regulation changes in women

ABSTRACT Obesity in the United States has risen to 42 percent of its adult population and is similarly problematic in many other countries. Although the U.S. government has provided education on healthy eating and the need to exercise regularly, behavioral obesity treatments have largely failed to sustain reductions in weight. Self-regulation, and the incorporation of exercise for its psychological impacts on eating, has sometimes been targeted. While there has been sporadic investigation into the carry-over of exercise-related self-regulation to eating-related self-regulation, the present aim is to further inquiry in that area to inform future treatment content for improved effects. Women enrolled in community-based obesity treatments with either a self-regulation (n = 106) or education (n = 54) focus were assessed on changes in exercise- and eating-related self-regulation, negative mood, completed exercise, and weight. Improvements were significantly greater in the self-regulation-focused group. After controlling for initial change in eating-related self-regulation, change in that measure from Month 3 to 6 was significantly predicted by change in exercise-related self-regulation during the initial 3 treatment months. This suggested a carry-over effect. A stronger predictive relationship was associated with the self-regulation-focused treatment. In further analyses, paths from changes in exercise→negative mood→self-regulation of both exercise and eating were significant. Increase in eating-related self-regulation was significantly associated with weight loss over 6, 12, and 24 months. The self-regulation-focused group had stronger relationships, again. Findings suggested utility in targeting exercise-related self-regulation to impact later change in eating-related self-regulation, and the use of exercise-associated mood improvement to bolster participants’ self-regulation capabilities.

Rethinking Behavioral Interventions for Adolescent Obesity

Rethinking Behavioral Interventions for Adolescent Obesity

Relationship of increased fruit/vegetable intake with reduced consumption of sweets: Psychological mechanisms and associated weight loss in women within behavioral obesity treatments

Although an increase in fruit and vegetable (FV) consumption in adults might result in reductions in their intake of sweets, there has been minimal direct testing of this. Women participated in 6-month community-based obesity treatment conditions where either their psychological skills development (n = 66) or knowledge regarding healthful eating and exercise (n = 39) was emphasized. Improvements in FV and sweets intake, eating-related self-regulation, self-efficacy for controlled eating, and negative mood were significantly more pronounced in the psychological skills group participants. Together, participants’ change in self-regulation, self-efficacy, and mood significantly mediated the relationship of their changes in FV and sweets. Within simple mediation analyses, participants’ changes in self-efficacy and negative mood were significant mediators, and their treatment group membership moderated effects on sweets. We provided suggestions for future treatments based on the present findings.

Psychosocial Predictors of Maintained Weight Loss in Women: Informing Behavioral Obesity Treatment Foci.

Behavioral obesity treatments are typically unable to facilitate meaningful weight loss beyond the short term. Implications of malleable psychosocial factors are unclear, which limits behavioral intervention contents. The current aim was to inform obesity treatments to improve their foci on psychosocial factors leading to resilient behavioral changes and maintained weight loss. Based on pre-planned analyses, women participating in a community-based obesity treatment emphasizing self-regulation and exercise, and who lost at least 3% of their initial weight (N = 89), were measured on eating-related self-efficacy, negative mood, emotional eating, body satisfaction, and self-regulating eating at baseline, Month 3, and Month 6; and on weight change over 12months. From baseline to Month 6, there was a significant overall improvement in each psychosocial variable. In separate multiple regression equations, scores at (1) Month 6, (2) change from baseline to Month 6, and (3) change from Month 3 to Month 6 were entered as predictors of maintained weight loss from Month 6 to Month 12. Using a backward elimination process, only negative mood was retained in the final Month 6 model, and significantly predicted maintained weight loss (R2adjusted = .03, p = .050). Changes in self-efficacy, mood, emotional eating, and self-regulation were retained in the final baseline to Month 6 model, and significantly predicted weight loss maintained over 12months (R2adjusted = .30, p < .001). Findings add to research on obesity treatment development by suggesting an enhanced focus on facilitating changes in self-efficacy, mood, emotional eating, and self-regulation may enhance maintenance of lost weight (or increase weight loss).

