Family-based behavioural treatment in primary care more than doubled the fall in children's relative BMI

Design

Pragmatic, comparative-effectiveness randomised trial with blinded assessors (TEAM UP)

Population

730 children aged 6 to 15 with obesity, 41 US primary care practices

Primary outcome

Change in percent median BMI at 12 months

Effect

−6.4 vs −2.6; difference −3.8 (95% CI −6.20 to −1.34)

Specialist weight management for children is hard to reach. TEAM UP tested whether family-based behavioural treatment could be added inside primary care. It randomised 730 children aged 6 to 15 with obesity, each with a parent, in 41 primary care practices across four US states, to enhanced standard care led by their primary care clinician, with or without family-based treatment from a trained interventionist, for 12 months. Nearly half had Medicaid and 22% had food insecurity.

At 12 months, percent median BMI fell by 6.4 units with family-based treatment and 2.6 units with enhanced standard care alone (difference −3.8, 95% CI −6.2 to −1.3). Weight-related quality of life improved more with the combination. There were no adverse events related to the trial.

The treatment focused on healthy eating, activity, positive parenting and managing cues at home, delivered alongside the primary care visit rather than in a specialist clinic. It shows a structured, family-based programme can work at practice level across diverse families. For clinicians, it supports involving parents directly and referring to family-based programmes where they exist.

• Involve a parent directly in treatment for children with obesity, not only the child.
• Refer to a family-based behavioural programme where one is available locally.
• Focus sessions on eating, activity, parenting strategies and cues in the home environment.
• Review progress regularly and intensify support if BMI is not improving.

Why it matters

It brings an effective family-based treatment out of specialist clinics and into everyday practice.

Don't overread it

The main result is at the end of 12 months of treatment; whether the extra benefit lasts was assessed separately at 18 months.

The statistics, in plain English

Percent median BMI expresses a child's BMI relative to the median for age and sex. A between-group difference of 3.8 units is modest in absolute terms but more than doubles the effect of enhanced usual care. The confidence interval does not cross zero, so the benefit is unlikely to be chance.

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