Childhood Obesity Treatment: A Maintenance Approach

Childhood Obesity (CO) prevalence in the United States has tripled in recent decades, and
nearly 30% of children aged 6 to 11 are overweight or obese. CO is a serious public health
problem, and is associated with both immediate and long-term health problems (e.g.,
hypertension, type 2 diabetes, asthma) and psychosocial problems (e.g., social isolation,
depression, eating disorder symptomatology). Furthermore, CO is a significant risk factor
for adult obesity with several prospective studies showing that, if untreated, about half of
overweight grade-school children remain obese as adults. Fortunately, children respond
favorably to family-based behavioral weight loss treatment (FBT), the most well-established
intervention for the treatment of overweight in children 7 to 12 years old. Weight loss
treatments for overweight children have been associated with significant physical and
psychosocial health benefits; however, despite initial success with lifestyle interventions,
considerable relapse often occurs once treatment ends. Clearly, CO is a significant public
health problem, and long-term maintenance of weight loss remains a priority to stem the
increased costs to the individual and society. Therefore, we propose to conduct a multi-site
randomized controlled trial with overweight children (N=241) and their parents (N=241) [for
a total N=482]. All participants will complete 4 months of FBT and then be randomized to one
of three, 8-month maintenance conditions: (1) Weight Maintenance Therapy, who will receive
SFM - Low Dose [LOW] (16 sessions over 8 months), (2) Intensive Weight Maintenance Therapy,
who will receive SFM - High Dose [HIGH] (32 sessions over 8 months), or (3) Current Standard
of Care, who will receive Weight Maintenance Education (16 sessions over 8 months). Relative
weight and associated outcomes will be assessed at 0 (pre-weight loss), 4 (post-weight
loss), 12 (post-maintenance treatment),18 months and 24 months. Additionally, brief
assessments will be conducted at four points during the course of maintenance treatment to
measure presumed mediators.

Inclusion Criteria:

- Children will be between the ages of 7 and 11 and at or above the 85th percentile for
weight.

- At least one parent of the participating child must be overweight (BMI ≥ 25).

- One parent must agree to attend all parent/child treatment meetings as the
participating parent.

- Participants must be able to speak and comprehend English.

Exclusion Criteria:

- Participating parent or child having a thought disorder, suicidality, bipolar
disorder, or drug or alcohol dependence.

- Participating parent or child having a physical disability or illness that prevents
performance of physical activity at level equivalent to a brisk walk or that places
severe restriction on diet.

- Participating parent or child being on a medication regimen that affects weight.

- Participating parent or child being involved in active psychiatric treatment for an
ongoing problem that causes either social or occupational impairment.

- Parents (participating and nonparticipating) and children having an eating disorder
(i.e., anorexia nervosa, bulimia nervosa, binge eating disorder) or having
subclinical levels of eating disturbance (i.e., reporting key eating disorder
behaviors of purging, fasting, or binge eating more than two times per month).