Childhood obesity remains a serious health problem in the United States, with one in five children affected. The US Preventive Services Task Force now recommends that pediatricians screen for obesity during primary care visits and refer families to behavioral intervention programs. While there is a growing interest in offering these services, accessibility continues to challenge their success.
To address this, researchers at the University of California San Diego School of Medicine conducted a randomized clinical trial to compare a pioneering treatment program, Family-Based Therapy (FBT), with new guided self-help (GSH) program designed to provide similar resources in a less intensive and more accessible way.
The study, published June 17, 2022, in Pediatrics, found that GSH and FBT were similarly effective in supporting weight loss in children, but that families were more likely to maintain attendance at GSH.
164 children and their parents were randomly assigned to one of two programs in the clinical trial. Participants were drawn from two San Diego County clinics that primarily serve Latino families. Childhood obesity is prevalent in these neighborhoods (Escondido and Chula Vista) at 38%.
A traditional FBT program consists of 20 one-hour group sessions over six months. FBT is held in academic research centers, which adds geographic restrictions. Attrition rates in these programs are high, with many parents citing scheduling problems, transportation difficulties, competing work, and family responsibilities as contributing factors.
In response to these challenges, the GSH model was created to provide shorter treatment sessions and greater scheduling flexibility. The new program consists of 14 visits, each of 20 minutes in duration, and takes place in the child's primary care clinic. Families are given materials to practice in between sessions in a self-guided fashion, then meet on their own with a health coach to review strategies and troubleshoot problems.
Both programs teach families how to self-monitor their food intake, set healthy goals, and make changes to their home environment to encourage behavioral change. Additional sessions cover issues such as body image, bullying, and emotional health.
"The program is not framed around weight loss per se, but about developing healthy lifestyle behaviors," said study author Kyung Eri, MD, professor of pediatrics at the University of California, San Diego School of Medicine.
However, children in both groups showed significant reductions in BMI percentages, which were largely maintained at the time of the six-month follow-up. However, families assigned to GSH showed an approximately 70 percent reduction in risk of attrition and reported greater satisfaction and comfort. GSH participants attended more than half of the treatment sessions while FBT participants attended only one in five sessions on average.
"The success of the guided self-help program is very promising for both patients and clinicians," said Rey. "It's always rewarding to hear how grateful the families are for our assistance." but we have also been surprised by how grateful the doctors are to provide this program in their offices. These can be difficult conversations for them to begin with regular checkups, but knowing they had a clear and effective way of delivering care was truly theirs. Empowerment".
In the current program, health coaches at GSH were trained and employed by the research team. To maintain the program, Rey said health care groups will have to work within the existing primary care system to identify individuals who can provide these services on-site. She said the goal is to work toward a collaborative care model in which clinics employ their own behavioral counselors and support the provision of additional services in schools and community centers.
“We can't make a difference if families can't come in for treatment, so we owe it to them to make these programs as accessible and effective as possible,” Ray said.
Co-authors are Lourdes Herrera, David Strong, Eastern Kang-Sim, Yuyan Shi, and Kerri N. Boutelle, all at the University of California, San Diego.
Kyung E. Rhee, Lourdes Herrera, David Strong, Eastern Kang-Sim, Yuyan Shi, Kerri N. Boutelle. Guided Self-Help for Pediatric Obesity in Primary Care: A Randomized Clinical Trial. Pediatrics, 2022; DOI: 10.1542/peds.2021-055366