Childhood obesity is a widespread problem in the U.S. And while research-proven behavioral treatments for obesity exist, they rely on regular one-on-one meetings with a trained health coach, making them beyond the reach of many families.
Now, researchers from Seattle-based Group Health Cooperative have found it feasible and acceptable to give this same kind of behavioral treatment to groups of families in primary care.
Paula Lozano, M.D., M.P.H., a Group Health pediatrician and assistant medical director of preventive care, published results of the cooperative’s Family Wellness Program intervention in the Permanente Journal.
The program recommends screening children for obesity from age six years — and referring children who are obese to intensive behavioral treatment. This kind of treatment provides information about healthy eating and physical activity and gives parents and children a place to share their experiences and get social support.
“Most important, behavioral treatment teaches parents and children skills like tracking their eating and activity, setting goals, and holding themselves accountable for working toward those goals,” Lozano said.
Behavioral treatment also involves taking a look at the child’s environment (the home, school, friends’ and relatives’ homes) and trying to promote healthy behaviors by making small changes across all these places where children eat and are active.
“This approach has been proven to create and sustain healthy changes in lifestyle,” she said.
Although this kind of treatment has been proven effective, it’s disappointingly hard to find.
“That’s why we set out to adapt family-based behavioral treatment to a real-world setting: in this case, primary care,” Lozano said. “And we found that it was feasible, families liked it, and parents and children lost weight.”
The Family Wellness Program had Group Health pediatricians invite families of children who are obese to participate. As other research teams have observed before, most families didn’t feel ready or willing to participate.
But about one-quarter did agree to take part. Of the 38 parent-child pairs who enrolled in the program, 24 completed the program of 12- to 16-week groups led by masters-level health coaches. Each coach helped families to create short- and long-term plans to achieve diet and exercise goals. Every week, the coach checked in with the family to see how they’d done –and held them accountable.
In the families that completed the program, children’s body mass index (BMI) improved, on average. (Because children are still growing taller, researchers measure change by looking at “standardized” BMI units, rather than weight or BMI, as used in adults.)
While the children remained obese at the end of the study, 70 percent experienced some meaningful improvement (standardized BMI decrease of 0.05) and nearly half achieved a degree of weight loss found in research studies with one-on-one treatment (standardized BMI decrease of 0.10). Parents’ BMI declined by an average of 0.9: around six pounds.
“Parents told us that their children’s quality of life improved,” Lozano said.
“For kids, the way we measure quality of life includes experiences like being bullied or excluded, being unable to keep up with other children, and feeling worried or angry. When parents tell us that their kids feel better about themselves in social settings and are happier, that is a tangible benefit of this kind of program.”
Families did best when they had good social support from friends and relatives who joined in making healthy changes. But often a child’s other parent or grandparents didn’t “get with the program” — instead sabotaging the family’s attempts to adopt healthier habits.
Researchers say the pilot is a small step toward understanding how to make intensive behavioral treatment available to families in a variety of settings (outside of research studies) where the group format makes treatment much more affordable and feasible to deliver.
These settings might include doctor’s offices, hospitals, and potentially community agencies that serve families.
Source: Group Health Research Institute