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More than 15 percent of children in Europe are overweight; another 5 percent are obese. The high prevalence of obesity emphasizes the necessity of developing evidence-based treatment programs that are useful in a clinical setting. Management of childhood obesity is commonly based on lifestyle interventions where nutrition, physical activity, and behavior modification are the main targets. To incorporate lifestyle interventions, many childhood obesity treatment models use different psychological models, such as behavior modification or cognitive behavior therapy. This paper presents the key lessons from a research program on an empirically supported family-therapy-based treatment, Standardized Obesity Family Therapy (SOFT). SOFT is based on systemic and solution-focused theories and has shown positive effects on the child with respect to degree of obesity, physical fitness, self-esteem, and family functioning in several studies. The distinguishing features of SOFT are the focus on family interactions as an important source for implementing and maintaining lifestyle changes, the multidisciplinary team approach, and a limited number of sessions (three to four per year). The main aim of this paper is to provide tools for clinicians in the field of obesity who work with families, alone or in a multidisciplinary team.

Objective: The aim was to evaluate the efficacy of a Family Weight School treatment based on family therapy in group meetings with adolescents with a high degree of obesity., Methods: Seventy-two obese adolescents aged 12-19 years old were referred to a childhood obesity center by pediatricians and school nurses and offered a Family Weight School therapy program in group meetings given by a multidisciplinary team. Intervention was compared with an untreated waiting list control group. Body mass index (BMI) and BMI z-scores were calculated before and after intervention., Results: Ninety percent of the intervention group completed the program (34 boys, 31 girls; baseline age = 14.8 +/- 1.8 years [mean +/- standard deviation, SD], BMI = 34 +/- 4.0, BMI z-score = 3.3 +/- 0.4). In the control group 10 boys and 13 girls (baseline age = 14.3 +/- 1.6, BMI = 34.1 +/- 4.8, BMI z-score = 3.2 +/- 0.4) participated in the 1-year follow-up. Adolescents in the intervention group with initial BMI z-score < 3.5 (n = 49 out of 65, baseline mean age = 14.8, mean BMI = 33.0, mean BMI z-score = 3.1), showed a significant decrease in BMI z-scores in both genders (-0.09 +/- 0.04, p = 0.039) compared with those in the control group with initial BMI z-score < 3.5 (n = 17 out of 23, mean baseline age = 14.1, mean baseline BMI = 31.6, mean baseline BMI z-score = 3.01). No difference was found in adolescents with BMI z-scores > 3.5., Conclusions: Family Weight School treatment model might be suitable for adolescents with BMI z-score < 3.5 treated with a few sessions in a multidisciplinary program.

A dramatic increase in prevalence of pediatric obesity has occurred in most countries over the past few decades. This is of particular significance given the fact that overweight children and adolescents are at increased risk for multiple medical co-morbidities, as well as psychosocial and behavioral difficulties. While considerable attention has recently been paid to identifying obesity and the importance of associated co-morbidities, there has been less focus on considerations related to effective interventions. Interventions aimed at childhood obesity include prevention and treatment. Both prevention and treatment need improvement to be useful in the clinical setting. Few investigators have demonstrated that treatment is effective. The aim of this review is to examine the effectiveness of family-based interventions in obese pediatric subjects and to explore what specific components of family-based programs are of particular significance when treating obese children. A literature search was performed and relevant studies are presented. A majority of the studies support the use of family-based treatment. Furthermore, to develop a fully interactive model, more focus is needed on the specific techniques used in evidence-based programs.

Aims: To study the influence of low-intensity solution-focused family therapy with obese and extremely obese pediatric subjects on body mass index (BMI) z-scores and self-esteem., Materials and Methods: Fifty-four obese children, aged 6-17 years, were referred to an outpatient obesity clinic. The families received solution-focused family therapy provided by a multidisciplinary team. Height and weight were recorded; BMI and BMI z-scores were derived. Self-esteem was assessed with a validated questionnaire, "I Think I Am." Parents completed "The Family Climate Scale" assessing family dynamics., Results: Eighty-one percent of the children (n =44, mean age 11.9 years, mean BMI z-score 3.67, range 2.46-5.48) and their parents participated in the follow-up. Eleven children were treated for 6-12 months, and 33 for more than 12 months. On average, the families received 3.8 family therapy sessions. Intervention resulted in a mean decrease in BMI z-score of 0.12 (p =0.0001). Self-esteem on the global scale improved after intervention (p =0.002), and also on sub-scales, depicting physical characteristics (p <0.001), psychological well-being (p =0.026), and relations with others (p =0.046). The Family Climate Scale showed improvement in the sub-scales for Expressiveness (p = 0.002) and Chaos (p =0.002)., Conclusions: Solution-focused family therapy provided by a multidisciplinary team to obese and extremely obese children may prove useful in the clinical setting, with a positive impact on obesity and self-esteem.

By observing and analyzing the influence of the therapist on the family as well as interactions between family members, the encounter with a family in a medical setting can serve to improve the health of its members, by improving their ability to use their own resources. This method of focusing on the interaction between individuals in a family or other systems has been a valuable addition to medical treatment of chronic disease. Family therapy has been shown to effectively improve treatment of diabetes, asthma and obesity. A review of the literature is presented.

Study Objective: To evaluate the effect of family therapy on childhood obesity., Design: Clinical trial. One year follow-up., Setting: Referral from school after screening., Participants: Of 1774 children (aged 10 to 11), screened for obesity, 44 obese children were divided into two treatment groups. In an untreated control group of 50 obese children, screened in the same manner, body mass index (BMI) values were recorded twice, at 10 to 11 and at 14 years of age., Intervention: Both treatment groups received comparable dietary counseling and medical checkups for a period of 14 to 18 months, while one of the groups also received family therapy., Results: At the 1-year follow-up, when the children were 14 years of age, intention-to-treat analyses were made of the weight and height data for 39 of 44 children in the two treatment groups and for 48 of the 50 control children. The increase of BMI in the family therapy group was less than in the conventional treatment group at the end of treatment, and less than in the control group (P = .04 and P = .02, respectively). Moreover, mean BMI was significantly lower in the family therapy group than in the control group (P < .05), and the family therapy group also had fewer children with BMI > 30 than the control group (P = .02). The reduction of triceps, subscapular, and suprailiac skinfold thicknesses, expressed as percentages of the initial values, was significantly greater in the family therapy group than in the conventional treatment group (P = .03, P = .005 and P = .002, respectively), and their physical fitness was significantly better (P < .05)., Conclusions: Family therapy seems to be effective in preventing progression to severe obesity during adolescence if the treatment starts at 10 to 11 years of age.