Like many of you, I am always looking for new resources to help my patients and their families. There is a high proportion of patients with overweight and obesity in my practice, and this proportion has only increased in the past two years. Our institution has a fitness clinic and other resources for families, but most of them require parents to take time off from work or to drive to an exercise or nutrition class after a long, hard day. While family-based behavioral therapy (FBT) has been successfully used, it requires families to commit to 20+ hours (including both group and individual sessions) over 6-12 months. Again, this is just not feasible for many families.
My eyes were thus drawn to an article that is being early released this week by Pediatrics, entitled “Guided Self-Help for Pediatric Obesity in Primary Care: A Randomized Clinical Trial,” by Dr. Kyung E. Rhee and colleagues from the University of California-San Diego (10.1542/peds.2021-055366).
The authors randomized patients aged 5-13 years with overweight/obesity and their families to either a FBT program held at UC-San Diego or a guided self-help (GSH) program. In the GSH program, families were provided with a manual that covered nutrition, physical activity, and behavioral strategies that are taught in FBT. Additionally, to promote adherence, provide accountability, and help with problem-solving, families had 14 individual sessions with a health coach. The first session was 1 hour long, and subsequent sessions were 20 minutes long.
A total of 164 families were randomized. Only 5 families (3 in the FBT program, 2 in the GSH program) dropped out. GSH participants were more than 2 times more likely to attend their sessions and were 67% less likely to miss 3 or more consecutive sessions. Both groups had significant reductions in BMI, and there was no difference between the groups.
There is a lot more in this study, which I hope you read! Importantly, this study population was largely Latino and from lower-income communities. While this may limit the generalizability of the study, a program that is successful in communities that have fewer resources is probably just as likely – if not more likely – to be successful in communities with more resources.
Programs like this are very much needed in all of our communities, and I’m hopeful that these types of programs can be expanded and scaled so that all of our families can access them.
