Family-based Behavioral Treatment Research Articles

The role of motivational interviewing in the management of obesity in adults

Introduction: The last 50 years have seen a significant global increase in the obesity rate. The prevalence of excess weight gain has doubled worldwide since 2000 and approximately one-third of the world's population is obese or overweight. Purpose: To identify the role of motivational interviewing in the management of obesity in adults. Methodology: This narrative review was based on the bibliographic search of reviews and research studies drawn from international databases. The exclusion criterion of the articles was the language other than English and Greek. Results: There is evidence for the effectiveness of family-based behavioral treatment for controlling weight and improving health outcomes. Obesity-related health risks have been documented such as metabolic syndrome. The importance of dietary prevention is also a major modifiable factor in cardiovascular disease and diabetes mellitus. One of the most prevalent health-related behavior modification models is Motivational Interviewing which is a patient-centered communication style that uses specific methods such as reflective listening, autonomy support, shared decision-making, and eliciting change talk. Conclusion: Recent studies support the use of motivational Interviewing for weight loss in primary care.

Design of the FRESH-teen study: A randomized controlled trial evaluating an adapted emotion regulation weight loss program for adolescents with overweight or obesity and their parent

Overweight and obesity affect >40% of adolescents. Family-based behavioral treatment (FBT) is the most efficacious behavioral treatment for weight management among youth and consists of nutrition and physical activity education, behavior change skills, and parent skills training. However, the efficacy of FBT decreases for youth as they get older. Increased emotional lability and limited emotion regulation skills may contribute to the reduced efficacy of FBT for adolescents. To date, there are no treatments for overweight or obesity specifically adapted for the needs of adolescents.We developed a treatment that integrates components from Dialectical Behavior Therapy and Emotion Focused Therapy with FBT (FBT+ER or FBT-ER) to address the specific needs of adolescents. The current study randomized 166 adolescents (BMI = 32.8; 14.3 years; 57% female; 32% Hispanic, 50% Non-Hispanic White, 18% Non-Hispanic and Non-White) and one of their parents (BMI = 32.9; 45.3 years; 85% female; 27% Hispanic, 57% Non-Hispanic White, 16% Non-Hispanic and Non-White) to 6 months of either standard FBT or FBT+ at 2 sites. 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 outcomes are adolescent weight (BMIz/%BMIp95), emotion regulation skills, and emotional eating behaviors. Given the public health concern of adolescent obesity, FBT+ could prove extremely useful to provide more targeted and effective intervention for adolescents with overweight or obesity. Clinical trials# NCT03674944

Predictors of parent self-monitoring patterns in a family-based behavioral weight loss treatment program.

Self-monitoring dietary intake is a critical component of family-based intensive health behavior and lifestyle treatment for pediatric obesity, but adherence rates are often low. This study identifies predictors of parent self-monitoring rates during treatment. A secondary analysis of parent self-monitoring data from a randomized controlled trial involving 150 parent-child dyads. Patterns of self-monitoring were identified using a latent class mixed model approach. Logistic regression analyses evaluated predictors of self-monitoring patterns. Latent class models identified two trajectory groups: a high consistent self-monitoring group and a low-decreasing self-monitoring group. When compared to parents in the low group, parents in the high group lost more weight throughout treatment. Children in the high group had a similar trajectory for weight loss; however, the groups were not statistically different. Higher levels of family chaos and poorer family problem-solving skills were associated with higher odds of being in the low group. This study identified two patterns of rates of parent self-monitoring, which were associated with parent weight loss and were differentiated by family chaos and poor problem-solving. These findings suggest that families with high levels of chaos and poor problem-solving could benefit from early intervention to improve outcomes in pediatric obesity treatment programs. Clinicaltrials.gov Identifier: NCT01197443.

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.

Study protocol for clinical trial of the FIT Families multicomponent obesity intervention for African American adolescents and their caregivers: Next step from the ORBIT initiative

IntroductionThis study will test the effectiveness of FIT Families (FIT), a multicomponent family-based behavioural intervention, against a credible attention control condition, Home-Based Family Support (HBFS). This protocol paper describes the...

