Published August 25, 2014
“Our results show that the traditional approach to overweight prevention and treatment focusing only on the child is obsolete,” says Quattrin, UB Distinguished Professor, chair of the Department of Pediatrics and chief of the Division of Endocrinology and Diabetes.
“This study is important because while we know that it is critical to begin treating overweight or obese children early, we’ve had limited data on what works best in preschool-age children,” she says.
Children in the study were overweight or obese and had an overweight or obese parent who also participated.
Children who received treatment concurrently with a parent experienced more appropriate weight gain while growing normally in height.
Children in the intervention group gained an average of 12 pounds over 24 months, compared to children in the control group who gained almost 16 pounds. This more appropriate weight accrual resulted in a decrease of 0.21 percent over body mass index (BMI) from baseline to 24 months.
Parents in the intervention group lost an average of 14 pounds, resulting in a BMI decrease of more than 2 units, while the weight of parents in the control group was essentially unchanged.
The parents — who from a practical standpoint implemented the intervention for their children — learned about the appropriate number of food servings for children and appropriate calorie values. However, parents in the intervention group applied the same principles to themselves and modeled healthy choices.
The parents also learned to avoid “high-energy” foods, such as those with high sugar content, more than 5 grams of fat per serving or artificial sweeteners.
The parents monitored the number of servings in each food category, using a diary to cross off icons representing the food consumed or type of physical activity performed. They learned to record their own and their child’s weight on a graph.
Weight loss goals were 0.5 to 1 pound per week for children, and at least 1 pound per week for parents.
The paper suggests family-based strategies for any chronic disorder, including obesity, can be successful in primary care, Quattrin notes.
“The pediatrician’s office can become a ‘family-centered medical home,’ ” she says.
“Instead of the more traditional approach of referring these patients to a specialty clinic, the patient-centered medical home in the pediatrician’s office may be an ideal setting for implementing these family-based treatments,” says Quattrin.
“We have entered a new era where students, trainees and specialists have to learn how to better interact with primary care providers and implement care coordination.”
The research was part of Buffalo Healthy Tots, a novel family-based, weight control intervention in preschool children that Quattrin directed in urban and suburban pediatric practices in Western New York.
When funded in 2010 with a $2.6 million grant from the National Institutes of Health, the intervention was the first of its kind in the nation. The goal was to compare traditional approaches, where only the child receives treatment, to family-based, behavioral treatment implemented in pediatric primary care practices.
This study of 96 children ages 2–5 found that when overweight and obese youth and their parents received treatment in a primary care setting with behavioral intervention, parents and children experienced greater decreases in BMI than children who received traditional child-only treatment.
Parents and children sustained weight loss after a 12-month follow-up.
Quattrin notes that an important feature of the study was the use of practice enhancement assistants who had training in psychology, nutrition or exercise science and who learned about motivational interviewing and behavioral modification conducive to a healthy lifestyle.
These assistants worked with families both during educational sessions at the pediatrician’s office and afterward by phone.
She says results suggest that overweight or obese children and their parents can receive successful treatment in the primary care setting with the help of practice enhancers who assist the pediatrician in implementing the Expert Committee Recommendations for the prevention and treatment of overweight.
In addition to Quattrin, other co-authors played integral roles.
Authors from the Department of Pediatrics are:
Co-author James N. Roemmich, PhD, formerly with UB, is now with the USDA/ARS Grand Forks Human Nutrition Research Center.