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Family-based weight loss therapy sessions worked just as well whether children attended or not, as long as their parents did, according to a randomized non-inferiority trial.

After 6 months of therapy, the mean change in body-mass index (BMI) for overweight and obese children who attended a family-based program was the same as for those who stayed home while their parents attended (-0.25 BMI z score; mean difference 0.001; 95% CI -0.06 to 0.06; P=0.96), reported researchers led by Kerri Boutelle, PhD, of the University of California, San Diego.

The weight changes were sustained during 18 months of follow-up after the interventions, the team wrote online in .

There were also no significant differences between the two groups for changes in the number of calories consumed per day (mean difference -2.9; 95% CI -93 to 87; P=0.95) or the number of minutes per day spent in moderate to vigorous physical activity (mean difference -0.2; 95% CI -0.58 to 0.17; P=0.28), the study found.

"In parent-based treatment, a reliable and caring adult provides all the information and reinforcement to the child and can adapt the program to the child's needs because they know the child's learning strategies and motivators," the researchers explained. "Parent-based treatment emphasizes the role of parents as the primary agent of change ... In the process of helping their child lose weight, they serve to verbally teach their children the weight control material, model healthy behaviors, and reinforce the acquisition and maintenance of healthy eating and exercise behaviors.

"In considering clinical applications, there are a number of reasons why parents would prefer one model versus the other," the team continued. "Families may prefer family-based treatment when parents believe that information delivered directly to the child is important in achieving weight loss. Family-based treatment may also be a preferable model for children who would benefit from social support. Parent-based treatment may be more enticing to families where the child does not want to come to treatment or scheduling does not permit time for family-based therapy."

In an accompanying the study, Li Ming Wen, MD, PhD, of the University of Sydney in Australia, called the study important for two reasons: "First, it shows that it is possible to engage parents only for their children in an obesity treatment program; and second, the results show that the parent-based therapy program was non-inferior to family-based therapy on child weight outcomes ... Overall, the study concluded that the parent-based therapy model is similarly effective to family-based therapy and can be considered a viable and alternative treatment model."

The two-arm trial included 150 overweight or obese children ages 8 to 12 and their parents. For the children, mean age was 10 and mean BMI was 26. Two-thirds (66%) were girls. For the parents, mean age was 43 and mean BMI was 32. About one-third (31%) of participants were Hispanic, 49% were white, and 20% were another race/ethnicity.

The participants were randomized to family-based therapy, which the parents and children attended, or to parent-based therapy, which only a parent or parents attended. Both interventions consisted of 20 1-hour group meetings followed by a half-hour individualized behavioral coaching session, delivered over 6 months. Both interventions included recommendations for diet and exercise and behavioral-modification strategies. Other than the participation of the child, the strategies were identical.

The primary outcome was change in the children's weight (BMI z score). Secondary outcomes included changes in child and parent caloric intake and physical activity and changes in parental weight. Measures were collected at baseline, 3 months, 6 months, 12 months, and 18 months.

For the two groups of parents, there were no significant differences in weight change (mean difference 0.15; 95% CI -0.40 to 0.71; P=0.10), changes in caloric intake (mean difference 13.7; 95% CI -78.4 to 105.8; P=0.77), or changes in physical activity (mean difference 0.26; 95% CI -0.05 to 0.57; P=0.10) during the study period.

The dropout rate was higher in the parent-based treatment group, and participants in this group attended a mean of two fewer meetings than the family-based group, the team reported. "Parent-based treatment was perceived to be less convenient by parents ... Unfortunately, none of the families who dropped out gave reasons beyond logistical issues, so we are unable to identify why more parent-based therapy families dropped in this study."

Boutelle and colleagues noted some study limitations, including the lack of a placebo-control intervention. In addition, the results might not be generalizable to families with children of different ages or higher BMIs.

"This study provides sound empirical evidence supporting a parent-based treatment model for the delivery of childhood obesity treatment," the team concluded. "Given the high rates of obesity in children, parent-based treatment is a model that could be used to provide treatment to a greater proportion of the population."