Tailoring parenting styles and family-based interventions cross-culturally as an effective prevention strategy for youth substance use: a scoping review.

The challenge of substance use among youth continues to be a highly concerning public health issue across the globe. The notion that parenting lifestyles and family-based intervention can help in the prevention of adolescent substance use have received robust attention from policy makers, researchers' clinicians and general public, nonetheless, there is scarcity of high quality evidence to support these concepts. To review available literature which assessed the effects of parenting styles and family-based interventions on the prevention of adolescent substance use. A scoping review of literature to identify studies published in English between 2012 and 2022 was conducted searching Scopus, MEDLINE, PsychInfo, and CINAHL databases focused on effects of parenting styles and family-based interventions in the prevention of adolescent substance use.Keywords of family-based intervention strategies and possible outcomes of parenting styles on youth substance use were coded from the results, discussion, or conclusion. Strategies were inductively categorized into themes according to the focus of the strategy. A total of 47 studies, published between 2012 and 2022 in English language included. Narrative synthesis illustrated that parental involvement, restriction of mature-rated content, parental monitoring, authoritative parenting styles, and parental support and knowledge can help in the prevention of adolescent substance use. On the contrary, poor parent-child bonding, overprotection, permissive parenting, parental frustrations, authoritarian and harsh parenting styles promoted adolescent substance use disorders. Proximal risk factors like peer influence, previous use of other substances, and risky behaviours had more effect than just parenting styles. Culturally tailored family-based intervention strategies such as "Preventive Parenting", "Parent Training", and "Parent Involvement", with focus on "Technology Assisted Intervention", particularly "SMART "(Substance Misuse among Adolescents in Residential Treatment) are found as effective family-based intervention strategies to mitigate substance use in youth. Culturally tailored family-based behavioural strategies psychosocial intervention strategies can be considered of the most effective strategies to prevent substance use disorders in youth.

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.

Translation of a family-based behavioral intervention for adolescent obesity using the RE-AIM framework and common steps from adaptation frameworks.

Interventions for adolescent weight management that are ready to use in clinical settings are needed to address the obesity epidemic and improve the health and wellbeing of affected adolescents. This report describes the systematic process our team followed to adapt an evidence-based intervention (EBI) for adolescent weight management from its randomized control trial protocol to a package for delivery in a group-based telehealth format within a medical center. The EBI adaptation was clinician initiated, prompted by identified practice needs, and involved collaboration of the clinical team with the EBI developer. The process was guided by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework and followed key steps for adapting EBIs to new contexts. RE-AIM-aligned adaptations included telehealth delivery and broader inclusion criteria, separate clinical and research evaluation batteries, adaptations to fit the clinical practice, practical fidelity checklists to guide and record session delivery, and continuous quality improvement processes aimed to facilitate program longevity and family engagement. The process culminated in a package of adapted intervention materials deemed by stakeholders as appropriate to the practice and congruent with the EBI model. This report provides a much-needed practical demonstration of the translation of an EBI for adolescent weight management from research protocol to group telehealth delivery in a medical center. Key lessons include the value of clinician-researcher collaboration, the breadth of resources needed to adapt EBIs for real-world delivery, and the importance of considering delivery context in implementation and evaluation decisions, including defining inclusion criteria, staffing, and outcomes assessments.

Barriers to participation in a telemedicine-based, family-based behavioral group treatment program for pediatric obesity: qualitative findings from rural caregivers

ABSTRACT This study examined factors influencing rural caregivers’ decision to decline participation in a healthy lifestyle intervention. Eligible caregivers of rural children who declined participation in a healthy lifestyle intervention were interviewed regarding reasons for declining. Inductive thematic analyses were conducted for responses. Caregiver interviews (n = 16) resulted in 5 saturated themes: (1) rural families’ household schedules prohibit participation, (2) preference for diverse treatment approaches, (3) desire for information across multimedia platforms, and more communication with a point-of-contact, (4) support for an inclusive approach integrated with existing school practices, and (5) caregivers had an understanding of behaviors that promote health.

