Obesity is on the rise, and childhood obesity is increasingly becoming a problem as well. In the US, the prevalence of obesity for children aged 2-19 was 19.7% in 2022. That's 14.7 million American children and adolescents who suffer from obesity. Now, a new study suggests how interventions can be more effective: by targeting the entire family.
Family and obesity
Having overweight family and friends increases the likelihood of becoming overweight, a Harvard study found in 2007. While some people have some genetic predisposition to obesity, depending on their family history and ethnicity, the influence of family on obesity goes beyond just genetics. That's why researchers from the National Heart, Lung, and Blood Institute (NHLBI) set out to investigate how family interventions can improve childhood obesity.
The study took place in four U.S. locations over a period of four years, from 2017 to 2021. It involved 452 children aged 6 to 12 years, their parents, and 106 siblings. The families were randomly divided into two group: one received the family-based treatment and another received the usual care.
"This research shows that the healthy behaviors the treatment promotes extend beyond the parent and child being treated to potentially make the whole family healthier," says David C. Goff Jr., MD, Ph.D., director, Division of Cardiovascular Sciences, NHLBI. What's more, the fact that this weight-loss study was implemented during the COVID-19 pandemic, when many adults and children gained weight, is noteworthy.
The study found that children in the family treatment group enjoyed much better results. They were three times more likely to undergo a clinically significant reduction in obesity. Overall, 27% of the children in this group reported progress, compared to only 9% in the regular group.
"Our study is the first to test family-based treatment in primary care for children 6–12 years old and it worked for the child, for parents and even for their untreated siblings," says Leonard H. Epstein, Ph.D., senior author, SUNY Distinguished Professor and chief of the Division of Behavioral Medicine in the Department of Pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB.
"Many families with obesity have multiple children with obesity, as well as parents with obesity," says Epstein, "but traditional treatment for childhood obesity only focuses on the child; it may provide ideas about healthier foods and the recommendation to be more active, but the parent is never an active target for intervention, nor is the parent taught positive parenting."
Oftentimes, people attempt to treat obesity through a single intervention, like a one-time dietary change or weight loss surgery, but this study suggests that behavioral interventions may be more effective. In the study, family interventions included dietary plans, activity plans, education in parenting, and facilitation of behavioral changes.
The family members participated in individualized sessions. In these sessions, they were taught to self-monitor eating and activity levels. They also discussed with experts about goal setting for weight and behavior. Families met weekly for the first four months to learn the program, then bi-weekly and then monthly -- but the benefits were reported two years after the interventions.
This is an innovative approach, but it seems to work.
"Family-based therapy is unique in using up-to-date behavioral treatments to teach parents and children methods to eat healthier and be more physically active, and in the process teach positive parenting," says Epstein.
"The results of the study underscore the need for 'coaches' in the primary care setting who can help with obesity treatment as well as many other behavioral problems, such as anxiety, depression, eating disorders and a host of other issues which require psychological support and behavior modification," says Quattrin, also a pediatric endocrinologist with UBMD Pediatrics.
The findings provide a promising new path for healthcare providers, especially those in primary care settings, to treat childhood obesity more effectively. By utilizing behavioral treatments that involve the whole family, health professionals can more fully address the complex, intertwined factors that contribute to obesity.
While further research is needed to confirm and expand upon these results, the study offers an important message: combating childhood obesity isn't just about helping individual children lose weight; it's about fostering healthier lifestyle choices within the whole family environment.
Journal Reference: Leonard H. Epstein et al, Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care, JAMA (2023). DOI: 10.1001/jama.2023.8061