Parenting Training Plus Behavioral Treatment for Children With Obesity: A Randomized Clinical Trial

Abstract

Importance: Family-based behavioral treatment (FBT) is recommended for childhood obesity treatment; however, it is not effective for all families. Since parenting training (PT) has been associated with healthy weight and eating behaviors, intensive PT may augment delivery of behavior change strategies and improve child weight loss outcomes.

Objective: To compare the efficacy of child overweight or obesity treatment that adds intensive PT to standard FBT with the efficacy of FBT alone.

Design, setting, and participants: This 2-arm randomized clinical trial (Reinforced, Enhanced, Families, Responsibility, Education, Support, and Health [ReFRESH]) conducted from April 2017 to November 2022 at an academic center in San Diego, California, included children aged 7 to 12 years with overweight or obesity (body mass index [BMI]≥85th to <99.9th percentile) and one of their parents.

Interventions: Parent-child dyads were randomized 1:1 to the intervention group, which received FBT plus PT, or the control group, which received FBT alone. Both groups received twenty 60-minute sessions over 6 months with separate parent and child groups led by staff and nine 20-minute behavior change coaching sessions. The FBT plus PT group sessions incorporated additional intensive parenting skills training in an interactive format.

Main outcomes and measures: The primary outcome was change from baseline in child BMI z score and BMI as a percentage of the 95th BMI percentile (BMIp95) after treatment (month 6) and at 6- and 12-month follow-up. Secondary outcomes included the proportion of children who attained clinically meaningful weight loss (ie, reduction of ≥0.20 BMI z score units) and intervention dropout rates. Intention-to-treat analysis was conducted using linear mixed models and logistic regression.

Results: A total of 140 parent-child dyads were included, with 70 in each treatment arm. Mean (SD) child age was 9.91 (1.54) years, and baseline BMI z score was 2.28 (0.80); 71 children (50.7%) were female. There were no significant between-group differences in BMI z score or BMIp95 after treatment or at the follow-up time points. Both groups had significant decreases in weight status after treatment (combined BMI z score: β, -0.14 [95% CI, -0.21 to -0.07]; P < .001; combined BMIp95: β, -3.46 [95% CI, -5.41 to -1.51]; P < .001). More children in the FBT plus PT arm compared with the FBT arm had a reduction of at least 0.20 BMI z score units (34 [48.6%] vs 22 [31.4%]; P = .01) after treatment (adjusted odds ratio, 2.10 [95% CI, 1.01-4.47]). Both treatments were well accepted, with no between-group differences in risk of dropout (hazard ratio, 1.01 [95% CI, 0.72-1.43]).

Conclusions and relevance: In this randomized clinical trial examining the effect of parenting training on child weight status, there were no significant differences in weight status between groups; children in both groups had a significant reduction in weight status. However, more children had clinically meaningful weight loss in the FBT plus PT group. Further work is needed to determine factors associated with treatment response and changes in parenting skills.

Trial registration: ClinicalTrials.gov Identifier: NCT02976636.

Figure 1.. CONSORT Flow Diagram

FBT indicates family-based behavioral treatment; PT, parenting training.

Figure 2.. Changes in Body Mass Index (BMI) z Score and BMI as a Percentage of the 95th BMI Percentile (BMIp95) After Treatment and at 6-Month and 12-Month Follow-Up

Error bars indicate 95% CIs. FBT indicates family-based behavioral treatment; PT, parenting training.