A randomized clinical trial comparing delivery of behavioral pediatric obesity treatment using standard and enhanced motivational approaches

Abstract

Objective: To examine the efficacy of an adjunct motivational and autonomy-enhancing intervention (self-directed) for behavioral family-based pediatric obesity relative to the standard prescription of uniform behavioral skills use and interventionist goal assignment (prescribed).

Methods: In this randomized clinical trial, 72 overweight/obese children and their parents/caregivers were assigned to either self-directed or prescribed intervention for 20 weeks, with approaches diverging after week 5. Anthropometric measurements from child and participating parent at baseline, posttreatment, and 3-month, 6-month, 1-year, and 2-year follow-ups were evaluated for change (n = 59 in follow-up analyses).

Results: The approaches demonstrated similar child body mass index (BMI) z-score and parent BMI change from baseline to posttreatment and throughout follow-up, with child and parent weight status lower than baseline at 2 years after treatment cessation.

Conclusions: An adjunct motivational and autonomy-enhancing approach to behavioral family-based pediatric obesity treatment is a viable alternative to the standard intervention approach.

Keywords: health promotion and prevention; obesity; weight management.

Figure 1.

Participant flow.

Figure 2.

Change in child BMI z-score for the prescribed and self-directed treatment approaches; *baseline to posttreatment among children randomized and attending first treatment session (n = 72); **posttreatment through all follow-ups among children with any follow-up data (n = 59); error bars indicate two standard errors above and below the mean for each approach at each time point.

Figure 3.

Categories of child BMI z-score change for assessment completers at each time point (n = 57 for posttreatment; n = 52 for 1-year follow-up; n = 46 for 2-year follow-up) and for ITT (intent-to-treat) sample of children (n = 72) assuming an increase in BMI z-score at 2-year follow-up for those with missing 2-year follow-up data (n = 26).

Figure 4.

Change in participating parent BMI for the prescribed and self-directed treatment approaches; *baseline to posttreatment among parents randomized and attending first treatment session (n = 72); **posttreatment through all follow-ups among parents with any follow-up data (n = 60); error bars indicate two standard errors above and below the mean for each approach at each time point.