Family-based Obesity Treatment Research Articles

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.

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.

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.

Qualitative Comparative Analysis of Program and Participant Factors That Explain Success in a Micropolitan Pediatric Weight Management Intervention.

Background: Building Healthy Families (BHF) was developed through a community-academic partnership to provide a 12-week family-based obesity treatment program. Nine cohorts of BHF have been delivered in multiple micropolitan settings between 2009 and 2016, but participant outcomes have varied. This study sought to explore the variation in BHF outcomes to identify the necessary and sufficient conditions that are associated with larger 12-week reductions in BMI z-scores. Methods: A qualitative comparative analysis was used to determine potential causal conditions or combination of conditions associated with larger reductions in BMI z-score. Seventy-five participants with 12-week outcome data were rank ordered as the 10 most successful participants (largest reductions in BMI z-score; m ± std = -0.64 ± 0.18) and the 10 least successful participants (smallest reductions or an increase in BMI z-score; m ± std = 0.02 ± 0.04). The conditions selected for analysis were identified based on theory and the delivery team's experience with implementing BHF. Results: Necessary conditions (i.e., present in all highly successful participants, but also some less successful participants) included children with high attendance and self-regulation, at least one adult with high attendance and self-regulation, a mother who lost weight during the program and achieved clinically meaningful weight loss. Sufficient conditions (i.e., present in only the highly successful participants) included mothers with self-regulation scores >45% (range 46.7%-98.2%), and children with a combination of high attendance (72%-100%) and self-regulation scores ≥45% (45%-92.7%). Conclusion: Program implementers should continue to focus on encouraging high attendance and emphasize the necessity of enacting self-regulation strategies at both the child and parent level.

Odds of fussy eating are greater among children with obesity and anxiety.

BackgroundFussy eating has been associated with autism spectrum disorder (ASD), attention‐deficit/hyperactive disorder (ADHD), anxiety, and depression. Despite these disorders being prevalent in obesity treatment, no studies have been published on the association of fussy eating in children with obesity and these disorders. Understanding fussy eating in children with obesity and comorbid disorders is important as acceptance of healthy foods tends to be low, especially in children with sensory sensitivities.ObjectivesInvestigate the prevalence of fussy eating in a cross‐sectional sample of children with obesity and ASD, ADHD, anxiety, and depression; and whether they were more likely to be fussy eaters, comparing those with and without these disorders.MethodsOne hundred and four children referred to family‐based obesity treatment in Iceland 2011–2016, mean age 12.0 (SD = 3.0), mean body mass index standard deviation score 3.5 (SD = 0.9). Binary logistic regression was used to estimate the relationship between fussy eating and disorders, adjusting for medication use.ResultsA large minority (41.6%) were fussy eaters and 48.9% had at least one comorbid disorder. Over a third of children rejected bitter and sour tastes, and 1.9% and 7.9% rejected sweet and salty tastes, respectively. Compared with those without disorders, the odds of being a fussy eater were increased by a factor of 4.11 when having anxiety (95% confidence intervals) (1.02–16.58, p = 00.046), adjusting for medication use. The odds of being a fussy eater were not increased for other disorders; ASD, ADHD, or depression.ConclusionsIn children attending obesity treatment, fussy eating was common. Clinical care models in pediatric obesity treatment should address fussy eating, especially in children with anxiety.

86185 Food Cost and Perceptions: through the lens of coaches providing family-based childhood obesity treatment

ABSTRACT IMPACT: This work will help to identify ways to adapt family-based obesity treatment based on families’ food purchasing behaviors and beliefs. OBJECTIVES/GOALS: Families in obesity treatment are encouraged to make dietary changes. Dietary changes are impacted by food choices, which can be influenced by food cost. The objective of this research is to explore families’ food purchase behaviors and beliefs from the perspective of their health coach, and to assess how health coaches adapt treatment to address these. METHODS/STUDY POPULATION: Semi- structured telephone interviews were conducted with 10 health coaches in the Effectiveness of Family-Based Weight Loss Treatment Implementation in Primary Care (PLAN) study across four geographic locations in MO, NY, and OH. Topics covered were professional background, perspectives on working with families, and discussions with families regarding cost perception and food choice. Conventional content analysis was used through ‘open-coding’ of transcribed text by reading the transcripts and assigning labels. Codes were then organized into themes. In addition to the interviews, coaches were asked to complete a FRAME checklist to identify adaptations or modifications that were made to the treatment. RESULTS/ANTICIPATED RESULTS: The coaches reported that cost is a barrier to making healthier food choices for some but not all of their FBT families. Themes for cost as a barrier include: fast food is cheaper; justification to choose old food choices; sales on foods high in calories and sugar; bulk buying; and fewer sales on healthier options. Themes for what families consider when purchasing healthier items include: perishable foods, increased waste, picky kids, lack of knowledge about healthy eating on a budget, afraid of including new foods, and no money for new foods. The final stage of content analysis for the FRAME schematic checklist is ongoing. DISCUSSION/SIGNIFICANCE OF FINDINGS: The results exemplify that families’ have different food purchasing behaviors and beliefs and consider a variety of factors when making food choices. The data gathered from the FRAME checklists will help in characterizing the adaptations or modifications made by coaches and allow for better understanding of the impact on the families.

