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Promising Findings Regarding Self-Guided Therapy for Obesity

February 3, 2025

Editor’s Note: Dr. Ella Perrin (she/her/hers) is a resident physician in pediatrics at Naval Medical Center San Diego. Her interests include disordered eating, obesity, decreasing weight stigma and bias, and the field of hospital medicine. The views expressed in this blog are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or the US Government. Dr. Perrin declares no conflicts of interest. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics

Excess adiposity is associated with increased risk of many negative health outcomes (hypertension, diabetes mellitus, eating disorders, etc.), which often can be seen in pediatric populations.

Although family-based therapy (FBT) is one of only a handful of evidence-based treatments for pediatric obesity, it is time and resource intensive, limiting access to treatment. Asynchronous, at-home FBT would expand access to FBT by decreasing restraints due to limited space and staffing. It would also make it more practical for families who cannot make set group meeting times due to work, lack of transportation, etc.

In an article and accompanying video abstract entitled “Guided Self-Help vs. Group Treatment for Children with Obesity: A Randomized Clinical Trial,” Kerri Boutelle, PhD, and colleagues from UC San Diego, Brown University, and the University of Minnesota compare the efficacy of a primarily virtual FBT program and standard FBT (10.1542/peds.2024-066561).

The authors had previously developed a guided self-help version of FBT (gshFBT) that delivers FBT material to families primarily remotely. In this study they randomized participants to receive 6 months of treatment with either gshFBT or group-based FBT to determine if gshFBT is noninferior to FBT with regard to child weight outcomes. They also assessed the cost of each treatment and the effect of each treatment on parental BMI, parent and child eating behaviors, and physical activity.

All study participants were age 7–12.9 years old, with a BMI between the 85th and 99th percentiles. The FBT program consisted of weekly 60-minute meetings for psychoeducation and biweekly meetings with a behavior coach (23 hours in-person), whereas the gshFBT program provided psychoeducation via at-home manuals and had 20-minute meetings every other week with a behavior coach (5.3 hours in-person). The families were assessed at baseline, during treatment, at the end of treatment (6 months), and 6 and 12 months after completing treatment.

The study had many promising findings:

  • Both treatment groups had significant decreases in BMI (z-score and percentile).
  • There was no difference in BMI reduction between groups.
  • Parents in both groups also had a significant reduction in BMI.
  • There was no difference in minutes of moderate-vigorous physical activity or eating behaviors between groups.
  • There was no difference in attendance rate between groups.
  • There was no difference in family satisfaction between groups.

This study took place from 2017 to 2023, so it was interrupted by the COVID-19 pandemic, which undoubtedly had some effect on the results. Weight loss in each group was also less than expected, possibly due to the pandemic.

Regardless, it seems clear that gshFBT is non-inferior to FBT for weight loss in this population, which has huge implications for equitable access to weight-management treatment. I hope these results encourage more centers to pursue adopting a version of FBT that is feasible for them. I know that I am excited to share them with my hospital.

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