Published online September 28, 2009
PEDIATRICS Vol. 124 No. 4 October 2009, pp. 1060-1068 (doi:10.1542/peds.2008-3727)

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ARTICLE

Family-Based Treatment of Severe Pediatric Obesity: Randomized, Controlled Trial

Melissa A. Kalarchian, PhD^a, Michele D. Levine, PhD^a, Silva A. Arslanian, MD^b, Linda J. Ewing, PhD, RN^a, Patricia R. Houck, MS^a, Yu Cheng, PhD^c, Rebecca M. Ringham, PhD^a, Carrie A. Sheets, MS^a and Marsha D. Marcus, PhD^a

Departments of ^a Psychiatry
^b Pediatrics University of Pittsburgh School of Medicine, and Department of
^c Statistics, University of Pittsburgh, Pittsburgh, Pennsylvania

OBJECTIVE: We evaluated the efficacy of family-based, behavioral weight control in the management of severe pediatric obesity.

METHODS: Participants were 192 children 8.0 to 12.0 years of age (mean ± SD: 10.2 ± 1.2 years). The average BMI percentile for age and gender was 99.18 (SD: 0.72). Families were assigned randomly to the intervention or usual care. Assessments were conducted at baseline, 6 months, 12 months, and 18 months. The primary outcome was percent overweight (percent over the median BMI for age and gender). Changes in blood pressure, body composition, waist circumference, and health-related quality of life also were evaluated. Finally, we examined factors associated with changes in child percent overweight, particularly session attendance.

RESULTS: Intervention was associated with significant decreases in child percent overweight, relative to usual care, at 6 months. Intent-to-treat analyses documented that intervention was associated with a 7.58% decrease in child percent overweight at 6 months, compared with a 0.66% decrease with usual care, but differences were not significant at 12 or 18 months. Small significant improvements in medical outcomes were observed at 6 and 12 months. Children who attended 75% of intervention sessions maintained decreases in percent overweight through 18 months. Lower baseline percent overweight, better attendance, higher income, and greater parent BMI reduction were associated with significantly greater reductions in child percent overweight at 6 months among intervention participants.

CONCLUSIONS: Intervention was associated with significant short-term reductions in obesity and improvements in medical parameters and conferred longer-term weight change benefits for children who attended 75% of sessions.

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Key Words: behavioral intervention • childhood obesity • obesity treatment • weight management

Abbreviations: CHQ-PF50—Child Health Questionnaire, Parent Version • ITT—intent-to-treat

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Accepted May 28, 2009.

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