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期刊来源：JAMA

文献发表时间：2023-06-13

原文链接：https://jamanetwork.com/journals/jama/article-abstract/2805906

关键点内容如下：

问题

儿童超重和肥胖的家庭行为治疗在儿科初级保健机构实施时的效果如何？

调查结果

在这项随访超过24个月的随机试验中，超重或肥胖的儿童、父母和兄弟姐妹被分配接受基于家庭的治疗，其减肥效果明显好于那些被分配接受常规护理的儿童、家长和兄弟姐妹，这是通过高于其年龄和性别的中等体重指数的百分比来衡量的。

意义

以家庭为基础的治疗可以在儿科初级保健机构成功实施，并改善参与儿童及其父母和兄弟姐妹的减肥效果。

摘要内容如下：

重要性

国家指南建议对儿童超重和肥胖进行强化行为干预，但目前主要在专科诊所提供。缺乏证据表明其在儿科初级保健环境中的有效性。

目标

评估在儿科初级保健中实施的超重或肥胖家庭治疗对儿童及其父母和兄弟姐妹的影响。

研究对象

这项随机临床试验在美国4个地区招募了452名6至12岁的超重或肥胖儿童、他们的父母和106名兄弟姐妹。参与者被分配接受以家庭为基础的治疗或常规护理，并随访24个月。该试验于2017年11月至2021年8月进行.

暴露因素

以家庭为基础的治疗使用各种行为技术来培养家庭内的健康饮食、身体活动和养育行为。治疗目标是在24个月内进行26次治疗，教练接受过行为改变方法的培训。根据家庭进展情况对治疗次数进行个体化。

主要结果和措施

主要转归是儿童从基线到24个月时超过按年龄和性别标准化的普通美国人群中身体质量指数（BMI）中位数的百分比的变化。

次要结果

次要结果是兄弟姐妹的这一指标和父母的BMI的变化。在452对登记的儿童-父母二人组中，226人随机接受以家庭为基础的治疗，226人接受常规护理，（儿童平均[SD]年龄为9.8[1.9]岁；53%为女性；高于中位BMI的平均百分比，59.4%[n=27.0]；其中黑人153例（27.2%），白人258例（57.1%）为）；包括106个兄弟姐妹。在24个月时，接受以家庭为基础的治疗的儿童比接受常规护理的儿童有更好的体重结果，这是基于中位数BMI以上百分比变化的差异（-6.21%[95%CI，-10.14%至-2.29%]）。纵向生长模型发现，接受以家庭为基础的治疗的儿童、父母和兄弟姐妹均具有优于常规护理的结果，这些结果在6个月时明显，并维持至24个月（0至24个月时，以家庭为基础的治疗和常规护理高于中位BMI的百分比变化为0.00%[95%CI，-2.20%至2.20%]，而儿童为6.48%[95%CI，4.35%-8.61%]；父母为-1.05%[95%可信区间，-3.79%至1.69%]vs 2.92%[95%可信区间，0.58%-5.26%]；同胞）分别为0.03%[95%CI，-3.03%至3.10%]和5.35%[95%CI，2.70%-8.00%]。

结论和相关性

以家庭为基础的儿童超重和肥胖治疗在儿科初级保健机构成功实施，并在24个月内改善了儿童和父母的体重结果。未接受直接治疗的兄弟姐妹的体重也有所改善，这表明这种治疗可能为有多个孩子的家庭提供了一种新的方法。

英文原文如下：

Key Points

Question  How effective is family-based behavioral treatment for childhood overweight and obesity when implemented in pediatric primary care settings?

Finding  In this randomized trial with follow-up over 24 months, children, parents, and siblings with overweight or obesity assigned to undergo family-based treatment had significantly better weight loss outcomes, measured by percentage above the median body mass index for their age and sex, than those assigned to undergo usual care.

Meaning  Family-based treatment can be successfully implemented in pediatric primary care settings and leads to improved weight loss outcomes among participating children and their parents and siblings.

Abstract

Importance  Intensive behavioral interventions for childhood overweight and obesity are recommended by national guidelines, but are currently offered primarily in specialty clinics. Evidence is lacking on their effectiveness in pediatric primary care settings.

Objective  To evaluate the effects of family-based treatment for overweight or obesity implemented in pediatric primary care on children and their parents and siblings.

Design, Setting, and Participants  This randomized clinical trial in 4 US settings enrolled 452 children aged 6 to 12 years with overweight or obesity, their parents, and 106 siblings. Participants were assigned to undergo family-based treatment or usual care and were followed up for 24 months. The trial was conducted from November 2017 through August 2021.

Interventions  Family-based treatment used a variety of behavioral techniques to develop healthy eating, physical activity, and parenting behaviors within families. The treatment goal was 26 sessions over a 24-month period with a coach trained in behavior change methods; the number of sessions was individualized based on family progress.

Main Outcomes and Measures  The primary outcome was the child’s change from baseline to 24 months in the percentage above the median body mass index (BMI) in the general US population normalized for age and sex. Secondary outcomes were the changes in this measure for siblings and in BMI for parents.

Results  Among 452 enrolled child-parent dyads, 226 were randomized to undergo family-based treatment and 226 to undergo usual care (child mean [SD] age, 9.8 [1.9] years; 53% female; mean percentage above median BMI, 59.4% [n = 27.0]; 153 [27.2%] were Black and 258 [57.1%] were White); 106 siblings were included. At 24 months, children receiving family-based treatment had better weight outcomes than those receiving usual care based on the difference in change in percentage above median BMI (−6.21% [95% CI, −10.14% to −2.29%]). Longitudinal growth models found that children, parents, and siblings undergoing family-based treatment all had outcomes superior to usual care that were evident at 6 months and maintained through 24 months (0- to 24-month changes in percentage above median BMI for family-based treatment and usual care were 0.00% [95% CI, −2.20% to 2.20%] vs 6.48% [95% CI, 4.35%-8.61%] for children; −1.05% [95% CI, −3.79% to 1.69%] vs 2.92% [95% CI, 0.58%-5.26%] for parents; and 0.03% [95% CI, −3.03% to 3.10%] vs 5.35% [95% CI, 2.70%-8.00%] for siblings).

Conclusions and Relevance  Family-based treatment for childhood overweight and obesity was successfully implemented in pediatric primary care settings and led to improved weight outcomes over 24 months for children and parents. Siblings who were not directly treated also had improved weight outcomes, suggesting that this treatment may offer a novel approach for families withmultiple children.