Temporal Aspects of Psychosocial Mediators of the Exercise-Weight Loss Maintenance Relationship Within Scalable Behavior-Change Treatments.

Limited knowledge of psychological correlates of weight loss is associated with continuing failures of behavioral obesity treatments beyond the short term. This study aimed to inform health professionals' obesity interventions via an increased knowledge of mediators of the exercise-weight loss maintenance relationship. Women participated in 6-month obesity treatments within community settings emphasizing moderate exercise and self-regulation skills development via primarily in-person (n = 54) or primarily written (n = 54) means. Changes in mood, self-regulating eating, and weight over 6, 12, and 24 months were assessed. A moderated mediation model was tested using the PROCESS macro instruction. Improvements in mood, self-regulating eating, and weight were significantly greater in the in-person group. The relationship between a dichotomous measure of completing at least 3 sessions of exercise per week (or not) and change in weight over 6 months was no longer significant when the mediators of changes in negative mood and self-regulation of eating were sequentially entered. Paths of exercise→negative mood reduction→eating self-regulation increase→weight loss over 6, 12 and 24 months were significant. Exercise self-regulation at Month 3 significantly moderated the mood change→eating self-regulation change relationship. Based on the identified paths, scalable obesity-treatment content and emphases were informed. This could help guide health professionals' actions concerning the management of obesity.

A randomized controlled trial examining general parenting training and family-based behavioral treatment for childhood obesity: The ReFRESH study design

Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.

Change in exercise, rather than in eating behaviors, mediate effects of changes in previously indicated psychological variables on weight during the regain phase of behavioral obesity treatments among United States women

Change in exercise, rather than in eating behaviors, mediate effects of changes in previously indicated psychological variables on weight during the regain phase of behavioral obesity treatments among United States women

The past, present, and future of behavioral obesity treatment.

Over the last century, hundreds of evaluations have been conducted to examine weight-management interventions related to diet, physical activity, and behavior therapy. These investigations have contributed to a growing body of knowledge that has consistently advanced the field of obesity treatment, while also revealing some persistent challenges. This narrative review summarizes key findings from randomized controlled trials conducted in adults that have combined diet, physical activity, and behavior therapy, an approach variously referred to as behavioral treatment, comprehensive lifestyle modification, or intensive lifestyle intervention. The review shows that current behavioral approaches induce average reductions in baseline body weight of 5 to 10% at 6 to 12 months. Such losses have proven effective in reducing the risk of type 2 diabetes in persons with impaired glucose tolerance and in improving other obesity-related complications. These benefits have also been associated with reductions in healthcare costs. Despite these advances, behavioral treatment is challenged by the need for larger losses to achieve optimal improvements in health, by difficulties associated with maintaining weight loss, and by barriers limiting access to treatment. New anti-obesity medications, when combined with behavioral obesity treatment, hold promise of addressing the first two issues.

Social network enhanced behavioral interventions for diabetes and obesity: A 3 arm randomized trial with 2 years follow-up in Jordan.