Children with Severe Obesity in Family-Based Obesity Treatment Compared with Other Participants: Conclusions Depend on Metrics.

This study compares children with severe obesity and children with mild obesity/overweight participating in family-based obesity treatment (FBT) on change in (1) relative weight and adiposity and (2) psychosocial distress. Children 7 to 11 years old (N = 241) and their parents participated in 12 months of behavioral treatment (FBT + maintenance treatment) and completed anthropometric, adiposity, and psychosocial assessments (psychiatric disorder symptomology, quality of life). Severe obesity was defined as a baseline BMI ≥ 120% of the 95th percentile (N = 105). At 12 months, 40% of children with baseline severe obesity no longer had severe obesity. Percent overweight and fat mass index measurements showed similar magnitudes of change among children with severe obesity and children with mild obesity/overweight, whereas BMI z score and percent body fat change was lower in the group with severe obesity. Youth with severe obesity were higher on some measures of psychosocial distress at baseline but generally experienced improvements similar to children with mild obesity/overweight. FBT with maintenance treatment is beneficial for children with severe obesity and is recommended for use prior to more invasive treatments in severe pediatric obesity. Future studies should assess the necessity of additional treatment, as children with severe obesity still have high relative weights post intervention.

Dose response relationship between program attendance and children\u2019s outcomes in a community based weight management program for children and their families

IntroductionThe Go4Fun program in New South Wales, Australia is a community based weight management program for overweight and obese children aged 7–13 years and their families. This study assessed the impact of the number and type of sessions attended on body mass index (BMI) z-score, fruit and vegetable intake and physical activity and sedentary behaviours to determine the number of sessions required to achieve optimal program outcomes.MethodsSecondary analysis was conducted on pre and post participant program data collected over 3.5 years. Relationships between session attendance and program outcomes were assessed using Spearman’s correlation and multivariate analyses of variance and multivariate regression. Number of sessions required to achieve optimal program outcomes was determined using piecewise linear regression.ResultsFor 3090 participants (48.5% of registrants) who attended at least five sessions, outcome measures improved significantly at post program compared with pre (p < 0.01). No relationships were seen between number and type of sessions attended and outcome measures.Children of mothers without a post-school qualification (university degree or vocational qualification) were more likely to achieve lower levels of improvements in BMI z-score (p = 0.02) and vegetable intake (P < 0.01) than those children with post-school qualified mothers (F = 3.68, p = 0.03). Children of mothers without post-school education that attended seven sessions or more achieved significantly better BMI z-score outcomes (p < 0.01) than those who attended fewer sessions.ConclusionsMaternal educational attainment influences program attendance and health and behavioural outcomes in a family based obesity treatment program.

Health-related quality of life after camp-based family obesity treatment: an RCT

ObjectiveTo compare the effects of a 2-year camp-based immersion family treatment for obesity with an outpatient family-based treatment for obesity on health-related quality of life (HRQoL) in two generations.DesignRandomised controlled...

Child and parent reports of children's depressive symptoms in relation to children's weight loss response in family-based obesity treatment.

