自己ガイド型の肥満治療がコストを削減(Guided Self-Help Makes Treating Children With Obesity Easier and More Affordable)

2025-01-30

2025-01-29 カリフォルニア大学サンディエゴ校(UCSD)

カリフォルニア大学サンディエゴ校(UCSD)の研究チームは、「家族ベースの行動療法(FBT)」のガイド付きセルフヘルプ版が、従来の臨床医主導のFBTと同等に効果的であり、かつ柔軟性と経済性に優れていることを発見しました。従来のFBTは、臨床医が家族と協力して子供の肥満治療を行う方法で、時間的・経済的負担が大きいとされていました。
◆研究チームは、20分間の隔週セッションと教育資料を組み合わせたガイド付きセルフヘルプ版FBTを開発し、150組の親子を対象に従来のFBTと比較しました。その結果、セルフヘルプ版は従来のFBTと同様の体重減少効果を示し、医療提供者との接触時間はセルフヘルプ版が5.3時間、従来のFBTが23時間と大幅に短縮され、費用もセルフヘルプ版が1,498ドル、従来のFBTが2,775ドルと低減しました。この研究は、子供の肥満治療において、よりアクセスしやすく効果的なアプローチを提供する可能性を示しています。

<関連情報>

肥満の子どもに対する指導的セルフヘルプと集団治療の比較: 無作為臨床試験
Guided Self-Help vs Group Treatment for Children With Obesity: A Randomized Clinical Trial

Kerri N. Boutelle, PhD;Kyung E. Rhee, MD, MSc, MA;David R. Strong, PhD;Michael A. Manzano, MA;Rebecca S. Bernard, PhD;Dawn M. Eichen, PhD;Cheryl C.A. Anderson, PhD, MPH;Bess H. Marcus, PhD;Natacha Akshoomoff, PhD;Scott J. Crow, MD
Pediatrics Published:January 29 2025
DOI:https://doi.org/10.1542/peds.2024-066561

BACKGROUND AND OBJECTIVES
Family-based behavioral treatment (FBT) for children with obesity is provided in weekly parent and child groups over 6 months. A guided self-help FBT program (gshFBT) is provided to the dyad in short meetings. Both interventions provide the same content; however, gshFBT provides this content in less time (FBT = 23 hours, gshFBT = 5.3 hours). This study aimed to evaluate whether gshFBT is noninferior to FBT on child weight loss and cost-effectiveness.

METHODS
150 children aged between 7.0 and 12.9 years with a BMI between the 85th and 99.9th percentile and their parent were recruited and randomized to a 6-month program of gshFBT (n = 75) or FBT (n = 75) and were followed 12 months post-treatment.

RESULTS
A total of 150 children (mean age = 10.1 years, 49% female, mean BMIz = 2.09) and their parent (mean age = 41.5 years, 87% female, 45% Hispanic, 37% White non-Hispanic, 9.7% Asian, 4.8% Black, 7.3% other) were recruited from the San Diego Metropolitan area. Joint LME models showed that gshFBT was noninferior to FBT on child weight loss (ΔBMIz = -0.02 [90% credible interval [CI] -0.08–0.05, P = .65]; ΔBMIp95% = -1.57 [90% CI –4.46–1.31, P = .28]) and cost less (cost/dyad gshFBT = $1498; FBT = $2775).

CONCLUSION
The gshFBT program provided similar weight losses for children with less contact hours and with lower cost than FBT. The reduced time and ease of scheduling for the family in gshFBT will allow for an increased reach of treatment to a greater proportion of families in need.