Obesity Treatment Interventions Research Articles

American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016

BackgroundBariatric surgery, despite being the most successful long-lasting treatment for morbid obesity, remains underused as only approximately 1% of all patients who qualify for surgery actually undergo surgery. To determine if patients in need are receiving appropriate therapy, the American Society for Metabolic and Bariatric Surgery created a Numbers Taskforce to specify annual rate of use for obesity treatment interventions. ObjectivesThe objective of this study was to determine metabolic and bariatric procedure trends since 2011 and to provide the best estimate of the number of procedures performed in the United States in 2016. SettingUnited States. MethodsWe reviewed data from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, National Surgical Quality Improvement Program, Bariatric Outcomes Longitudinal Database, and Nationwide Inpatient Sample. In addition, data from industry and outpatient centers were used to estimate outpatient center activity. Data from 2016 were compared with the previous 5 years of data. ResultsCompared with 2015, the total number of metabolic and bariatric procedures performed in 2016 increased from approximately 196,000 to 216,000. The sleeve gastrectomy trend is increasing, and it continues to be the most common procedure. The gastric bypass and gastric band trends continued to decrease as seen in previous years. The percentage of revision procedures and biliopancreatic diversion with duodenal switch procedures increased slightly. Finally, intragastric balloons placement emerged as a significant contributor to the cumulative total number of procedures performed. ConclusionsThere is increasing use of metabolic and bariatric procedures performed in the United States from 2011 to 2016, with a nearly 10% increase noted from 2015 to 2016.

Viewpoints of overweight and obese adolescents attending lifestyle obesity treatment interventions: a qualitative systematic review

BackgroundA third of children in England are overweight or obese (body-mass index >25 kg/m2). Current guidance from the National Institute for Health and Care Excellence recommends that obese adolescents attend a family-based multicomponent lifestyle weight management programme. However, these programmes have low recruitment and high rates of attrition. An understanding of the opinions of adolescents is necessary for planning and developing future interventions. The aim of this systematic review was to explore the viewpoints of overweight–obese adolescents who have attended a lifestyle obesity treatment intervention. MethodsStudies of overweight–obese adolescents (aged 12–17 years) who attended a single or multicomponent lifestyle treatment intervention were examined. Only studies that collected and analysed data qualitatively were included. There were no language restrictions. Published literature was identified by searching the following databases: Medline, EMBASE, Web of Science, PsycINFO, ASSIA, and CINAHL between July 27 and 31, 2016. Search terms included obesity, overweight, views, experiences, opinions, attitudes, satisfaction, preferences, adolescents, diet, activity, and behaviour. Reference lists of included studies were screened. Titles and abstracts of identified records were assessed independently by two reviewers. Full texts of all potentially relevant papers were retrieved and assessed independently by two reviewers, reasons for exclusion were recorded, and differences in opinions were resolved by a third reviewer. Methodological quality was assessed by two reviewers independently, in terms of trustworthiness and usefulness of findings, with an EPPI-Centre tool. Full texts were analysed with thematic synthesis. The Confidence in the Evidence from Reviews of Qualitative research approach was used to assess the certainty of review findings. This study is registered with PROSPERO, number CRD42016039588. Findings19 230 records were identified for title and abstract screening. 284 full -texts were assessed, with 24 included. Thematic synthesis resulted in 178 descriptive codes, which led to the development of 43 analytical themes that have been broadly divided into eight sections: support, motivations, intervention content, maintenance, diet, technology, barriers, and physical activity. Analytical themes included “professional support valued”, “tailored intervention”, “adolescents enjoy using technology and do so with ease”, “prior fears of attending intervention”, “enjoyment of sport and physical activity”, and “longer term support”. InterpretationOur findings may inform local and national policy makers in the development of future interventions for overweight–obese adolescents. Developing interventions with adolescents' opinions in mind, might assist in the improvement of recruitment and attrition rates. FundingNIHR Collaboration for Leadership in Applied Health Research and Care West Midlands (for HJ's PhD).

Impact of child summertime obesity interventions on body mass index, and weight-related behaviours: a systematic review and meta-analysis protocol

IntroductionIn previous studies, it has been found that on average, children consistently gained weight during the summer months at an increased rate compared with the 9-month school year. This contributed...