While obesity and diabetes are rising pandemics, few low-cost and effective prevention and management strategies exist, especially in the Middle East. Nearly 20% of adults in Jordan suffer from diabetes, and over 75% are overweight or obese. Social network-based programs have shown promise as a viable public health intervention strategy to address these growing crises. We evaluated the effectiveness of the Microclinic Program (MCP) via a 6-month multi-community randomized trial in Jordan, with follow-up at 2 years. The MCP leverages existing social relationships to propagate positive health behaviors and information. We recruited participants from 3 community health centers in Amman, Jordan. Participants were eligible for the study if they had diabetes, pre-diabetes, or possessed ≥1 metabolic risk factor along with a family history of diabetes. We randomized participants into three trial arms: (A Group) received the Full MCP with curriculum-activated social network interactions; (B Group) received Basic MCP educational sessions with organic social network interactions; or (C Group-Control) received standard care coupled with active monitoring and parallel screenings. Groups of individuals were randomized as units in a 3:1:1 ratio, with resulting group sizes of n = 540, 186, and 188 in arms A, B, and C, respectively. We assessed the overall changes in body weight, fasting glucose, hemoglobin A1c (HbA1c) and mean arterial blood pressure between study arms in multiple evaluations across 2 years (including at 6-months and 2-years follow-up). We investigated the effectiveness of Full and Basic MCP social network interventions using multilevel models for longitudinal data with hierarchical nesting of individuals within MCP classrooms, within community centers, and within temporal cohorts. We observed significant overall 2-year differences between all 3 groups for changes in body weight (P = 0.0003), fasting blood glucose (P = 0.0015), and HbA1c (P = 0.0004), but not in mean arterial blood pressure (P = 0.45). However, significant changes in mean arterial pressure were observed for Full MCP versus controls (P = 0.002). Weight loss in the Full MCP exceeded (-0.97 kg (P<0.001)) the Basic MCP during the intervention. Furthermore, both Full and Basic MCP yielded greater weight loss compared to the control group at 2 years. The Full MCP also sustained a superior fasting glucose change over 2 years (overall P<0.0001) versus the control group. For HbA1c, the Full MCP similarly led to greater 6-month reduction in HbA1c versus the control group (P<0.001), with attenuation at 2 years. For mean arterial blood pressure, the Full MCP yielded a greater drop in blood pressure versus control at 6 months; with attenuation at 2 years. These results suggest that activated social networks of classroom interactions can be harnessed to improve health behaviors related to obesity and diabetes. Future studies should investigate how public health policies and initiatives can further leverage social network programs for greater community propagation. Trial registration. ClinicalTrials.gov Identifier: NCT01818674.

Pragmatic Implementation of Online Obesity Treatment and Maintenance Interventions in Primary Care

Behavioral weight loss interventions have achieved success in primary care; however, to our knowledge, pragmatic implementation of a fully automated treatment that requires little researcher oversight has not been tested. Moreover, weight loss maintenance remains a challenge. To evaluate the long-term effectiveness of an automated, online, behavioral obesity treatment program (Rx Weight Loss [RxWL]) at 12 months (primary end point) and 24 months when delivered pragmatically in primary care and to compare the effectiveness of 3 weight loss maintenance approaches. This randomized clinical trial of RxWL, an online weight loss program, recruited patients from a Rhode Island primary care network with approximately 60 practices and 100 physicians. Eligible participants were primary care patients aged 18 to 75 years with overweight or obesity who were referred by their nurse care manager and enrolled between 2018 and 2020. All participants were included in the intention-to-treat analysis, whereas only those who engaged with maintenance intervention were included in the per-protocol analysis. Data were analyzed from August 2022 to September 2023. All participants were offered the same 3-month weight loss program, with randomization to one of three 9-month maintenance programs: control intervention (monthly online newsletters), monthly intervention (9 monthly video lessons and 1 week of self-monitoring per month), or refresher intervention (an introductory session and two 4-week periods of lessons and self-monitoring at 7 and 10 months). The primary outcome was weight change at 12 months using height and weight data collected from electronic medical records through 24 months. Among the 540 participants (mean [SD] age, 52.8 [13.4] years; 384 females [71.1%]) in the intention-to-treat analysis, mean estimated 3-month weight loss was 3.60 (95% CI, -4.32 to -2.88) kg. At the 12-month primary end point, the amount of weight regained in the monthly (0.37 [95% CI, -0.06 to 0.81] kg) and refresher (0.45 [95% CI, 0.27 to 0.87] kg) maintenance groups was significantly less than that in the newsletter control maintenance group (1.28 [95% CI, 0.85 to 1.71] kg; P = .004). The difference in weight regain between the monthly and refresher maintenance groups was not statistically significant. This pattern persisted at 24 months. In the per-protocol analysis of 253 participants, mean weight loss at the end of the initial 3-month intervention was 6.19 (95% CI, -7.25 to -5.13) kg. Similarly, at 12 months there was less weight regain in the monthly (0.61 kg) and refresher (0.96 kg) maintenance groups than in the newsletter control maintenance group (1.86 kg). Results of this randomized clinical trial indicate that pragmatic implementation of a 12-month automated, online, behavioral obesity treatment that includes 9 months of active maintenance produces clinically significant weight loss over 2 years in primary care patients with overweight or obesity. These findings underscore the importance of providing ongoing maintenance intervention to prevent weight regain. ClinicalTrials.gov Identifier: NCT03488212.

