Family-Centered Child Obesity Treatment

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.