Abstract P616: Implementing a Dietary Energy Density Intervention in Preschool Children

Introduction: The preschool years have been identified as a critical time to intervene on energy balance behaviors to halt the progression of obesity. In children, strategies for achieving physical activity recommendations are well established. Less clear are strategies for implementing an optimal dietary approach—one that maintains a healthy body weight and improves diet quality. Energy density (ED), the amount of energy per unit weight of food (kcal/g), may be a promising dietary approach. Hypothesis: We tested the hypothesis that a lower ED dietary approach will lower ED and energy intake and demonstrate better maintenance of body mass index (BMI z-score) than standard dietary recommendations in young children at risk for obesity. Methods: Thirty-six preschool children (3.5±1.1 years; 52.8% female; 52.8% White; 16.7% Hispanic or Latino; BMI percentile 56.8±22.2) and their parent (35.4±6.2 years; 86.1% female; 55.6% White; 13.9% Hispanic or Latino; BMI 38.2±5.4 kg/m 2 ) participated in a 6-month, 14-session, family-based behavioral intervention. Participants were randomized to a low-ED dietary approach (consume ≥10 foods/day with an ED ≤1.0 kcal/g and ≤2 foods/day with an ED ≥ 3.0 kcal/g; LOW-ED), or standard dietary recommendations (meet recommended daily servings of fruits, vegetables, and whole grains; STANDARD). Both interventions had physical activity goals of 60 minutes/day for children and 150 minutes/week for adults. Dietary and anthropometric assessments occurred at baseline and 6-months. Completer and intent-to-treat (ITT) analyses, with outliers removed, used repeated measures general linear mixed models to examine child change in ED (calculated as both all foods and beverages and food only), kcals, and BMI z-score from baseline to 6 months. Results: ITT analyses showed that the change in ED did not differ between the LOW-ED condition and STANDARD condition when calculated as for foods and beverages (LOW-ED: Δ-0.1 kcal/g vs. STANDARD: Δ+0.1 kcal/g, p = 0.12) or food only (LOW-ED: Δ-0.2 kcal/g vs. STANDARD: Δ+0.1 kcal/g, p = 0.06). There was a significant time by condition interaction with kcals/d decreasing in LOW-ED and increasing in STANDARD over time for completers (LOW-ED: Δ-98 kcals vs. STANDARD: Δ+212 kcals, p = 0.04), but not when using ITT (LOW-ED: Δ+5 kcals vs. STANDARD: Δ+211 kcals, p = 0.09). Under ITT BMI z-score had a main effect of time, with both LOW-ED and STANDARD conditions significantly increasing over time (p=0.03). Conclusion: In conclusion, these data suggest a LOW-ED dietary approach is an alternative way to lower ED and energy intake in young children at risk for obesity.

Abstract P254: Mental Well-Being of Caregivers With Overweight and Obesity is Associated With Cognitive Stimulation Provided to Children in the Home

Introduction: Parents with poor mental health are less likely to engage in cognitively enriching parenting behaviors, such as reading and playing with their children. This, in turn, is associated with increased risk of obesity in the child and poor treatment outcomes for children enrolled in behavioral weight management. Parents and caregivers with obesity also have worse mental health and lower life satisfaction than their non-obese counterparts. Among parents with overweight and obesity who have a child with overweight/obesity, the relationship between parent mental health and cognitive enrichment provided in the home is unknown. Hypothesis: We hypothesize that higher depressive symptoms and lower subjective well-being scores among parents will be associated with less cognitive enrichment provided to children. Further, we hypothesize that these relationships will be moderated by the sex of the parent. Methods: This study was a secondary analysis of baseline data from 452 parent-child dyads with overweight/obesity enrolled in a family-based behavioral treatment study for obesity. Depression symptoms and subjective well-being were assessed using the Patient Health Questionnaire-9 scale and the MacArthur Scale of Subjective Social Status, respectively. Cognitive stimulation was measured with the Cognitive Stimulation subscale of the Environmental Enrichment scale. Univariable relationships were assessed using Pearson correlations. Multivariable linear regression models were used to control for study site, parent characteristics (age, BMI, sex, race/ethnicity, education), child characteristics (age, and sex), and family characteristics (health insurance status and household income). Results: Higher depression symptom score was correlated with lower cognitive stimulation (ρ = -0.165, p < 0.001), whereas higher subjective well-being was associated with higher cognitive stimulation (ρ = 0.377, p < 0.001). These relationships were maintained even after controlling for covariates in the multivariable models, with each one-unit increase in depression symptoms associated with a 0.16 unit decrease in cognitive stimulation (95% CI -0.27 to -0.06, p = 0.003) and each one-unit increase in subjective well-being associated with a 0.04 unit increase in cognitive stimulation (95% CI 0.01, 0.07, p = 0.01). Parent sex did not moderate these effects. Conclusions: Mental well-being of parents and caregivers with overweight/obesity is associated with the degree of cognitive enrichment provided to the child in the home, though the effect sizes after controlling for covariates were modest. Thus, interventions targeting parental wellbeing offer a potential avenue to improve their child’s cognitive wellbeing and response to obesity treatment.

