High intensity specialized intervention content following family-based intervention yields improved childhood weight loss

1. In this study of family-based intervention for childhood obesity, a specialized intervention incorporating social facilitation and behavioral skills was associated with improved weight loss results compared to education alone.

2. Interventions implemented at a greater frequency and number were associated with improved weight loss compared to less frequent sessions.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Childhood obesity is associated with significant short-term and long-term morbidity. The current study sought to evaluate the effectiveness of a family-based intervention followed by a maintenance program that addressed dietary, social, and coping behaviors delivered in varying intensity compared to an education-only control. The study found that the enhanced social facilitation maintenance [SFM+] program reduced the proportion of obese children. The program that was delivered every week (HIGH intensity) was more effective than when delivered every other week (LOW intensity).

The study demonstrates both the effectiveness of an enhanced behavioral and social-based intervention with a clear dose-response relationship for reducing childhood obesity. The study included a good number of parent-child dyads with diverse population demographics. The main limitations of the investigation included the strict academic setting and well-funded intervention that may not be easily replicated in a primary care setting.

Click to read the study in JAMA Pediatrics

Relevant Reading: Family-based models for childhood-obesity intervention: a systematic review of randomized controlled trials

In-Depth [randomized controlled trial]: This study included children aged 7-11 years who were overweight or obese with at least one parent who was overweight or obese as well. Participants were excluded if they were participating in other weight loss programs, were on medications with known effects on weight, or had psychiatric or medical conditions precluding participation. Participants participated in a four-month family-based weight loss intervention and were then randomized to either a control or intervention maintenance phase arm, with the intervention provided at low or high intensity. The control consisted of weight management education only, while the intervention included skill development in peer interactions and coping skills that can affect weight and body image. Sessions occurred weekly in the high-intensity arm, and biweekly in the low-intensity arm.

Children in the low intensity arm had reduced rates of obesity compared to the control arm (95%CI, −6.21 to −0.47; d = −0.40; p = 0.02); while High intensity was superior to both low intensity (95% CI, −6.15 to −0.59; d = −0.38; p = 0.02) and the control (95%CI, −9.57 to −3.84; d = −0.77; p < .001).

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