Comparative effectiveness of interventions for treatment of overweight and obesity

Overweight and obesity are amongst most common problems of our time and have a significant negative impact on somatic health. Recently have been published several systematic reviews and meta-analysis that evaluated the effectiveness of various methods for overweight and obesity treatment. These studies are not yet included in the clinical guidelines, but might contain important results.

Treating Obesity in Latino Children: A Systematic Review of Current Interventions

Childhood obesity remains a significant public health issue in the U.S. and globally. Rates are disproportionately higher in Latinos than other ethnic groups. This review provides a qualitative synthesis of the current evidence for childhood obesity treatment interventions among Latino children. A systematic search was performed in PubMed, Web of Science and Google Scholar for articles published from September 2010 to December 2015. Randomized controlled trials treating childhood overweight/obesity in Latino children ages 5-19 focused on diet and/or physical activity (PA) behaviors were included. Of the records initially identified (n=1,592), 11 studies met the inclusionary criteria. The majority included a family-based component (n=8; 73%). Nearly half (n=5) focused on children ages 5-12, with three specifically developed for the pre-adolescence stage (ages 8-12). Nine studies acknowledged cultural tailoring, most frequently by seeking input from their intended population and utilizing bilingual delivery staff. Improvements in anthropometric measures (e.g. body mass index (BMI) z-score) were observed in 55% of the studies (n=6). Many interventions with a combined focus of diet and PA, in the form of nutrition education in a group setting and in-person activity/exercise sessions and incorporated a parent/family component reported positive anthropometric results. Three (27%) studies included a follow-up period, all of which observed a sustained decrease in BMI over time. Overall, family-based interventions focusing on both diet and PA demonstrated promising results. However, additional research incorporating a follow-up period is warranted to assess sustainability of these outcomes. Additionally, more interventions could be developed specifically for the critical developmental stage of pre-adolescence

Clinical, functional, behavioural and epigenomic biomarkers of obesity.

Overweight and obesity are highly prevalent conditions worldwide, linked to an increased risk for death, disability and disease due to metabolic and biochemical abnormalities affecting the biological human system throughout different domains. Biomarkers, defined as indicators of biological processes in health and disease, relevant for body mass excess management have been identified according to different criteria, including anthropometric and molecular indexes, as well as physiological and behavioural aspects. Analysing these different biomarkers, we identified their potential role in diagnosis, prognosis and treatment. Epigenetic biomarkers, cellular mediators of inflammation and factors related to microbiota-host interactions may be considered to have a theranostic value. Though, the molecular processes responsible for the biological phenomenology detected by the other analysed markers, is not clear yet. Nevertheless, these biomarkers possess valuable diagnostic and prognostic power. A new frontier for theranostic biomarkers can be foreseen in the exploitation of parameters defining behaviours and lifestyles linked to the risk of obesity, capable to describe the effects of interventions for obesity prevention and treatment which include also behaviour change strategies.

Randomised controlled trial evaluating the effectiveness and cost-effectiveness of 'Families for Health', a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years.

