One in five children between the ages of two and 19 in the U.S. are obese, but few families have access to weight-management programs designed for children. One approach that seems to help is to work with the child's healthcare provider to make weight-management a family affair.

A randomized trial led by researchers across the country recently found that family-based behavioral management delivered in the pediatrician's office can be effective in treating childhood obesity. Helping kids attain a healthy weight is seen as the best way to prevent health problems later in life.

“When children have obesity, they often need a more personalized approach to help build skills and modify behaviors. That is what family-based programs in primary care can provide,” Amanda Staiano, first author on the study, told TheDoctor.

Parents should discuss their child's body mass index and weight at well-child checkups, just as they would discuss any health concern. “Weight is part of a child's development and growth, so it should be a part of the conversation.”

More than 700 children between the ages of six and 15 with obesity participated in the five-year study. They were seen at one of 41 primary care clinics in Missouri, Louisiana, Illinois and New York. Participants were placed in one of two groups at random for one year.

One group received enhanced standard of care, meaning they had follow-up visits with their healthcare provider for obesity treatment. At these visits, they received personalized behavioral counseling and their primary care doctor monitored their progress.

To help kids stay motivated to make the kinds of lifestyle changes needed to lose weight, providers and kids' families brainstormed ways to improve children's sleep timing and duration, diet and exercise habits.

Children and their families were offered from six to 21 provider visits based on the child's progress and the family's availability and motivation.

The second group received the same enhanced standard of care plus up to 33 sessions of family-based behavioral therapy with a trained provider, such as a dietitian or social worker. Children and their parents attended about 17 behavioral therapy sessions in which they learned how to monitor and set goals around diet, physical activity and weight. Parents learned how to support and encourage their child and model healthy behaviors.

At the end of one year, children in both groups lost weight, but those in the enhanced care plus family-based behavioral therapy group lost a few more pounds. When they started the study, all the kids weighed in at 77 percent above a healthy weight. But by the end of the study, the group that got family-based therapy was down to about 70 percent above a healthy weight and the enhanced care-only group was down to about 74 percent.

Things got even better after every child in the study was followed for another six months beyond the initial one-year study period. During this follow-up period, those in the enhanced care plus behavioral therapy group lost about 1.5 times more weight than those who received enhanced care only, which was enough to improve their heart and metabolic health.

Parents of children who were in the enhanced care plus behavioral therapy group reported more improvements in their child's weight-related quality of life. They also noted more improvement in their family's diet and a greater increase in physical activity levels.

All the participants started the study at 77 percent above a healthy weight, but at the end of the study period, the group that got family-based therapy was down to about 70 percent above a healthy weight

The study took place from 2019 to 2024, so COVID-19 restrictions were in place during part of the study period. More than 75 percent of family-based behavioral therapy visits were remote telehealth. Both telehealth and in-person visits were equally successful. “We were excited to see there was no difference in effectiveness between telehealth and in-person counseling,” Staiano said.

She urges parents to discuss their child's weight with their pediatrician or family doctor at well-child checkups, just as they would any health concern. “Weight is part of a child's development and growth, so it should be a part of the conversation,” said Staiano, the director of the pediatric obesity and health behavior laboratory at the Pennington Biomedical Research Center at Louisiana State University.

Parents concerned about their children's weight can visit the American Academy of Pediatrics website where handouts are available through the organization's Institute for Healthy Childhood Weight. More information can be found on the organization's parenting website, Healthy Children.

The study is published in JAMA Pediatrics.