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Randomized Controlled Trial
. 2009 Oct;124(4):1060-8.
doi: 10.1542/peds.2008-3727. Epub 2009 Sep 28.

Family-based treatment of severe pediatric obesity: randomized, controlled trial

Melissa A Kalarchian  1 , Michele D Levine, Silva A Arslanian, Linda J Ewing, Patricia R Houck, Yu Cheng, Rebecca M Ringham, Carrie A Sheets, Marsha D Marcus
Affiliations
Randomized Controlled Trial

Family-based treatment of severe pediatric obesity: randomized, controlled trial

Melissa A Kalarchian et al. Pediatrics. 2009 Oct.

Abstract

Objective: We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity.

Methods: Participants were 192 children 8.0 to 12.0 years of age (mean +/- SD: 10.2 +/- 1.2 years). The average BMI percentile for age and gender was 99.18 (SD: 0.72). Families were assigned randomly to the intervention or usual care. Assessments were conducted at baseline, 6 months, 12 months, and 18 months. The primary outcome was percent overweight (percent over the median BMI for age and gender). Changes in blood pressure, body composition, waist circumference, and health-related quality of life also were evaluated. Finally, we examined factors associated with changes in child percent overweight, particularly session attendance.

Results: Intervention was associated with significant decreases in child percent overweight, relative to usual care, at 6 months. Intent-to-treat analyses documented that intervention was associated with a 7.58% decrease in child percent overweight at 6 months, compared with a 0.66% decrease with usual care, but differences were not significant at 12 or 18 months. Small significant improvements in medical outcomes were observed at 6 and 12 months. Children who attended > or =75% of intervention sessions maintained decreases in percent overweight through 18 months. Lower baseline percent overweight, better attendance, higher income, and greater parent BMI reduction were associated with significantly greater reductions in child percent overweight at 6 months among intervention participants.

Conclusions: Intervention was associated with significant short-term reductions in obesity and improvements in medical parameters and conferred longer-term weight change benefits for children who attended > or =75% of sessions.

Trial registration: ClinicalTrials.gov NCT00277229.

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Figures

Figure 1
Figure 1
Study design and recruitment.
Figure 2
Figure 2
Changes in child percent overweight over time (ITT). Note. There were significant effects for time (F = 6.61, df =3, 405, p = .0002) and group by time (F = 4.61 df = 3, 405, p = .004).
Figure 3
Figure 3
Changes in child medical outcomes over time. Notes. For systolic blood pressure there were effects for group (F = 13.25, df = 1, 202, p = .0003), time (F = 3.82, df = 2, 182, p = .024) and group by time (F = 3.07, df = 2, 182, p = .049) and diastolic blood pressure and effect for group (F = 5.61, 1, df = 198, p = .019). For percent body fat, there were effects for group (F = 4.10, df = 1, 204, p = .0441), time (F = 3.47, df = 2, 182, p = .0333) and group by time (F = 6.45, df = 2, 182, p = .002). For waist circumference, there was a significant effect for time (F = 68.51, df = 2, 145, p < .0001) and group by time (F = 7.53, df = 2, 145, p = .0008).
Figure 4
Figure 4
Changes in child percent overweight over time (completers). Note. There were significant effects for group (F = 9.34, df = 1, 123, p = .0027), time (F = 14.25, df = 3, 235, p = .0001) and group by time (F = 11.40, df = 3, 235, p = .0001).
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