Effective programmes to help children manage their weight are required. 'Families for Health' focuses on a parenting approach, designed to help parents develop their parenting skills to support lifestyle change within the family. Families for Health version 1 showed sustained reductions in mean body mass index (BMI) z-score after 2 years in a pilot project. The aim was to evaluate its effectiveness and cost-effectiveness in a randomised controlled trial (RCT). The trial was a multicentre, investigator-blind RCT, with a parallel economic and process evaluation, with follow-up at 3 and 12 months. Randomisation was by family unit, using a 1 : 1 allocation by telephone registration, stratified by three sites, with a target of 120 families. Three sites in the West Midlands, England, UK. Children aged 6-11 years who were overweight (≥ 91st centile BMI) or obese (≥ 98th centile BMI), and their parents/carers. Recruitment was via referral or self-referral. Families for Health version 2 is a 10-week, family-based community programme with parallel groups for parents and children, addressing parenting, lifestyle, social and emotional development. Usual care was the treatment for childhood obesity provided within each locality. Joint primary outcome measures were change in children's BMI z-score and incremental cost per quality-adjusted life-year (QALY) gained at 12 months' follow-up (QALYs were calculated using the European Quality of Life-5 Dimensions Youth version). Secondary outcome measures included changes in children's waist circumference, percentage body fat, physical activity, fruit/vegetable consumption and quality of life. Parents' BMI and mental well-being, family eating/activity, parent-child relationships and parenting style were also assessed. The process evaluation documented recruitment, reach, dose delivered, dose received and fidelity, using mixed methods. The study recruited 115 families (128 children; 63 boys and 65 girls), with 56 families randomised to the Families for Health arm and 59 to the 'usual-care' control arm. There was 80% retention of families at 3 months (Families for Health, 46 families; usual care, 46 families) and 72% retention at 12 months (Families for Health, 44 families; usual care, 39 families). The change in BMI z-score at 12 months was not significantly different in the Families for Health arm and the usual-care arm [0.114, 95% confidence interval (CI) -0.001 to 0.229; p = 0.053]. However, within-group analysis showed that the BMI z-score was significantly reduced in the usual-care arm (-0.118, 95% CI -0.203 to -0.034; p = 0.007), but not in the Families for Health arm (-0.005, 95% CI -0.085 to 0.078; p = 0.907). There was only one significant difference between groups for secondary outcomes. The economic evaluation, taking a NHS and Personal Social Services perspective, showed that mean costs 12 months post randomisation were significantly higher for Families for Health than for usual care (£998 vs. £548; p < 0.001). The mean incremental cost-effectiveness of Families for Health was estimated at £552,175 per QALY gained. The probability that the Families for Health programme is cost-effective did not exceed 40% across a range of thresholds. The process evaluation demonstrated that the programme was implemented, as planned, to the intended population and any adjustments did not deviate widely from the handbook. Many families waited more than 3 months to receive the intervention. Facilitators', parents' and children's experiences of Families for Health were largely positive and there were no adverse events. Further analysis could explore why some children show a clinically significant benefit while others have a worse outcome. Families for Health was neither effective nor cost-effective for the management of obesity in children aged 6-11 years, in comparison with usual care. Further exploration of the wide range of responses in BMI z-score in children following the Families for Health and usual-care interventions is warranted, focusing on children who had a clinically significant benefit and those who showed a worse outcome with treatment. Further research could focus on the role of parents in the prevention of obesity, rather than treatment. Current Controlled Trials ISRCTN45032201. This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 1. See the NIHR Journals Library website for further project information.

Protective Effect of Gymnema sylvestre Ethanol Extract on High Fat Diet-induced Obese Diabetic Wistar Rats.

Obesity is associated with numerous co-morbidities such as cardiovascular diseases, type 2 diabetes, hypertension and others. Therefore, the present study was planned to investigate the effect of water- soluble fraction of Gymnema sylvestre ethanol extract on biochemical and molecular alterations in obese diabetic rats. Diabetes was induced by single i.v. injection of streptozotocin (45 mg/kg) via tail vein. Obesity was induced by oral feeding of high fat diet for a period of 28 days in diabetic rats. Body weight gain, food intake, water intake, hemodynamic parameters (systolic, diastolic, mean arterial blood pressures and heart rate), serum biochemical parameters (leptin, insulin, lipid levels, apolipoprotein B and glucose), cardiomyocyte apoptosis (cardiac caspase-3, Na(+)/K(+) ATPase activity and DNA fragmentation) organs and visceral fat pad weight and oxidative stress parameters were measured. Oral treatment with water soluble fraction of Gymnema sylvestre ethanol extracts (120 mg/kg/p.o.) for a period of 21 days, resulted in significant reduction in heart rate, mean arterial pressure, serum leptin, insulin, apolipoprotein B, lipids, glucose, cardiac caspase-3 levels, Na(+)/K(+) ATPase activity and DNA laddering, visceral fat pad and organ's weight and improved the antioxidant enzymes levels in the high fat diet induced obesity in diabetic rats. The results of present study reveal that water soluble fraction of Gymnema sylvestre ethanol extract could be useful intervention in the treatment of obesity and type-2 diabetes mellitus.

