Family-based behavioral treatment (FBT) for pediatric weight loss is often provided at tertiary care academic centers and can be difficult to access. The goal of this project was to deliver a less intense Guided Self-Help (GSH) treatment for childhood obesity in the primary care setting and assess the impact on access to treatment and child BMI z-score.
We conducted a pragmatic RCT in a large pediatric network in San Diego County. Children between the ages of 5-13 years old and a BMI ≥ 85th percentile were randomized within the clinics to one of two arms. The intervention group received GSH (14 sessions over 6 months, 5.3 hrs of treatment) delivered by a health coach in the clinic. The control group received FBT (20 sessions over 6 months, 26 hrs of treatment) at the academic center in La Jolla. Cox proportional hazards and linear mixed effects models were used for analysis.
716 families were referred; 164 were randomized. Mean age of participating children was 9.7 years, BMI z-score of 2.13, 49.3% female, and >90% Hispanic. During the course of the intervention, there was greater attendance in the GSH group. Those assigned to GSH had a 64% reduced risk of dropout (HR=0.36, p<0.001) compared to those assigned to FBT (control group). Stratifying by the number of sessions attended (≤1, 2-6, ≥7), over 50% of families in GSH attended 7 or more sessions while over 50% of families in FBT attended ≤1 session. Intent to treat analysis showed a significant reduction in BMIz from baseline to post-treatment in both groups (β=0.09, S.E. 0.02, p<0.01), but no between-group differences in the rate of change in BMIz over time (β=0.021, S.E. 0.06, p=0.71).
The results of this study provide support for a novel, less intense model of obesity treatment (GSH). This model can be more easily implemented in the primary care setting and increase access to treatment for families that cannot access similar, more intense programs at academic centers.