Exploring predictors and moderators of response to multimodal obesity treatment in children

ObjectiveThe aim of this study was to determine whether specific psychological factors influence intervention effects for children with severe obesity in a clinical setting.DesignSecondary analyses of data about attention deficit/hyperactivity...

Perceived barriers in family-based behavioural treatment of paediatric obesity - Results from the FABO study.

To date, few studies have investigated perceived barriers among those who participate in and drop out of family-based behavioural treatment (FBT) for paediatric obesity. Examining experienced barriers during treatment, and their role in participation and completion of treatment has important implications for clinical practice. To compare perceived barriers to participating in a family-based behavioural social facilitation treatment (FBSFT) for obesity among families who completed and did not complete treatment. Data were analysed from 90 families of children and adolescents (mean (M) age=12.8 years, standard deviation (SD)=3.05) with severe obesity enrolled in a 17-session FBSFT program. After completing 12 sessions or at the time of dropout, parents and therapists completed the Barriers to Treatment Participation Scale (BTPS), a 5-point Likert scale (1=never a problem, 5=very often a problem) which includes four subscales: 1. Stressors and obstacles that compete with treatment, 2. Treatment demands and issues, 3. Perceived relevance of treatment, 4. Relationship with the therapist. Families who did not complete treatment scored significantly higher on the BTPS subscales stressors and obstacles that compete with treatment (M=2.03, SD=0.53 vs. M=1.70, SD=0.42), p=0.010 and perceived relevance of treatment (M=2.27, SD=0.48 vs. M=1.80, SD=0.50), p < 0.001 than families who completed treatment. No other significant differences between groups were observed. Families are more likely to drop out of FBSFT when experiencing a high burden from life stressors or when treatment is not meeting the expectations and perceived needs of the family.

Design of the FRESH-DOSE study: A randomized controlled noninferiority trial evaluating a guided self-help family-based treatment program for children with overweight or obesity

Overweight and obesity affect 45% of children and increases the risk for several negative health sequelae. Family-Based Behavioral Treatment (FBT) is the most efficacious treatment for child weight management and consists of nutrition and physical activity education, behavior change skills and parenting skills training. FBT is time and staff intensive and can include 20, 60-min separate groups for parents and children, as well as 20-min behavior coaching sessions to help problem solve barriers to implementing the skills learned and individualize the program. Guided self-help (GSH) therapies involve providing families a manual to review independently and brief coaching sessions by an interventionist to facilitate adherence. We developed a GSH version of FBT (gshFBT) which provides a manual to both parents and children and includes 14, 20-min coaching sessions over 6-months. The current study randomized 150 children (mean age = 10.1 years (SD = 1.38); mean BMI% = 97.3% (SD = 2.84); mean BMIz = 2.09 (SD = 0.40); 49% female; 43% Hispanic) and one of their parents (mean age = 41.8 years (SD = 6.52); mean BMI = 32.0 (SD = 7.24); 87.3% female; 43% Hispanic) to either a group-based FBT program or a gshFBT program. Assessments are conducted at baseline, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). Primary outcomes are child weight change (BMIz) and cost effectiveness. Recruitment occurred between May 2017 and October 2021 and follow-up assessments are underway. Given the public health concern for children with obesity and the low level of access to FBT, gshFBT could prove extremely useful to provide intervention to a greater proportion of the population.

