Reinforced Enhanced - Families Responsibility Education Support and Health

Authoritative parenting style has been associated with decreased obesity risk in children,
increased weight loss during interventions, and can modify the delivery and impact of weight
control strategies, making them more effective. At this time, gold-standard treatment for
childhood obesity is family-based behavioral therapy (FBT). This treatment relies on
behavioral strategies and the use of praise and a positive reinforcement system to change
eating and activity behaviors, but does not target other aspects of parenting. Broadening
parenting instruction to include effective limit-setting behaviors, parent-child
communication, and authoritative parenting may increase parents' confidence and ability to
successfully make behavior changes and modify the impact of the behavioral strategies being
used. In this application, the investigators propose to test the efficacy of a 20-week
weight control program that combines traditional family-based behavioral therapy with
comprehensive parenting training (FBT-PT) and compare it to traditional family-based
behavioral therapy (FBT). The investigators hypothesize that there will be an additive
effect of parenting training such that FBT-PT will have a greater effect on child weight
loss (measured by BMI z-score) than traditional FBT. In addition, the investigators will
measure parenting style, parenting strategies, behavioral strategies, and child factors
(like impulsive behavior and temperament) to better understand the mediators and moderators
of weight loss. These measures will be obtained by standard self-report measures and
videotape encounters, allowing one to more objectively measure parenting dimensions.
Clinical outcomes, like drop-out and acceptability, will also be assessed from the two
treatment arms. The purpose of this study is to evaluate the effect of adding a
comprehensive parenting training to traditional FBT. If successful, this program will be
able to increase our ability to help children successfully lose weight.

Inclusion Criteria:

1. Children between the ages of 7 and 12 years old;

2. BMI ≥85th percentile but <100% overweight, so as to limit those children who are
morbidly obese and are in need of more intense medical treatment;

3. Children with mothers who are willing to attend 20 weekly group sessions and be
randomized to either treatment arm;

4. Have at least one parent who is overweight or obese (BMI≥25); and

5. Parents who speak English at a 5th grade level.

Exclusion Criteria:

1. Children with serious medical conditions that affect their weight;

2. Children taking medication that affect appetite or weight;

3. Children with severe developmental delay or disability that would affect
participation;

4. Children or parents with psychological illness that would limit treatment
participation;

5. Families who will move out of the area within the time frame of the study.