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Published on: February 2, 2017
Family-Centered Child Obesity Treatment: The TEAM UP Randomized Clinical Trial
Amanda E Staiano1, Stephen R Cook2, Richard I Stein3
1Pennington Biomedical Research Center, Baton Rouge, Louisiana.
Insights
Enhanced standard of care with family-based behavioral treatment (ESOC+FBT) significantly reduced pediatric obesity more than ESOC alone. This approach is feasible for diverse populations, improving quality of life.
Area of Science:
- Pediatric Obesity Management
- Comparative Effectiveness Research
- Behavioral Health Interventions
Background:
- Limited access to pediatric weight management services impacts families.
- Childhood obesity is a significant public health concern requiring effective interventions.
- Primary care settings offer a potential venue for obesity treatment delivery.
Purpose of the Study:
- To compare the effectiveness of enhanced standard of care with family-based behavioral treatment (ESOC+FBT) versus ESOC alone in reducing relative weight in children and adolescents.
- To evaluate the impact of ESOC+FBT on children's quality of life.
- To assess the feasibility of ESOC+FBT in diverse primary care settings.
Main Methods:
- Pragmatic, comparative-effectiveness randomized clinical trial involving 730 children aged 6-15 with obesity.
- Interventions included ESOC (PCP-led) and ESOC+FBT (additional behavioral intervention).
- Primary outcome was change in percent median BMI at 12 months; quality of life was also assessed.
Main Results:
- ESOC+FBT resulted in a significantly greater reduction in percent median BMI (-6.4%) compared to ESOC alone (-2.6%).
- Between-group difference in BMI reduction was -3.8 units (P=.002).
- Both groups showed improved quality of life, with greater gains in the ESOC+FBT group.
Conclusions:
- ESOC+FBT is more effective than ESOC alone in reducing pediatric obesity.
- Integrating FBT into primary care is valuable and feasible across diverse populations.
- This approach shows promise for improving health outcomes and quality of life for children with obesity.
Importance:
Families have limited access to pediatric weight management services.
Objective:
To compare the effectiveness of enhanced standard of care (ESOC) with family-based behavioral treatment (FBT) vs ESOC alone in reducing percent over median body mass index (percent median BMI) among children and adolescents with obesity. ESOC+FBT was hypothesized to reduce relative weight more than would ESOC alone.
Design, Setting, And Participants:
This was a pragmatic, comparative-effectiveness randomized clinical trial (2019-2024). Data collectors were blinded, and patients were followed up at 18 months. The setting included a total of 41 primary care clinical practices in Louisiana, New York, Missouri, and Illinois. Children and adolescents aged 6 to 15 years with obesity were referred by their primary care practitioner (PCP) or self-selected into the trial.
Interventions:
ESOC was led by the PCP and intensified depending on a child's response. ESOC+FBT included all ESOC components plus meetings with an FBT interventionist, focusing on nutritious eating, physical activity, positive parenting strategies, and management of social and environmental cues. Both interventions lasted 12 months.
Main Outcomes And Measures:
Change in percent median BMI at 12 months (end of treatment).
Results:
A total of 1631 parents completed the web screen for their child, and 901 parent-child dyads were excluded or declined participation before randomization. The final sample of 730 children, each with a participating parent, had a mean (SD) age of 10.8 (2.5) years, 387 (54%) were female, 337 (47%) had Medicaid, and 160 (22%) had food insecurity. At the end of the treatment period, children in the group receiving ESOC+FBT experienced a significant reduction in percent median BMI (-6.4; 95% CI, -8.29 to -4.43) vs ESOC (-2.6; 95% CI, -4.46 to -0.71), with a mean between-group difference of -3.8 units (95% CI, -6.20 to -1.34 units; P = .002). Children's quality of life improved across both treatment arms at months 12 and 18. Similarly, weight-associated quality of life improved in both treatment arms, with greater improvements in ESOC+FBT at the end of the treatment period (6.8; 95% CI, 5.33-8.30 vs 4.8; 95% CI, 3.40-6.17; difference, 2.0 units; 95% CI, 0.05-4.00 units). There were no adverse events related to trial participation.
Conclusions And Relevance:
Results of this randomized clinical trial show that ESOC+FBT demonstrated a significantly larger reduction in child percent median BMI than did ESOC alone. These findings support the added value of incorporating FBT into pediatric primary care settings and its feasibility in reaching a geographically and socioeconomically diverse patient population.
Trial Registration:
ClinicalTrials.gov Identifier: NCT03843424.
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