Boutelle Kerri N, Rhee Kyung E, Liang June, Braden Abby, Douglas Jennifer, Strong David, Rock Cheryl L, Wilfley Denise E, Epstein Leonard H, Crow Scott J
Department of Pediatrics, University of California, San Diego2Department of Psychiatry, University of California, San Diego.
Department of Pediatrics, University of California, San Diego.
JAMA Pediatr. 2017 Jul 1;171(7):622-628. doi: 10.1001/jamapediatrics.2017.0651.
Family-based weight loss treatment (FBT) is considered the gold-standard treatment for childhood obesity and is provided to the parent and child. However, parent-based treatment (PBT), which is provided to the parent without the child, could be similarly effective and easier to disseminate.
To determine whether PBT is similarly effective as FBT on child weight loss over 24 months. Secondary aims evaluated the effect of these 2 treatments on parent weight loss, child and parent dietary intake, child and parent physical activity, parenting style, and parent feeding behaviors.
DESIGN, SETTING, AND PARTICIPANTS: Randomized 2-arm noninferiority trial conducted at an academic medical center, University of California, San Diego, between July 2011 and July 2015. Participants included 150 overweight and obese 8- to 12-year-old children and their parents.
Both PBT and FBT were delivered in 20 one-hour group meetings with 30-minute individualized behavioral coaching sessions over 6 months. Treatments were similar in content; the only difference was the attendance of the child.
The primary outcome measure was child weight loss (body mass index [BMI] and BMI z score) at 6, 12, and 18 months post treatment. Secondary outcomes were parent weight loss (BMI), child and parent energy intake, child and parent physical activity (moderate to vigorous physical activity minutes), parenting style, and parent feeding behaviors.
One hundred fifty children (mean BMI, 26.4; mean BMI z score, 2.0; mean age, 10.4 years; 66.4% girls) and their parent (mean BMI, 31.9; mean age, 42.9 years; 87.3% women; and 31% Hispanic, 49% non-Hispanic white, and 20% other race/ethnicity) were randomly assigned to either FBT or PBT. Child weight loss after 6 months was -0.25 BMI z scores in both PBT and FBT. Intention-to-treat analysis using mixed linear models showed that PBT was noninferior to FBT on all outcomes at 6-, 12-, and 18-month follow-up with a mean difference in child weight loss of 0.001 (95% CI, -0.06 to 0.06).
Parent-based treatment was as effective on child weight loss and several secondary outcomes (parent weight loss, parent and child energy intake, and parent and child physical activity). Parent-based treatment is a viable model to provide weight loss treatment to children.
Clinicaltrials.gov Identifier: NCT01197443.
基于家庭的减肥治疗（FBT）被认为是儿童肥胖的金标准治疗方法，且面向家长和孩子。然而，仅面向家长的家长治疗（PBT）可能同样有效且更易于推广。
确定PBT在24个月内对儿童减肥的效果是否与FBT相似。次要目标评估这两种治疗方法对家长减肥、儿童和家长饮食摄入、儿童和家长身体活动、育儿方式以及家长喂养行为的影响。
设计、地点和参与者：2011年7月至2015年7月在加利福尼亚大学圣地亚哥分校的学术医学中心进行的双臂随机非劣效性试验。参与者包括150名8至12岁超重和肥胖儿童及其家长。
PBT和FBT均通过6个月内的20次一小时小组会议以及30分钟的个性化行为指导课程进行。治疗内容相似；唯一的区别是孩子是否出席。
主要结局指标是治疗后6个月、12个月和18个月时儿童的体重减轻（体重指数[BMI]和BMI z评分）。次要结局包括家长体重减轻（BMI）、儿童和家长的能量摄入