A Brief History and Future of the Traffic Light Diet

Abstract The Traffic Light Diet is a commonly used component of many behavioral treatment programs for pediatric obesity. Vorland, Brown, Cardel and Brown (1) raise some interesting and important issues related to the Traffic Light Diet. This commentary is designed to provide a background on the history and purpose of the Traffic Light Diet, to indicate the Traffic Light Diet is only one component of effective Family-Based Behavioral Treatments for pediatric obesity, and to support an idea for future directions for the Traffic Light Diet based on unique dietary and nutritional requirements for specific diseases.

Guided Self-Help for Pediatric Obesity in Primary Care: A Randomized Clinical Trial.

Our aim was to compare the effect of 2 treatment models on attendance and child weight status: a less intense guided self-help (GSH) program delivered in the primary care setting versus traditional family-based behavioral treatment (FBT) delivered in an academic center. We conducted a randomized clinical trial among 164 children between 5 and 13 years old with a BMI ≥85th percentile and their parents. The intervention group (GSH) received 14 individual sessions over 6 months, with 5.3 hours of treatment. The control group (FBT) received 20 group-based sessions over 6 months, with 20 hours of treatment. Main outcomes included proportion of sessions families attended and change in child BMI z-score (BMIz), percentage from the 95th BMI percentile, difference from the 95th BMI percentile at the end of treatment, and 6-month follow-up. Mean age of children was 9.6 years, BMI z-score 2.1, 49% female, and >90% Latino. The odds of attending GSH compared to FBT was 2.2 (P < 0.01). Those assigned to GSH had a 67% reduced risk of attrition (hazard ratio = 0.33, 95% confidence interval 0.22-0.50, P < .001). Intent-to-treat analysis showed no between-group differences in change in BMIz and percentage from the 95th BMI percentile over time. Combined, there was a significant reduction in BMIz from baseline to posttreatment (β = -0.07 (0.01), P < .01, d: 0.60) and a slight increase from posttreatment to follow-up (β = 0.007 (0.13), P = .56). This study provides support for a novel, less intense GSH model of obesity treatment, which can be implemented in the primary care setting. Future studies should examine effective approaches to dissemination and implementation of GSH in different settings to increase access to treatment.

Examining the Efficacy of a Virtual Multi-Disciplinary 10-Week Family-Based Behavioural Lifestyle Intervention in Children and Adolescents: A Pilot Study

ObjectivesThe Shapedown BC program (British Columbia, Canada) is a provincially funded 10-week family-based behavioural lifestyle intervention for children and adolescents (ages six to 17 years old) living with obesity (or an overweight condition with one comorbidity) delivered by a multidisciplinary team. Since 2006, this program has been offered in-person until the COVID-19 pandemic forced it to be provided in the virtual format only. It is unknown how this online format compares to the in-person intervention in eliciting health behaviour changes and consequent body mass index (BMI; kg/m2) outcomes in participants. Therefore, this study aims to explore the efficacy of a virtual Shapedown BC group program compared to in-person delivery on improving BMI-z. Secondary aims investigate the differences in program attendance and attrition, health behaviours, and metabolic markers among children.MethodsThis retrospective chart review study of n = 40 children (ages 10 to 17 years old) will use non-identifying data collected by the Shapedown BC multidisciplinary team. Data of participants in the virtual intervention (n = 20; September 2021 to March 2022) will be matched by age, sex, and BMI-z at baseline and compared with data from the in-person intervention (n = 20; 2016 to 2019). E-surveys at pre-and post-intervention are used to analyze changes in sociodemographic, diet quality (vegetable and sugary drink consumption), exercise, sitting behaviours, and family habits. Anthropometric measurements are collected during an in-person clinical visit at intake, pre-intervention, and then again at post-intervention. Attendance is collected throughout the intervention. Bloodwork (ALT- liver enzymes, fasting glucose, triglycerides, total cholesterol, high- and low-density lipoproteins) is collected at intake and again at week 10 for participants with abnormal levels.ResultsN/AConclusionsResults from this study will provide insight into the efficacy of a virtual multidisciplinary family-based behavioural lifestyle intervention, which will contribute to future design of virtual weight management programs for preventing childhood and adolescent obesity.Funding SourcesThe University of British Columbia, Faculty of Land and Food Systems; BC Children's Hospital Shapedown-BC Program.

