Parent-Only Education Program Helps Obese Preschoolers Lose Weight

By Megan Brooks

July 15, 2019

NEW YORK (Reuters Health) - A parent-only treatment program for preschoolers with obesity proved more effective than standard treatment involving the parent and child focusing on lifestyle changes in a randomized controlled trial.

"We show that parent-only obesity treatment, including parenting skills training with follow-up booster sessions (but not without), outperformed standard treatment regarding improvements in child weight status. Thus, for successful obesity treatment in preschoolers, only parents need to be involved," write the researchers online today in Pediatrics.

For the More and Less (ML) study, Dr. Anna Ek from Karolinska Institute, in Solna, Sweden, and colleagues recruited families of children 4 to 6 years of age with obesity from 68 child-care centers in Stockholm County. Participants were randomly assigned to a parent-only program (10 weekly sessions) with or without booster sessions or to standard treatment.

The parent-only program consisted of 10 weekly 90-minute sessions with a registered dietician focused on supporting parents in positive parenting practices (encouragement and limit-setting strategies) to improve parent-child communication, providing advice on healthy food habits and physical activity as well as techniques to regulate emotional control. Booster sessions consisted of 30-minute phone calls every four to six weeks for nine months.

Standard treatment was offered in outpatient pediatric clinics and was based on the action plan for childhood obesity in Stockholm County. Parents and children attended treatment together, which consisted of four or more 30-minute sessions over 12 months; the first and last with a pediatrician and the others with a pediatric nurse, with referral in some cases to a dietician or physiotherapist.

A total of 174 children (56% girls) and their parents participated, with 44 assigned to parent-only treatment with booster sessions, 43 to parent-only treatment without booster sessions and 87 to standard treatment. The children were 5 years old on average, with a BMI z score of 3.0.

After 12 months, children in the parent-only treatment group had a greater reduction in their BMI z score (0.30; 95% confidence interval, -0.45 to -0.15) compared with their peers in standard treatment (0.07; 95% CI, -0.19 to 0.05).

When comparing all three groups, improvements in weight status were only seen in the booster group (-0.54; 95% CI, -0.77 to -0.30). The booster group was 4.8 times (95% CI, 2.4 to 9.6) more likely to achieve a clinically significant reduction of at least 0.5 of the BMI z score compared with standard treatment.

In this study, intensive parent-only treatment focused on evidence-based parenting practices was "superior" to standard treatment in addressing obesity in preschoolers, with strongest effects for the booster group, write Dr. Ek and colleagues.

They note that "increased contact and length" were deciding factors because the booster group outperformed the other groups. "However, in the ML study, the highest number of visits corresponded to 21 hours, suggesting that treatments in this young age group can be less intensive but still need follow-up visits," point out.

"What sets the ML study apart from previous interventions is the large study population with sociodemographic variation in parental education and foreign background," they add. "A limitation in our study was the rate of children lost to follow-up among the families in the parent-only treatment (30%)."

"This study bolsters evidence from previous research in which intensive and parent-only obesity treatments for young children are favored," they conclude.

In email to Reuters Health, Dr. Ek said, "The ML program is manual-based and therefore easily learnt by health care personnel and easily taught to parents. The program is based on the KEEP program from the Oregon Learning Center in Eugene, Oregon. It is available in English and is now part of the large EU project Science and Technology in childhood Obesity Policy (STOP) and has been translated to Spanish and Romanian. As the program is already developed and translated, the only cost is a four-day education of group leaders plus weekly supervisions during 10 weeks. At present, the program is being implemented in to the child health care in different parts of Sweden where it has been well accepted."


Pediatrics 2019.