Background: Multicomponent family-based behavioral treatment (FBT) program for pediatric obesity includes nutrition and physical activity education, as well as behavior therapy techniques. Studies suggest that parent weight loss is the best predictor of child weight loss in FBT. However, given the important role that parents play in the implementation of FBT for their child, isolating the effects of specific FBT treatment component requires consideration of parent influences over time.
Methods: The following treatment components were assessed: stimulus control (high/low-fat food items in home), nutrition knowledge, energy intake, physical activity, and parental monitoring, as well as weekly anthropometric measures. Adjusted models of interest using inverse probability weights were used to evaluate the effect of specific FBT components on time-varying child weight loss rate, adjusting for time-varying influence of parent weight loss.
Results: One hundred thirty-seven parent-child dyads (CHILD: mean BMI = 26.4 (3.7) and BMIz = 2.0 (0.3); mean age = 10.4 (1.3); 64.1% female; ADULT: mean BMI = 31.9 (6.3); mean age = 42.9 (6.5); 30.1% Hispanic parents; 87.1% female) participated in an FBT program. In traditional model, adult BMI change (b = 0.08; p < 0.01) was the most significant predictor of child weight loss rates and no other treatment components were significant (p's > 0.1). In models that accounted for potential influences from parental weight loss and differential attendance during treatment period, lower availability of high-fat items (b = 1.10, p < 0.02), higher availability of low-fat items (b = 3.73; p < 0.01), and higher scores on parental monitoring practices (b = 1.10, p < 0.01) were associated with greater rates of weight loss, respectively.
Conclusion: Results suggest that outside of parent weight change, changes in stimulus control strategies at home and improved parental-monitoring practices are important FBT components for child weight loss.