Background

Multi-component family-based behavioral treatment program for pediatric obesity (FBT) 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 components requires consideration of parent influences over time.

Methods

Adjusted models of interest using inverse probability weights (IPW) 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. The following domains were assessed: stimulus control (high/low-fat food items in home), nutrition knowledge, energy intake, physical activity, self-monitoring, attendance and parental monitoring (Child Feeding Questionnaire; CFQ), as well as weekly anthropometric measures. 137 parent-child dyads (CHILD: mean 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.

Results

Linear mixed effect models adjusting for parent weight loss revealed that an increase of one standard deviation (SD) in high-fat items decreased the child weight-loss rate by 1.28 (p<0.01), while an increase in low-fat items increased the weight loss rate by 3.24 (p<0.01). An increase of one SD on parental monitoring score was associated with an increase in the rate of child weight loss rate by 0.76 (p<0.01). Without IPW, adult BMI change (b=0.08; p<0.01) was the most significant predictor of child weight loss and no other components were significant (p’s>0.1).

Conclusions

These results suggest that outside of parent weight change, changes in high/low-fat food items at home and decreasing parent-monitoring practices are important FBT components for child weight loss.