Carry-Over of Exercise-Related Self-Regulation to Eating-Related Self-Regulation in Women Participating in Behavioral Obesity Treatments

ABSTRACT Purpose: Because obesity has not responded well to instructing affected adults in healthier eating behaviors and increased physical activity/exercise, enhanced research on psychosocial determinants of those behavioral changes is needed. Intervention foci on self-regulation have been suggested, but targeted research is required. Method: Women with obesity participated in community-based treatments that were either self-regulation-focused (self-regulation emphasis group; n = 52) or typical instruction-based (education [treatment-as-usual] group; n = 54). Results: There were overall significant increases in exercise-related self-regulation, physical activity/exercise, exercise-related self-efficacy, and eating-related self-regulation that were each significantly more pronounced in the self-regulation emphasis group. Increase in exercise-related self-regulation over 3 months predicted eating-related self-regulation over 6 months; however, sequential entry of changes in physical activity and exercise-related self-efficacy significantly mediated that relationship. However, only the path from changes in exercise-related self-regulation to exercise self-efficacy to eating-related self-regulation was significant. In a revised model where change in exercise self-efficacy was the sole mediator, treatment group did not significantly moderate the exercise self-regulation to eating self-regulation change relationship, but full mediation of that relationship occurred. Conclusion: Findings indicated salience for perceived ability/self-efficacy for physical activity, over actual physical activity progress, and its role in the transfer of self-regulatory skills from an exercise to eating context. Increased eating self-regulation significantly predicted weight loss over 6, 12, and 24 months. In the self-regulation emphasis group that translated to meaningful weight loss/weight-loss maintenance of greater than 5% of initial weight. Findings contributed to an increased understanding of psychosocial-change processes within obesity treatment research.

Modifying diet and exercise in multiple sclerosis (MoDEMS): A randomized controlled trial for behavioral weight loss in adults with multiple sclerosis and obesity

Background: Obesity is a risk factor for developing multiple sclerosis (MS) and MS-related disability. The efficacy of behavioral weight loss interventions among people with MS (pwMS) remains largely unknown. Objective: Examine whether a group-based telehealth weight loss intervention produces clinically significant weight loss in pwMS and obesity. Methods: Seventy-one pwMS were randomized to the weight loss intervention or treatment-as-usual (TAU). The 6-month program promoted established guidelines for calorie reduction and increased physical activity. Anthropometric measurements, mobility tasks, self-report questionnaires, and accelerometry were used to assess changes at follow-up. Results: Mean percent weight loss in the treatment group was 8.6% compared to 0.7% in the TAU group (p < .001). Sixty-five percent of participants in the intervention achieved clinically meaningful weight loss (⩾ 5%). Participants in the treatment group engaged in 46.2 minutes/week more moderate-to-vigorous physical activity than TAU participants (p = .017) and showed improvements in quality of life (p = .012). Weight loss was associated with improved mobility (p = .003) and reduced fatiguability (p = .008). Conclusion: Findings demonstrate the efficacy of a behavioral intervention for pwMS and obesity, with clinically significant weight loss for two-thirds of participants in the treatment condition. Weight loss may also lead to improved mobility and quality of life.