Health Literacy and Weight Change in a Digital Health Intervention for Women: A Randomized Controlled Trial in Primary Care Practice

In the United States, 90 million adults have low health literacy. An important public health challenge is developing obesity treatment interventions suitable for those with low health literacy. The objective of this study was to examine differences in sociodemographic and clinical characteristics as well as weight and intervention engagement outcomes by health literacy. We randomized 194 participants to usual care or to the Shape Program intervention, a 12-month digital health treatment aimed at preventing weight gain among overweight and Class I obese Black women in primary care practice. We administered the Newest Vital Sign instrument to assess health literacy. More than half (55%) of participants had low health literacy, which was more common among those with fewer years of education and lower income. There was no effect of health literacy on 12-month weight change or on intervention engagement outcomes (completion of coaching calls and interactive voice response self-monitoring calls). Low health literacy did not preclude successful weight gain prevention in the Shape Program intervention. Goal-focused behavior change approaches like that used in Shape may be particularly helpful for treating and engaging populations with low health literacy.

Track: A randomized controlled trial of a digital health obesity treatment intervention for medically vulnerable primary care patients

IntroductionObesity continues to disproportionately affect medically vulnerable populations. Digital health interventions may be effective for delivering obesity treatment in low-resource primary care settings. MethodsTrack is a 12-month randomized controlled trial of a digital health weight loss intervention in a community health center system. Participants are 351 obese men and women aged 21 to 65years with an obesity-related comorbidity. Track participants are randomized to usual primary care or to a 12-month intervention consisting of algorithm-generated tailored behavior change goals, self-monitoring via mobile technologies, daily self-weighing using a network-connected scale, skills training materials, 18 counseling phone calls with a Track coach, and primary care provider counseling. Participants are followed over 12months, with study visits at baseline, 6, and 12months. Anthropometric data, blood pressure, fasting lipids, glucose and HbA1C and self-administered surveys are collected. Follow-up data will be collected from the medical record at 24months. ResultsParticipants are 68% female and on average 50.7years old with a mean BMI of 35.9kg/m2. Participants are mainly black (54%) or white (33%); 12.5% are Hispanic. Participants are mostly employed and low-income. Over 20% of the sample has hypertension, diabetes and hyperlipidemia. Almost 27% of participants currently smoke and almost 20% score above the clinical threshold for depression. ConclusionsTrack utilizes an innovative, digital health approach to reduce obesity and chronic disease risk among medically vulnerable adults in the primary care setting. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk patient population in need of evidence-based obesity treatment.

Current trends in the pharmacotherapy for obesity

Obesity represents a major global challenge from both healthcare and economic perspectives. Although lifestyle modifications aimed at reducing calorie intake and increasing energy expenditure remain the cornerstone of obesity management, pharmacotherapy can serve as a useful adjunct. Until recently, orlistat was the only medication registered for the treatment of obesity in the European Union (EU). A deeper understanding of the complexity of energy homeostasis has resulted in new pharmacological options for weight reduction. In 2015, two new antiobesity drugs were approved in the EU. These are a fixed combination of naltrexone/bupropion (Mysimba®) and liraglutide at a dose of 3.0 mg (Saxenda®). In addition, lorcaserin (Belviq®) and a fixed combination of phentermine/topiramate (Qsymia®) were introduced into the US market in 2012. However, the European Medicines Agency did not approve their use in the EU. The burden of previous weight loss agents that have been withdrawn due to safety concerns underlines the need for caution and close follow-up of patients undergoing pharmacological interventions for obesity treatment. This article provides an overview of the efficacy and safety of currently available weight loss pharmacotherapies.

Protocol for the Rural Engagement in Primary Care for Optimizing Weight Reduction (RE-POWER) Trial: Comparing three obesity treatment models in rural primary care

Obesity disproportionately affects rural residents in the United States, and primary care has the potential to fill a major gap in the provision of weight management services for rural communities. The objective of this cluster-randomized pragmatic trial is to evaluate the comparative effectiveness of three obesity treatment models in rural primary care: the Intensive Behavior Therapy fee-for-service (FFS) model reimbursed by Medicare, a team-based model that recognizes the patient-centered medical home (PCMH) as a preferred delivery approach, and the centralized disease management (DM) model, in which phone-based counseling is provided outside of the primary care practice. We hypothesize that the PCMH and DM treatments will be more effective than FFS in reducing weight at 24months. Thirty-six practices from the rural Midwestern U.S. are randomized to deliver one of the three interventions to 40 patients (N=1440) age 20 to 75 with a BMI 30–45kg/m2. In the FFS arm, primary care providers and their personnel counsel patients to follow evidence-based weight loss guidelines using the Medicare-designated treatment schedule. In the PCMH arm, patients receive a comprehensive weight management intervention delivered locally by practice personnel using a combination of in-person and phone-based group sessions. In the DM arm, the same intervention is delivered remotely by obesity treatment specialists via group conference calls. The primary outcome is weight loss at 24months. Additional measures include fasting glucose, lipids, quality of life indicators, and implementation process measures. Findings will illuminate effective obesity treatment intervention(s) in rural primary care.

