小児科プライマリケアにおける子供の減量治療は、家族に焦点を当てたものであることが最も効果的である。(Weight-loss treatment for kids in pediatric primary care works best when family-focused)

2023-06-14

2023-06-13 バッファロー大学(UB)

◆米国バッファロー大学の研究者によって開発された、家族に焦点を当てた集中的な行動療法が、過体重または肥満の子供とその両親を対象にしています。
◆この治療法は、従来は専門クリニックでのみ利用可能でしたが、このエビデンスに基づいた治療法が初めて、米国の4つの都市で実施された多施設研究で小児医療機関で行われました。
◆研究結果は、子供と両親の体重減少効果があり、未治療の兄弟にも及ぶことを示しています。この研究は、全米心臓・肺・血液研究所の支援を受けて行われました。

<関連情報>

小児プライマリケアで実施された小児肥満に対する家族ベースの行動療法無作為化臨床試験 Family-Based Behavioral Treatment for Childhood Obesity Implemented in Pediatric Primary Care A Randomized Clinical Trial

Leonard H. Epstein, Denise E. Wilfley, Colleen Kilanowski, Teresa Quattrin, Steven R. Cook, Ihuoma U. Eneli, Nancy Geller, Daphne Lew, Michael Wallendorf, Peter Dore, Rocco A. Paluch, Kenneth B. Schechtman
American Medical Association Published:June 13, 2023
DOI:10.1001/jama.2023.8061

Key Points

Question How effective is family-based behavioral treatment for childhood overweight and obesity when implemented in pediatric primary care settings?

Finding In this randomized trial with follow-up over 24 months, children, parents, and siblings with overweight or obesity assigned to undergo family-based treatment had significantly better weight loss outcomes, measured by percentage above the median body mass index for their age and sex, than those assigned to undergo usual care.

Meaning Family-based treatment can be successfully implemented in pediatric primary care settings and leads to improved weight loss outcomes among participating children and their parents and siblings.

Abstract

Importance Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings.

Objective To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings.

Design, Setting, and Participants This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021.

Interventions Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress.

Main Outcomes and Measures The primary outcome was the child’s change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents.

Results Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (-6.21% [95% CI, -10.14% to -2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, -2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; -1.05% [95% CI, -3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, -3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings).

Conclusions and Relevance Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families withmultiple children.

Trial Registration ClinicalTrials.gov Identifier: NCT02873715