Treatment outcomes of overweight children and parents in the medical home

Abstract

Objective: To test in the primary care setting the short- and long-term efficacy of a behavioral intervention that simultaneously targeted an overweight child and parent versus an information control (IC) targeting weight control only in the child.

Methods: Two- to 5-year-old children who had BMI ≥85th percentile and an overweight parent (BMI >25 kg/m2) were randomized to Intervention or IC, both receiving diet and activity education over 12 months (13 sessions) followed by 12-month follow-up (3 sessions). Parents in the Intervention group were also targeted for weight control and received behavioral intervention. Pediatricians in 4 practices enrolled their patients with the assistance of embedded recruiters (Practice Enhancement Assistants) who assisted with treatment too.

Results: A total of 96 of the 105 children randomized (Intervention n = 46; IC n = 50) started the program and had data at baseline. Children in the Intervention experienced greater reductions in percent over BMI (group × months; P = .002) and z-BMI (group × months; P < 0.001) compared with IC throughout treatment and follow-up. Greater BMI reduction was observed over time for parents in the Intervention compared with IC (P < .001) throughout treatment and follow-up. Child weight changes were correlated with parent weight changes at 12 and 24 months (r = 0.38 and 0.26; P < .001 and P = .03).

Conclusions: Concurrently targeting preschool-aged overweight and obese youth and their parents in primary care with behavioral intervention results in greater decreases in child percent over BMI, z-BMI, and parent BMI compared with IC. The difference between Intervention and IC persists after 12 months of follow-up.

Trial registration: ClinicalTrials.gov NCT01029834.

Keywords: expert committee recommendations; obesity; overweight; patient centered medical home; percent over BMI; preschool children.

Copyright © 2014 by the American Academy of Pediatrics.

Figures

FIGURE 1

This diagram summarizes the flow of study participants throughout the 12-month treatment period and 12-month follow-up. All participants who had data at baseline and received any of the allocated Intervention or Information control were included in the analysis.

FIGURE 2

Child %OBMI values (mean ± SEM) throughout the 12-month treatment period and 12-month follow-up were lower in the Intervention (open circles) compared with the IC group (solid circles). **P < 0.001; *P < 0.01.

FIGURE 3

Parent BMI values (mean ± SEM) throughout the 12-month treatment period and 12-month follow-up were lower in the Intervention (open circles) compared with the IC group (solid circles). *P < 0.001.