Gender expression associated with BMI in a prospective cohort study of US adolescents.

ObjectiveTo examine the relationship between gender expression (GE) and BMI in adolescence.MethodsRepeated measures of weight-related behaviors and BMI were collected 1996-2011 via annual/biennial self-report surveys from youth ages 10 to 23 years (6,693 females, 2,978 males) in the longitudinal Growing Up Today Study. GE (very conforming [referent], mostly conforming, nonconforming) was assessed in 2010/11. Sex-stratified, multivariable linear models estimated GE group differences in BMI and the contribution of sexual orientation and weight-related exposures to group differences. Models for males included interaction terms for GE with age.ResultsIn females, mostly conforming youth had 0.53 kg/m2 and nonconforming had 1.23 kg/m2 higher BMI; when adding adjustment for sexual orientation and weight-related exposures, GE-group estimates were attenuated up to 8% and remained statistically significant. In males, mostly conforming youth had −0.67 kg/m2 and nonconforming had −1.99 kg/m2 lower BMI (age [in years] interactions were between −0.09 to −0.14 kg/m2; when adding adjustment for sexual orientation and weight-related exposures, GE-group estimates were attenuated up to 11% and remained statistically significant.ConclusionsGE is a strong independent predictor of BMI in adolescence. Obesity prevention and treatment interventions with youth must address ways that gender norms may reinforce or undermine healthful behaviors.

Childhood Obesity and Bullying in Schools of Argentina: Analysis of This Behaviour in a Context of High Prevalence

Background: Obese children are more exposed to bullying (B). This study aims to analyse such under-researched association among a sample of school-aged children in Argentina. Methods: This case control study comprised 8 elementary public schools of the county of Moron, Province of Buenos Aires. In 2013, 740 children ages 9-10 completed a questionnaire evaluating type and role played in B. Five types of B were analysed: general, physical, verbal, relational, and cybernetic; analysed roles were victim and perpetrator. Height and weight were measured and body mass index (BMI) was calculated. The relation between bullying and BMI was studied using a general linear mixed model including BMI, gender, and height as fixed effects, and course as random effect. Findings: Types of B analysed showed a significant association between BMI and physical B (OR-obesity: 2.1; p = 0.001 y OR-overweight: 1.7; p = 0.011), between obesity and verbal B (OR: 1.7; p = 0.010) and between obesity and relational B (OR: 1.7; p = 0.023). Boys reported suffering more physical B than girls (OR: 1.7; p = 0.005), and a tendency to be more often the perpetrators (OR: 1.5; p = 0.070). Conclusions: Overweight and obese 9-10 year children of public schools of Argentine appear to be at significantly increased risk of bullying. Teachers, physical education instructors, and paediatricians should aim to address this behaviour when designing obesity prevention and treatment interventions.

Elevated BMI and Male Sex Are Associated with Greater Underreporting of Caloric Intake as Assessed by Doubly Labeled Water ,

