Abstract
Background/Aims The US Preventive Service Task Force recommends intensive behavioral treatment for children with BMI >85th percentile, but these programs typically rely on individual contact, making them costly and infeasible in health care. In response, we developed a group-based program, the Family Wellness Program (FWP), and piloted it in a primary care setting as a proof-of-concept.
Methods The single-arm FWP pilot teaches behavioral skills such as monitoring, goal setting, problem solving, contingency management, environmental control, and relapse prevention in separate parent and child groups. Pediatricians referred eligible families—a child aged 6–12 years with BMI ≥ the 85th percentile and a parent with BMI ≥ 25—and FWP staff followed up by phone for recruitment. Masters-level interventionists facilitated the weekly group sessions. Contact hours were 13 (over 12 weeks) for the first four cohorts and increased to 20 (16 weeks) for the last two cohorts. Primary outcomes were attendance and child and parent BMI. We present results from the first five cohorts, with a sixth underway.
Results Thirty-seven families enrolled, representing 33.6% (37 of 110) of those invited. Of families enrolled, 46.0% (17 of 37) completed the program (i.e., attended at least 75% of sessions); they constitute the study sample. All children (17 of 17, 100%) and most parents (12 of 17, 70.6%) were obese at baseline (BMI ≥ 95%ile for children, BMI ≥ 30 for adults). Immediately post-treatment, mean change in child BMI z-score was −0.11 (SD=0.12). BMI z-score decreased by .05–.10 in 6 children (35.3%) and by .10–.50 in another 6 (35.3%). In 5 children (29.4%), BMI z-score was unchanged (decrease of 0–.05). Mean change in parent BMI was −1.09 (SD=1.42), with 76.5% (13 of 17) having reduced BMI post-FWP.
Conclusions A group program for family-based behavioral pediatric weight management is feasible; however recruitment and retention are major challenges. Despite the FWP’s low intensity, child and parent BMI changes among completers are promising. A next step will be to increase the program’s intensity to that recommended by the USPSTF (>25 contact hours). Group-based treatment may represent a promising strategy for addressing pediatric obesity in health delivery systems.