Studies of the association between children's depressive symptoms and obesity treatment response show mixed results. Different measurement may contribute to the inconsistent findings, as children's depressive symptoms are often based on parent-report about their child rather than child self-report. We assessed both child- and parent-report of child depressive symptoms as predictors of children's obesity treatment response. Children with overweight/obesity (body mass index [BMI]≥85th percentile; N=181) and their parents reported on children's depressive symptoms prior to family-based behavioral weight loss treatment. Child percent overweight reduction from baseline to post-treatment was not predicted by child self-reported depressive symptoms or parent-report of child symptoms (P>0.80), but was significantly predicted by the interaction between child self-report and parent-report on child (β=0.14, P=0.05). In analyses using clinical cutoffs, amongst children with high self-reported symptoms, those whose parents reported low child depressive symptoms had greater reduction in percent overweight (t=2.67, P=0.008), whereas amongst children with low self-reported symptoms, parent ratings were not associated with treatment outcome. Including both child self-report and parent-report of child depressive symptoms may inform obesity care. Research is needed to examine differences amongst child and parent depressive symptom reports and strategies to address symptoms and optimize pediatric obesity treatment.

Change in eating disorder symptoms following pediatric obesity treatment.

The purpose of this study is to evaluate whether children with overweight or obesity participating in an evidence-based treatment, family-based behavioral treatment (FBT) for obesity, or a parent-only variant of FBT (PBT), experience an increase of eating disorder (ED) symptoms during and following treatment. Children (N = 150) participating in a randomized controlled trial of FBT or PBT completed measures of EDs attitudes and behaviors at baseline, following 6-months of treatment, 6 months, and 18 months after treatment. Linear-mixed effects models suggest that ED attitudes did not significantly increase. Rather, significant decreases of shape, weight, and eating concerns were shown following treatment. Loss of control over eating significantly decreased over treatment and follow-up. No participant endorsed purging at any time point. Results confirm the hypothesis that ED symptoms do not increase after participating in FBT or a FBT-based treatment. These findings should help assuage fears of parents that enrolling their child will exacerbate ED symptoms and aid children to access evidence-based treatments that may help reduce significant physical and psychosocial complications of childhood obesity.

Girls and Boys Have a Different Cardiometabolic Response to Obesity Treatment.

Background: Childhood obesity exposes individuals to cardiometabolic disturbances. We analyzed how family-based multidisciplinary obesity treatment influenced children's cardiometabolic health.Materials and methods: In this retrospective, two-year, follow-up study of 654 2- to 18-year-old children treated for obesity in three Finnish pediatric clinics in 2005–2012, blood pressure (BP), metabolic parameters, and the influence of sex, puberty and a change in body mass index standard deviation score (BMI SDS) were analyzed.Results: At baseline, at least one cardiovascular risk factor was present in 474 (80%) cases. Boys presented with more significant changes in cardiometabolic parameters than girls during the treatment. Boys' total cholesterol (TC) improved by 12 months (P = 0.009), and their low-density lipoprotein C (LDL-C) and glycosylated hemoglobin ameliorated by 12 months (P = 0.030 and 0.022, respectively) and 24 months (P = 0.043 and 0.025, respectively). Boys' triglycerides, insulin, homeostasis model assessment for insulin resistance (HOMA-IR) and systolic BP deteriorated at 24 months (P < 0.001, 0.004, 0.002, and 0.037, respectively). In all children, the number of acceptable TC, LDL-C, insulin, and HOMA-IR values increased if BMI SDS reduced 0.25 or more by 12 months.Conclusion: Minor cardiometabolic improvements were found during the obesity treatment. These findings indicate the need to assess treatment methods and focus on prevention.

Family-Based Treatment for Pediatric Obesity: Case Study of an Adaptation for a Non-Psychiatric Adolescent Population.

Pediatric overweight and obesity, a highly prevalent condition posing risks extending into adulthood, is considered a major public health concern. Findings from the pediatric obesity treatment literature support the efficacy of parental involvement across multiple formats. Family-based treatment is an outpatient intervention for adolescents with eating disorders that enlists parents as the primary agents of symptom management during the acute stages of illness, titrating down their involvement as severity of the disorder decreases. We adapted family-based treatment for pediatric obesity, modifying the original model to recognize that children and adolescents with obesity do not exhibit the developmental regression seen in eating disorders and to reflect the non-psychiatric nature of obesity. Thus, family-based treatment for pediatric obesity modulates the degree of parental involvement as a function of chronological developmental stage, not severity of the condition. To illustrate the implementation of this treatment, we present a case report of a 15-year old with an eight-year history of overweight and a greater than 30-pound weight gain prior to treatment. Through this case study, the three phases of family-based treatment for pediatric obesity and six-month post treatment follow-up results are presented through the lens of response from this adolescent and her family. We present this case report to illustrate the implementation of the intervention's adolescent module, and the potential impact of the approach in the treatment of adolescents with obesity and their families.