Randomized-controlled trial of a whole-family obesity prevention and treatment intervention designed for low-income Hispanic families: HeLP the healthy living program

BackgroundLow-income Hispanic families face marked disparities in obesity, but interventions for obesity prevention and treatment have rarely been designed with this population as a focus. Hispanic culture is characterized by Familism, a value that prioritizes familial respect, cooperation, and togetherness. We describe the rationale and design of a trial of the Healthy Living Program (HeLP), a bilingual whole-family behavioral obesity prevention and treatment intervention designed around the value Familism and addressing food insecurity. Methods/designThis two-group randomized comparative effectiveness trial will compare the effects of HeLP versus a primary care counseling intervention (Recommended Treatment of Obesity in Primary Care, or RTOP) on decreasing body mass index (BMI; kg/m2) in Hispanic children 2–16 years of age with obesity and preventing BMI increase among siblings without obesity. 164 families per arm will be recruited from primary care practices. Families randomized to HeLP will participate in 12 two-hour sessions, followed by booster sessions. HeLP sessions include family meals and instruction in parenting skills, nutrition, culinary skills, fitness, and mindfulness delivered at community recreation centers by bilingual health educators and athletic trainers. Families randomized to RTOP will be offered individual visits in primary care every 3 months throughout the 18-month follow-up period. Secondary outcomes include changes to objectively measured child fitness, the home environment related to nutrition, physical activity, and media usage, food insecurity, child eating behaviors, quality of life, parent BMI and waist circumference, and implementation outcomes. DiscussionThis protocol paper describes the rationale and planned methods for the comparative effectiveness trial. Trial registrationClinicaltrials.gov Identifier NCT05041855 (6/13/2023).

Evidence Base Update on Behavioral Treatments for Overweight and Obesity in Children and Adolescents

ABSTRACT Objective This review provides an update to a previous Evidence Base Update addressing behavioral treatments for overweight and obesity in children and adolescents. Method Articles were identified through a systematic search of the biomedical literature in PubMed/MEDLINE (1946-), Elsevier EMBASE (1947-), SCOPUS (1823-), Clarivate Web of Science Core Collection (WOS, 1900-), PsycINFO (1800-), The Cochrane Library and Clinicaltrials.gov published between June 2014 and August 2022. Results Family-based treatment (FBT) remains a well-established treatment for overweight and obesity in children and is now well-established in adolescents and toddlers. Parent-only behavioral treatment remains well-established in children and is now well-established among adolescents and children. Possibly effective treatments continue to include FBT-parent only for adolescents, and behavioral weight loss (BWL) with a family component for adolescents, children, and toddlers. Several variations of FBT and BWL can now be considered possibly effective including FBT+motivational interviewing, FBT+social facilitation maintenance, group-based FBT, low-dose FBT, BWL+stress management, and camp-based BWL. Cognitive behavioral treatment (CBT) for adolescents also met criteria for possibly effective treatments. Current research has also established that behavioral treatments can be effectively delivered in alternative settings (e.g. primary care) and through alternative mediums (e.g. telehealth). Conclusions Research continues to support the use of multicomponent lifestyle interventions in accordance with recent recommendations from the American Academy of Pediatrics, the American Psychological Association, and the United State Preventative Services Task Force. However, more work is needed to ensure appropriate access for children with comorbid medical and psychiatric disorders and children from socially, politically, and economically marginalized groups.

From Increased Exercise to Reductions in Emotional Eating and Weight/Waist Circumference: Refining Theory-Driven Psychosocial Targets for Treating Obesity

