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Summary: Background: Family based treatment is an effective, multipronged approach to address obesity as it plagues families. Objective: To investigate the relationships among sociodemographic characteristics (e.g., education and income), body mass index (BMI) and race/ethnicity with readiness to change for parents enrolled in the Primary care pediatrics, Learning, Activity and Nutrition (PLAN) study. Methods: Multivariate linear regressions tested two hypotheses: (1) White parents will have higher levels of baseline readiness to change, when compared to Black parents; (2) parents with higher income and education will have higher levels of readiness to change at baseline. Results: A positive relationship exists between baseline parent BMI and readiness to change (Pearson correlation, 0.09, p < 0.05); statistically significant relationships exist between parent education level (−0.14, p < 0.05), income (0.04, p < 0.05) and readiness to change. Additionally, a statistically significant relationship exists, with both White (β, −0.10, p < 0.05), and Other, non‐Hispanic (−0.10, p < 0.05) parents exhibiting lower readiness to change than Black, non‐Hispanic parents. Child data did not indicate significant relationships between race/ethnicity and readiness to change. Conclusions: Results demonstrate that investigators should consider sociodemographic characteristic factors and different levels of readiness to change in participants enrolling in obesity interventions. [ABSTRACT FROM AUTHOR]

Key Points: Question: How effective is family-based behavioral treatment for childhood overweight and obesity when implemented in pediatric primary care settings? Finding: In this randomized trial with follow-up over 24 months, children, parents, and siblings with overweight or obesity assigned to undergo family-based treatment had significantly better weight loss outcomes, measured by percentage above the median body mass index for their age and sex, than those assigned to undergo usual care. Meaning: Family-based treatment can be successfully implemented in pediatric primary care settings and leads to improved weight loss outcomes among participating children and their parents and siblings. Importance: Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings. Objective: To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings. Design, Setting, and Participants: This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021. Interventions: Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress. Main Outcomes and Measures: The primary outcome was the child's change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents. Results: Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (−6.21% [95% CI, −10.14% to −2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, −2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; −1.05% [95% CI, −3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, −3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings). Conclusions and Relevance: Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families with multiple children. Trial Registration: ClinicalTrials.gov Identifier: NCT02873715 This randomized clinical trial evaluates the effects of family-based treatment implemented in primary care pediatric settings on weight change for children with overweight or obesity. [ABSTRACT FROM AUTHOR]

Objective: Our goal was to determine whether behavioral economic constructs--including impulsivity (i.e., steep discounting of delayed food and monetary rewards), the relative reinforcing value of food (RRVfood), and environmental enrichment (i.e., the presence of alternatives to unhealthy foods in the home and neighborhood environments)--are significant pretreatment predictors of overweight children's weight loss within family-based treatment. Method: Overweight children (N = 241; ages 7-12 years; 63% female; 65% non-Hispanic White) enrolled in a 16-week family-based obesity treatment with at least one parent. At baseline, children completed a task to assess RRVfood and delay discounting measures of snack foods and money to assess impulsivity. Parents completed questionnaires to assess environmental enrichment. Results: Children who found food highly reinforcing and steeply discounted future food rewards at baseline showed a blunted response to treatment compared with children without this combination of risk factors. High environmental enrichment was associated with treatment success only among children who did not find food highly reinforcing. Monetary discounting rate predicted weight loss, regardless of children's level of RRVfood. Conclusions: Investigation is warranted into novel approaches to obesity treatment that target underlying impulsivity and RRVfood. Enriching the environment with alternatives to unhealthy eating may facilitate weight loss, especially for children with low RRVfood. [ABSTRACT FROM AUTHOR]

This article presents the results of a clinical trial to compare two weight loss approaches for overweight children. Childhood obesity is a huge problem around the world and especially in the U.S. where rates of obese children have tripled since the 1970s. Obesity is well known to be a source of several serious health issues such as diabetes and heart problems. Lifestyle interventions are the best established treatments for overweight 7-12 year-olds but keeping the weight off remains a challenge. Two methods are tested here: behavioral skills maintenance (BSM) and social facilitation maintenance (SFM) are compared to no treatment at all. The study found that children on BSM and SFM did better keeping the weight off than did those in the control group but the effects diluted over time.

Family-based behavioral treatment (FBT) is an evidence-based treatment for pediatric obesity. FBT has primarily been implemented in specialty clinics, with highly trained interventionists. The goal of this study is to assess effectiveness of FBT implemented in pediatric primary care settings using newly trained interventionists who might implement FBT in pediatric practices. The goal is to randomize 528 families with a child with overweight/obesity (≥85th BMI percentile) and parent with overweight/obesity (BMI ≥ 25) across four sites (Buffalo and Rochester, New York; Columbus, Ohio; St. Louis, Missouri) to FBT or usual care and obtain assessments at 6-month intervals over 24 months of treatment. FBT is implemented using a mastery model, which provides quantity of treatment tailored to family progress and following the United States Preventive Services Task Force recommendations for effective dose and duration of treatment. The primary outcome of the trial is change in relative weight for children, and secondarily, for parents and siblings who are overweight/obese. Between group differences in the tendency to prefer small immediate rewards over larger, delayed rewards (delay discounting) and how this is related to treatment outcome is also evaluated. Challenges in translation of group-based interventions to individualized treatments in primary care settings, and in study implementation that arose due to the COVID-19 pandemic are discussed. It is hypothesized that the FBT intervention will be associated with better changes in relative weight for children, parents, and siblings than usual care. The results of this study can inform future dissemination and implementation of FBT into primary care settings. [ABSTRACT FROM AUTHOR]

Summary: Background: Children with overweight/obesity are more likely to exhibit symptoms of depression and anxiety than are their peers without overweight/obesity; however, the rates and correlates of depression and anxiety symptoms among children seeking obesity treatment remain unclear. Objectives: Examine the prevalence and associated factors of depression and anxiety symptoms among treatment‐seeking children with overweight/obesity. Methods: Children 7 to 11 years old (N = 241) and their parents completed assessments before beginning family‐based behavioral weight‐loss treatment. Disorder‐specific self‐report questionnaires assessed child depression and anxiety. The social‐ecological model served as a framework for examining factors associated with depression and anxiety symptoms. Results: Among our sample, 39.8% (96/241) met clinical cutoffs for depression and/or anxiety symptomatology. Specifically, of these 96, 48 met criteria for both depression and anxiety, 24 for depression only, and 24 for anxiety only. Child eating disorder pathology, parents' use of psychological control (ie, a parenting style characterized by emotional manipulation), and lower child subjective social status were significantly associated with greater child depression symptomatology. Child eating disorder pathology and parent psychological control were significantly associated with greater child anxiety symptomatology. Conclusion: Nearly 40% of children exhibited psychopathology symptoms, and a variety of correlates were found. Thus, pediatric weight‐loss providers may consider screening for and addressing mental health concerns (and associated factors) prior to and during treatment. [ABSTRACT FROM AUTHOR]