Self-guided family-based treatment effective for childhood obesity

Family-based behavioral treatment (FBT) is a clinically-proven approach to treating children with obesity in which a health care professional works with the family to help children lose weight by promoting physical activity, encouraging healthy eating habits, and teaching age-appropriate behavioral skills. While FBT is traditionally led by clinicians, researchers at University of California San Diego's Center for Healthy Eating and Activity Research (CHEAR) have now found that self-guided FBT is just as effective in helping children lose weight compared to traditional approaches. It is also more flexible in terms of scheduling, costs significantly less and requires fewer contact hours with a provider. The results were recently published in Pediatrics.

Traditional FBT is an effective treatment for children with obesity, but it can be time-intensive, can only be offered at specific times, and is expensive, which makes families facing difficult financial circumstances less likely to seek treatment. By providing the same core skills as traditional FBT in a more flexible and condensed format, we can increase access to treatment for families who may not be able to participate in traditional group-based programs."

Kerri Boutelle, Ph.D., senior author, director of CHEAR and professor in the Departments of Pediatrics and Psychiatry at UC San Diego School of Medicine and the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science

About one-in-five children in the U.S. has obesity, according to 2017–2018 data from the National Health and Nutrition Examination Survey (NHANES). Obesity is associated with a wide range of negative health outcomes in children, such as increased risk of developing type 2 diabetes, high blood pressure and asthma. Obesity in children is also associated with mental health concerns such as depression, anxiety, low self-esteem and social isolation. Unlike obesity in adults, which is often managed individually, helping children lose weight is a family effort.

The researchers developed a guided self-help version of FBT that can be delivered through 20-minute biweekly visits, providing written educational materials for families to work through in between sessions. Traditional FBT is more time intensive, and is offered in weekly 60-minute parent and child separate group sessions in addition to 20-minute biweekly sessions. To determine whether the self-guided approach was as effective as standard FBT, the researchers randomly assigned 150 parent/child pairs to receive either traditional or self-guided FBT. They then compared the children's weight loss during treatment and at follow-up visits six, 12 and 18 months later.

The researchers found that self-guided FBT resulted in similar child weight losses to traditional FBT, but with much less contact time with a provider: 5.3 hours for self-guided versus 23 hours for traditional FBT. The cost of self-guided FBT was also significantly lower than traditional FBT: $1,498 per family for self-guided versus $2,775 per family for traditional FBT.

By demonstrating the efficacy of self-guided FBT, the study offers a more accessible solution to the growing crisis of obesity among children and throws a wrench in the idea that helping children lose weight requires substantial clinical resources.

"Previous studies suggest that outcomes are improved with more contact hours, but our findings show that it may not be so simple," said Boutelle. "We're finding that the most important thing is working with parents, which can be done without a trained clinician. While some families may benefit from the standard approach, providing more flexible and accessible alternatives like self-guided FBT can help us make a wider impact on the epidemic of childhood obesity."

Coauthors of the study include Kyung E. Rhee, Rebecca S. Bernard, Dawn M. Eichen and Natacha Akshoomoff and Michael A. Manzano at UC San Diego School of Medicine; David R. Strong and Cheryl A.M. Anderson at UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science; Bess H. Marcus at Brown University and Scott Crow at University of Minnesota.

The study was funded by the National Institutes of Health (grants R01DK10868, UL1TR001442).