Psychological predictors of family-based behavioral treatment response in a diverse sample of youth with obesity.

Psychological predictors of family-based behavioral treatment response in a diverse sample of youth with obesity.

Impaired Brain Satiety Responses After Weight Loss in Children With Obesity.

ContextObesity interventions often result in increased motivation to eat.ObjectiveWe investigated relationships between obesity outcomes and changes in brain activation by visual food cues and hormone levels in response to obesity intervention by family-based behavioral treatment (FBT).MethodsNeuroimaging and hormone assessments were conducted before and after 24-week FBT intervention in children with obesity (OB, n = 28), or children of healthy weight without intervention (HW, n = 17), all 9- to 11-year-old boys and girls. We evaluated meal-induced changes in neural activation to high- vs low-calorie food cues across appetite-processing brain regions and gut hormones.ResultsAmong children with OB who underwent FBT, greater declines of BMI z-score were associated with lesser reductions after the FBT intervention in meal-induced changes in neural activation to high- vs low-calorie food cues across appetite-processing brain regions (P < 0.05), and the slope of relationship was significantly different compared with children of HW. In children with OB, less reduction in brain responses to a meal from before to after FBT was associated with greater meal-induced reduction in ghrelin and increased meal-induced stimulation in peptide YY and glucagon-like peptide-1 (all P < 0.05).ConclusionIn response to FBT, adaptations of central satiety responses and peripheral satiety-regulating hormones were noted. After weight loss, changes of peripheral hormone secretion support weight loss, but there was a weaker central satiety response. The findings suggest that even when peripheral satiety responses by gut hormones are intact, the central regulation of satiety is disturbed in children with OB who significantly improve their weight status during FBT, which could favor future weight regain.

390 Adaptation and Evaluation of Guideline-Based Family-Based Behavioral Treatment for Overweight and Obesity in Childhood Survivors of Acute Lymphoblastic Leukemia (ALL)

OBJECTIVES/GOALS: Childhood survivors of ALL are at considerable risk for late effects which are exacerbated by excess weight. The proposed study involves the adaption and evaluation of the first empirically supported intervention for childhood survivors of ALL that is consistent with all national recommendations for the treatment of childhood obesity. METHODS/STUDY POPULATION: The proposed intervention will be adapted from family-based behavioral weight loss treatment (FBT) a multicomponent intervention which targets diet, activity, behavioral skills, parenting, and social facilitation among children and their parents. The Framework for Reporting Adaptations and Modifications-Enhanced structure (FRAME), a dissemination and implementation framework, will guide the adaptation, allowing for the incorporation of feedback previously gathered from key stakeholders. A single-arm, non-randomized trial of the adapted intervention will then be conducted to evaluate its acceptability, feasibility, and preliminary indications of efficacy including measures of relative weight change and associated health-related behaviors among 40 childhood ALL survivors and their families. RESULTS/ANTICIPATED RESULTS: Self-reported feedback from families at the end of treatment (EoT) is anticipated to demonstrate that this intervention will be regarded as both acceptable and feasible. Other measures of feasibility will include attendance and retention rates, which are expected to reflect to those of previous FBT trials (92% and 85%, respectively). Preliminary indications of the efficacy of the adapted intervention will be investigated through the comparison of a series of measurements taken at both baseline and EoT. Changes in relative weight will be assessed and are expected to meet a previously established range of clinically meaningful reduction in child percent overweight of 9 units or more. Improvements in dietary intake, physical activity, and health related quality of life are also anticipated. DISCUSSION/SIGNIFICANCE: Knowledge gained from the implementation of the first evidence-based intervention adapted for childhood survivors of ALL will be critical to the justification of a larger-scale, randomized controlled trial and holds promise to effectively modify the risk for chronic disease among a vulnerable population.