Exploring parent attitudes around using incentives to promote engagement in family-based weight management programs.

Incentives can promote adult wellness. We sought to examine whether incentives might help overcome barriers to engagement in child weight management programs and the ideal value, type and recipient of incentives. In 2017, we conducted semi-structured phone interviews with parents of children ≤17 years old, formerly or currently affected by obesity, who had (n = 11) or had never (n = 12) participated in family-based behavioral treatment (FBT) for obesity. Interviews explored the range and type of incentives families would be willing to accept. Interview transcripts were coded and data were analyzed using a thematic analysis. We found that some parents were skeptical about receiving cash incentives. However, once treatment-related costs were identified, some became more interested in reimbursement for out of pocket expenditures. Most parents felt up to $100/month would be adequate and that incentives should be tied to changing behaviors, not BMI. Some interviewees expressed preferences for non-cash incentives (e.g. a gift card) over cash incentives. Parents were willing to share incentives with adolescents, up to $50/month, but there was concern about incentives affecting a child's intrinsic motivation for behavior change. All parents acknowledged that moderate incentives alone couldn't overcome the realities of structural and familial barriers to engaging in weight management programs. In summary, we identified aspects of an incentive program to promote engagement in FBT that would be desirable and feasible to implement. Future quantitative work can reveal the value and structure of incentives that are effective for improving obesogenic health behaviors and outcomes.

Clinical-Community Collaboration: A Strategy to Improve Retention and Outcomes in Low-Income Minority Youth in Family-Based Obesity Treatment.

Clinical-community collaboration is a promising strategy for pediatric obesity treatment, but current research is limited. This study examined the effect of a family-based treatment program embedded in a primary care clinic on retention and changes in child weight status at 1 year. Children (2-16 years, BMI ≥85th percentile, 87.0% Hispanic) and their parents were recruited from a single pediatric clinic for Healthy Hawks Primary Plus (HHP+). Children were referred by physicians and enrolled by a bilingual clinic-based recruitment coordinator. Participants received 12 weekly 2-hour sessions focused on lifestyle modification and health behavior change and then received bimonthly follow-up visits with their clinic-based physician through 1-year follow-up. Child body mass index (BMI) percentage of the 95th percentile (%BMIp95) was measured as the primary outcome at baseline, postintervention, and 1-year follow-up. Random effect multilevel models assessed changes in child weight status over time accounting for clustering by family. To further evaluate the impact, HHP+ retention and changes in child weight status were compared to a standard 12-week treatment program only. HHP+ participants had significantly better retention at 1 year (73.9%, p ≤ 0.001) compared to the standard treatment program (38.3%). In HHP+, physician visit attendance was significantly correlated with retention at 1 year (r = 0.69, p ≤ 0.001), and HHP+ completers had significant reductions in %BMIp95 between baseline and 1-year follow-up (p = 0.03). Clinical-community partnerships might be a promising strategy to improve retention and reduce child weight status in populations currently underrepresented in obesity treatment.

Clinical-Community Collaboration: A Strategy to Improve Retention and Outcomes in Low-Income Minority Youth in Family-Based Obesity Treatment

Clinical-Community Collaboration: A Strategy to Improve Retention and Outcomes in Low-Income Minority Youth in Family-Based Obesity Treatment

Cost-effectiveness of Obesity Interventions: Will We Know It When We See It?

* Abbreviations: %OBMI — : percent over BMI FBT — : family-based obesity treatment IC — : information-based control intervention ICER — : incremental cost-effectiveness ratio QALY — : quality-adjusted life year DALY — : disability-adjusted life year In this issue of Pediatrics , Quattrin et al1 present the results of a cost-effectiveness analysis of a family-based obesity treatment (FBT) program relative to an information-based control intervention (IC). The IC educated parents to encourage their children to have a weight loss goal of 0.5 to 1 lb per week. Parents then attended 16 group meetings; each meeting delivered dietary and/or physical activity advice. In between meetings, a health coach telephoned the parents to remind them to attend the meetings. The FBT group attended the same number of group meetings and received the same information. They also received education on parenting techniques both at the group sessions and during brief individual sessions with a health coach, at which time the health coach would also problem solve any concerns raised. Parents in FBT were further instructed to monitor their children’s weight and their own weight twice a week and received additional dietary (1500 and 1800 kilocalories per day for mothers and fathers, respectively), physical activity, and sedentary activity recommendations. Parents were also instructed to record food intake and activity for their children and themselves in a diary by crossing off icons detailing food groups and physical and sedentary activities undertaken. The authors report that after 2 years, child percent over BMI (%OBMI) change decreased by 1.98 U in the FBT group versus an increase of 4.37 U in the IC group. Parents lost 5.95 kg in the FBT group versus 0.16 kg in the IC group. One way to consider the impact of FBT is … Address correspondence to Eric A. Finkelstein, PhD, MHA, Health Services and Systems Research Programme, Duke-NUS Medical School, 8 College Rd, Singapore 169857. E-mail: eric.finkelstein{at}duke-nus.edu.sg

