Adding family-based treatment to primary care obesity care lowered BMI more at 12 months

Design

Pragmatic, comparative-effectiveness randomised trial (TEAM UP) in 41 primary care practices

Population

730 children aged 6 to 15 with obesity and a participating parent, USA

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; P = .002)

TEAM UP was a pragmatic, comparative-effectiveness randomised trial in 41 primary care practices across four US states. It enrolled 730 children aged 6 to 15 with obesity, each with a participating parent (47% had Medicaid and 22% had food insecurity). All received enhanced standard care led by the primary care clinician; half also had meetings with a family-based behavioural treatment interventionist. Both lasted 12 months, and data collectors were blinded.

Percent median BMI fell by 6.4 with the added treatment (95% CI -8.29 to -4.43) and by 2.6 with standard care alone (95% CI -4.46 to -0.71), a difference of -3.8 (95% CI -6.20 to -1.34; P = .002). Weight-related quality of life also improved more with the added treatment (difference 2.0 units, 95% CI 0.05 to 4.00). No adverse events related to the trial were reported.

Many families approached declined or were excluded (901 before randomisation), so participants may be more motivated than average. Results at 18 months were collected but the 12-month end of treatment was the primary time point.

• Percent median BMI fell by 6.4 with family-based treatment added vs 2.6 with enhanced standard care alone.
• The between-group difference was -3.8 (95% CI -6.20 to -1.34).
• Weight-related quality of life improved more with the added treatment.
• Both arms improved, so the primary care-led intensive standard care was itself beneficial.
• Consider referral to family-based behavioural programmes where they exist in your area.

Why it matters

It tests behavioural treatment inside ordinary primary care practices and not specialist clinics.

Don't overread it

The trial was done in US practices with a motivated, self-selected group and the benefit at 12 months was moderate.

The statistics, in plain English

The 3.8-unit difference is a modest absolute gain in a relative-weight measure, and the interval (1.3 to 6.2) shows it could be smaller or larger. Because both arms improved, much of the benefit came from intensive primary care follow-up, which the control group also received.

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