Background: Inaccuracies in energy intake (EI) measurement hinder identification of risk factors that predict weight gain and evaluation of obesity prevention and treatment interventions. Research has used objective measures of EI to identify underreporting correlates, producing mixed results, suggesting the need to examine novel potential correlates.Objective: With the use of an objective measure of EI from doubly labeled water (DLW) this report examined multiple potential underreporting correlates.Methods: Adolescents from 2 studies (study 1, n = 91; mean age: 18.4 ± 0.58 y; 100% female; study 2, n = 162; mean age: 15.2 ± 1.99 y; 82 female adolescents; 80 male adolescents) completed a DLW assessment of EI, a food-frequency questionnaire, and measures of perceived pressure for thinness, thin-ideal internalization, body dissatisfaction, dieting, food-cue reactivity, eating disorder symptoms, socioeconomic status, and neural response to food; BMI (in kg/m2) was measured over a 2-y follow-up.Results: Elevated BMI correlated with underreported EI in study 1 (r = 0.26, P < 0.05) and study 2 (r = 0.20, P = 0.01), as did male sex in study 2 (r = 0.24, P < 0.01); the other survey measures did not. Underreporting correlated negatively (r = −0.29; uncorr P < 0.001) with responsivity of brain regions implicated in motor control to palatable food receipt and positively (r = 0.31; uncorr P < 0.001) with responsivity of a region implicated in taste processing to cues signaling impending milkshake receipt. Underreporting did not predict future change in BMI in either study.Conclusions: Findings document marked underreporting and replicate evidence that BMI correlates positively with underreporting and extends this literature by revealing that several novel factors were unrelated to underreporting and further that neural responsivity to food correlated with underreporting, suggesting that adolescents who showed reduced responsivity in a motor control region to food receipt and elevated responsivity of gustatory regions to anticipated palatable food receipt showed greater underreporting. This trial was registered at clinicaltrials.gov as NCT00433680 and NCT02084836.

Combating Childhood Obesity with an Integrated School Curriculum

The prevalence of overweight and obesity among US adults is well-documented and lifestyle intervention remains the foundation for all overweight and obesity treatment interventions, even when bariatric surgery is offered.

A Review of Primary Care-Based Childhood Obesity Prevention and Treatment Interventions.

Effective obesity prevention and treatment interventions targeting children and their families are needed to help curb the obesity epidemic. Pediatric primary care is a promising setting for these interventions, and a growing number of studies are set in this context. This review aims to identify randomized controlled trials of pediatric primary care-based obesity interventions. A literature search of 3 databases retrieved 2947 publications, of which 2899 publications were excluded after abstract (n=2722) and full-text review (n=177). Forty-eight publications, representing 31 studies, were included in the review. Eight studies demonstrated a significant intervention effect on child weight outcomes (e.g., BMI z-score, weight-for-length percentile). Effective interventions were mainly treatment interventions, and tended to focus on multiple behaviors, contain weight management components, and include monitoring of weight-related behaviors (e.g., dietary intake, physical activity, or sedentary behaviors). Overall, results demonstrate modest support for the efficacy of obesity treatment interventions set in primary care.

Overweight status in Indian children: Prevalence and psychosocial correlates

To examine the association between overweight status and psycho-social risk factors in Indian children. Data from India's nationally-representative Global School-based Student Health Survey were analyzed using SPSS for all participating students (n=8130, 58% males). The likelihood of being overweight was significantly higher for children with fewer friends (OR=1.16, 95%CI=1.13-1.18) or friends who were not kind or helpful, children with symptoms of depression (OR=1.20, 95%CI=1.03-1.39) and anxiety (OR=1.09, 95%CI=1.07-1.15), children with little parental involvement (OR=1.06, 95%CI=1.02-1.10), and children who felt lonely or missed school days without permission. Psychosocial distress in overweight Indian children warrants comprehensive interventions for screening and treatment of pediatric obesity.

Service evaluation of the GOALS family-based childhood obesity treatment intervention during the first 3 years of implementation

ObjectivesTo evaluate the impact of the GOALS (Getting Our Active Lifestyles Started) family-based childhood obesity treatment intervention during the first 3 years of implementation.DesignSingle-group repeated measures with qualitative questionnaires.SettingCommunity venues...

What Can We Learn About Family-Based Obesity Treatment From Family Therapists?

The current gold standard of pediatric obesity treatment involves a family-based approach and behavioral modification, as posited by the 2007 American Academy of Pediatrics Expert Committee1 and others.2-4 However, pediatricians implementing family-based approaches typically have experience in dyadic interactions, with a child and a parent, and not entire families. Effective therapies, such as Motivational Interviewing,5 were initially utilized in areas outside of obesity, and adapted for use in weight management settings with families.6 Similarly, weight management clinicians could gain valuable insight from those experienced in family therapy, but not necessarily weight management. The goal of this study was to gain a deeper understanding of perceptions and methods of family therapists outside the field of weight management. We sought to determine which theoretical models guide their treatment and explore successful approaches to engage and retain patients to inform future interventions for pediatric obesity treatment.