Overwhelmingly poor results beyond the short term suggest advances in treating obesity through behavioral means are required. Research on psychosocial intervention targets is particularly important. Because of possible widespread impacts crossing socioeconomic and racial/ethnic lines, methods that can effectively be disseminated in a large-scale and economical manner are also needed. This research assessed women participating in community-administered obesity treatments with similar curricula that were either manual-based ( n = 39) or in-person-based ( n = 44). Along with conclusions that emotional eating is relevant, especially in women, the paradigms of social cognitive theory, self-regulation theory, the mood-behavior-model, and coaction theory guided analyses of psychosocial predictors of weight/body composition changes. Both treatment formats were associated with significant improvements in exercise, mood disturbance, self-regulation of exercise and eating, emotional eating, weight, and waist circumference, with significantly greater improvements associated with the in-person format. Tests of model-fitting indicated that baseline–Time 2 change terms were the better predictor of the subsequent variable in planned regression models, except the self-regulation factors where Month 3 scores were strongest. Increased exercise predicted a reduction in mood disturbance. The path from mood→self-regulation of exercise→self-regulation of eating→emotional eating was significant, along with the direct path from (exercise-associated) changes in mood→emotional eating. Emotional eating reduction significantly predicted reduced weight and waist circumference over 6 and 12 months. The relation between mood and self-regulation supported the mood-behavior-model, whereas the prediction of self-regulation of eating by exercise-related self-regulation affirmed coaction theory. Findings may be used to inform further research and applications targeting psychosocial changes within behavioral obesity treatments.

Effects of Women's Body Satisfaction, Emotional Eating, and Race on Short-, Mid-, and Long-term Weight Loss

ObjectiveTo improve understanding of psychosocial factors, their changes, and racial differences with implications for behavioral obesity treatments. MethodsWomen with obesity of White (n = 64) and Black (n = 33) racial groups participated in cognitive-behavioral community-based obesity treatment and were assessed on body satisfaction, emotional eating, and weight changes over 3, 6, 12, and 24 months via mixed-model repeated-measures analysis of variance and stepwise multiple regression analyses. ResultsBaseline body satisfaction scores were significantly higher (P < 0.001) in Black participants. White participants had significantly higher (P = 0.04) emotional eating scores. Significant overall improvements (P < 0.001) in body satisfaction, emotional eating, and weight were found, with weight reduction significantly greater (P = 0.05) among the White women. Weight reductions were significantly predicted by changes in body satisfaction and emotional eating (R2 = 0.12–0.20, P < 0.01). When racial group was entered into the analyses, the explained variance in weight change over 6 and 12 months significantly increased (P < 0.05). Conclusions and ImplicationsFindings suggest addressing body satisfaction, emotional eating, and racial differences by adjusting obesity treatment targets could improve outcomes. Research-to-practice needs include a control group and further identification/elucidation of other psychosocial and economic factors that might affect outcomes.

The role of parents in behavioral treatment for adolescent obesity: design and rationale for the TEENS+ randomized clinical trial

BackgroundThere is an urgent need for innovative approaches to adolescent obesity treatment, particularly among individuals from racially and ethnically marginalized backgrounds, who face increased risk of obesity and its associated morbidity and mortality. There is a particular dearth of research on the long-term efficacy of adolescent obesity treatments. Further, research and clinical practice guidelines consistently recommend parents’ inclusion in their adolescents’ obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment remains unclear. Towards that end, this investigation will conduct a fully-powered, randomized clinical trial to examine the efficacy of two distinct approaches to involving parents in their adolescents’ obesity treatment.MethodsParticipants will be 210 12-16 year old adolescents (body mass index [BMI]≥85th percentile) and parents (BMI≥25 kg/m2) with overweight or obesity. Dyads will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child’s weight management via parent skills training based on authoritative parenting, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own behavioral weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments of anthropometrics, dietary intake, physical activity, parenting and home environment variables will be completed at 0, 2, 4, 8, and 12 months with the primary endpoint at 12-month follow-up.DiscussionResults of this investigation have the potential to significantly advance science in this area and ultimately inform clinical practice guidelines related to the role of parents in adolescent obesity treatment.Trial registrationClinicaltrials.gov NCT03851796. Registered: February 22, 2019.

Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care

Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings. To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings. This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021. Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress. The primary outcome was the child's change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents. Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (-6.21% [95% CI, -10.14% to -2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, -2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; -1.05% [95% CI, -3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, -3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings). Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families with multiple children. ClinicalTrials.gov Identifier: NCT02873715.