Cost-effectiveness of Family-Based Obesity Treatment.

We translated family-based behavioral treatment (FBT) to treat children with overweight and obesity and their parents in the patient-centered medical home. We reported greater reductions in child and parent weight at 6 and 24 months compared with an attention-controlled information control (IC) group. This article reports the cost-effectiveness of long-term weight change for FBT compared with IC. Ninety-six children 2 to 5 years of age with overweight or obesity and with parents who had a BMI ≥25 were randomly assigned to FBT or IC, and both received diet and activity education (12-month treatment and 12-month follow-up). Weight loss and cost-effectiveness were assessed at 24 months. Intention-to-treat, completers, and sensitivity analyses were performed. The average societal cost per family was $1629 for the FBT and $886 for the IC groups at 24 months. At 24 months, child percent over BMI (%OBMI) change decreased by 2.0 U in the FBT group versus an increase of 4.4 U in the IC group. Parents lost 6.0 vs 0.2 kg at 24 months in the FBT and IC groups, respectively. The incremental cost-effectiveness ratios (ICERs) for children and parents' %OBMI were $116.1 and $83.5 per U of %OBMI, respectively. Parental ICERs were also calculated for body weight and BMI and were $128.1 per 1, and $353.8/ per kilogram, respectively. ICER values for child %OBMI were similar in the intention-to-treat group ($116.1/1 U decrease) compared with completers ($114.3). For families consisting of children and parents with overweight, FBT presents a more cost-effective alternative than an IC group.

Family-based treatment for obesity in tweens: a three-year longitudinal follow-up study

ABSTRACTChildren's increasing obesity worldwide is creating negative health and socioeconomic drawbacks. To find the determinants of obesity, this research looked at the influence of (1) media usage; (2) advertising messages/brand recognition; and (3) communication or lack of communication between parents and their children on obesity and food-related Purchase Influence Attempts (PIAs) of tweens. A 3-year longitudinal follow-up study was conducted with 68 families whose children were either obese or at risk of becoming obese. The subjects were divided into the following four groups: (1) media amount was controlled; (2) brand recognition was controlled; (3) communication channel of family members was controlled; and (4) all three conditions were controlled. Our results showed significant weight-loss and reduction in PIAs in all groups except in group 2 (brand recognition controlled). This work shows the importance of changing habits using behavioural treatment and the importance of communication among family members on obesity prevention.

Parent-adolescent influences on everyday dietary practices: Perceptions of adolescent females with obesity and their mothers.

Parents demonstrate an important influence on adolescent obesity and dietary behavior; yet, family-based obesity interventions continue to exhibit limited success among adolescents. To further inform family-based approaches for adolescent obesity treatment, we examined the perceptions of adolescent females with obesity and their mothers of the influences experienced within the parent-adolescent relationship that affect everyday dietary practices. We conducted six focus group interviews (three adolescent female and three mother) among 15 adolescent (12-17years old) females with obesity and 12 of their mothers. Content analysis techniques were used to analyze the transcribed interviews. Adolescent females with obesity discussed a diverse set of parental influences (controlling, supporting and cultivating, overlooking and tempting, acquiescing, providing, attending, and not providing and avoiding) on their daily dietary practices. Among mother focus groups, mothers discussed specific intentional and unintentional types of influences from children that affected the food and drink they consumed, prepared, and acquired. Findings provide a fuller view of the varied social influences on everyday dietary practices within the parent-adolescent relationship. They indicate the importance of examining both parent-to-child and child-to-parent influences and begin to illuminate the value of attending to the social circumstances surrounding dietary behaviors to strengthen family-based obesity treatment approaches.