Family-based treatment of children with severe obesity in a public healthcare setting: Results from a randomized controlled trial

Abstract

To compare the effectiveness of family-based behavioural social facilitation treatment (FBSFT) versus treatment as usual (TAU) in children with severe obesity. Parallel-design, nonblinded, randomized controlled trial conducted at a Norwegian obesity outpatient clinic. Children aged 6-18 years referred to the clinic between 2014 and 2018 were invited to participate. Participants were randomly allocated using sequentially numbered, opaqued, sealed envelopes. FBSFT (n = 59) entailed 17 sessions of structured cognitive behavioural treatment, TAU (n = 55) entailed standard lifestyle counselling sessions every third month for 1 year. Primary outcomes included changes in body mass index standard deviation score (BMI SDS) and percentage above the International Obesity Task Force cut-off for overweight (%IOTF-25). Secondary outcomes included changes in sleep, physical activity, and eating behaviour. From pre- to posttreatment there was a statistically significant difference in change in both BMI SDS (0.19 units, 95% confidence interval [CI]: 0.10-0.28, p < .001) and %IOTF-25 (5.48%, 95%CI: 2.74-8.22, p < .001) between FBSFT and TAU groups. FBSFT participants achieved significant reductions in mean BMI SDS (0.16 units, (95%CI: -0.22 to -0.10, p < .001) and %IOTF-25 (6.53%, 95% CI: -8.45 to -4.60, p < .001), whereas in TAU nonsignificant changes were observed in BMI SDS (0.03 units, 95% CI: -0.03 to 0.09, p = .30) and %IOTF-25 (-1.04%, 95% CI: -2.99 to -0.90, p = .29). More FBSFT participants (31.5%) had clinically meaningful BMI SDS reductions of ≥0.25 from pre- to posttreatment than in TAU (13.0%, p = .021). Regarding secondary outcomes, only changes in sleep timing differed significantly between groups. FBSFT improved weight-related outcomes compared to TAU.

Keywords: adolescent; behavioural treatment; children; family-based treatment; paediatric obesity; randomized controlled trial.

FIGURE 1

Flow chart showing the FABO study design (modified from study protocol previously described). Coloured boxes represent study measurement time points. Evaluation 1: DXA, BIA, BP, height, weight, waistC. Evaluation 2: actigraphy, sleep and physical activity. Evaluation 3: questionnaire assessment (DEBQ, YEDE‐Q, YSR, CBCL, CDI, SPPC). Evaluation 4: BIA, BP, height, weight, waistC, questionnaire assessment (as for Evaluation 3). BTPS: applied after 12 FBSFT sessions and in dropout population. Abbreviations: BIA, bioelectrical impedance analysis; BP, blood pressure; BTPS, Barriers to Treatment Participation Scale; CBCL, Child Behaviour Checklist; CDI, Children's Depression Inventory; DEBQ, Dutch Eating Behaviour Questionnaire; DXA, dual‐energy X‐ray absorptiometry; FBSFT, family‐based behavioural social facilitation treatment; mo, months; SPPC, Self‐Perception Profile for Children; TAU, treatment as usual; waistC, waist circumference; YEDE‐Q, Youth Eating Disorder Examination Questionnaire; YSR, The Youth Self‐Report

FIGURE 2

Individual variation in BMI SDS change from pretreatment to posttreatment for family‐based behavioural social facilitation treatment (FBSFT) and treatment as usual (TAU) groups. Each bar represents the change in a single patient