A Parent Treatment Program for Preschoolers With Obesity: A Randomized Controlled Trial

Abstract

Background and objectives: Early obesity treatment seems to be the most effective, but few treatments exist. In this study, we examine the effectiveness of a parent-only treatment program with and without booster sessions (Booster or No Booster) focusing on parenting practices and standard treatment (ST).

Methods: Families of children 4 to 6 years of age with obesity were recruited from 68 child care centers in Stockholm County and randomly assigned to a parent-only program (10 weeks) with or without boosters (9 months) or to ST. Treatment effects on primary outcomes (BMI z score) and secondary outcomes (BMI and waist circumference) during a 12-month period were examined with linear mixed models. The influence of sociodemographic factors was examined by 3-way interactions. The clinically significant change in BMI z score (-0.5) was assessed with risk ratios.

Results: A total of 174 children (mean age: 5.3 years [SD = 0.8]; BMI z score: 3.0 [SD = 0.6], 56% girls) and their parents (60% foreign background; 39% university degree) were included in the analysis (Booster, n = 44; No Booster, n = 43; ST, n = 87). After 12 months, children in the parent-only treatment had a greater reduction in their BMI z score (0.30; 95% confidence interval [CI]: -0.45 to -0.15) compared with ST (0.07; 95% CI: -0.19 to 0.05). Comparing all 3 groups, improvements in weight status were only seen for the Booster group (-0.54; 95% CI: -0.77 to -0.30). The Booster group was 4.8 times (95% CI: 2.4 to 9.6) more likely to reach a clinically significant reduction of ≥0.5 of the BMI z score compared with ST.

Conclusion: A parent-only treatment with boosters outperformed standard care for obesity in preschoolers.

Trial registration: ClinicalTrials.gov NCT01792531.

Conflict of interest statement

POTENTIAL CONFLICT OF INTEREST: The More and Less parent program is based on the parent program Keeping Foster and Kin Parents Supported and Trained. Keeping Foster and Kin Parents Supported and Trained was developed by Dr Chamberlain at the Oregon Social Learning Center (Eugene, OR), who receives royalties as the model developer. Dr Chamberlain was a consultant for the More and Less study during the completion of this work; the other authors have indicated they have no potential conflicts of interest to disclose.

Copyright © 2019 by the American Academy of Pediatrics.

Figures

FIGURE 1

Study participant flowchart.

FIGURE 2

Mean difference change over time in primary (BMI z score) and secondary (BMI and WC) outcomes comparing obesity treatments over 12 months. A, Change in BMI z score. Shown are a parent-only treatment and ST. B, Change in BMI. Shown are a parent-only treatment and ST. C, Change in WC (centimeters). Shown are a parent-only treatment and ST. D, Change in BMI z score. Shown are a parent-only treatment (Booster and No Booster) and ST. E, Change in BMI. Shown are a parent-only treatment (Booster and No Booster) and ST. F, Change in WC (centimeters). Shown are a parent-only treatment (Booster and No Booster) and ST. *P < .05, **P < .01 (group difference, with ST as a reference).

FIGURE 3

A, Three-way interactions examining the effects of the father (foreign background) on BMI z score over 12 months. Three-way interactions examining the effects of the father (no foreign background) on BMI z score over 12 months. C, Three-way interactions examining the effects of the mother (foreign background) on BMI z score over 12 months. D, Three-way interactions examining the effects of mother (no foreign background on BMI z score over 12 months. The father’s foreign background affected the result, but only in the No Booster group (P = .006). Regarding the mother’s foreign background, the difference was not significant. Foreign background was defined as a parent and grandparents born abroad or a parent born in Sweden and grandparents born abroad.