AHRQ Innovations Exchange | Family-Oriented Program Combines Medical Care and Behavioral Counseling, Leading to Health Improvements in Obese Children and Adolescents

Family-Oriented Program Combines Medical Care and Behavioral Counseling, Leading to Health Improvements in Obese Children and Adolescents

Summary
The Brenner Children's Hospital's Families-in-Training (BrennerFIT) Program is an intensive, holistic treatment program for the families of obese children and adolescents between the ages of 2 and 18 years old with at least one medical complication of obesity. Throughout the 1-year program, a multidisciplinary team of professionals implements family-based behavior modification techniques and emphasizes improved nutrition and physical activity to encourage the development of healthier lifestyle habits. Anecdotal evidence suggests that BrennerFIT participants have reduced their body mass index and cardiovascular risk factors, while post-implementation data and surveys show a low dropout rate and high levels of patient/family satisfaction with the program.

See the Results section for updated information about significant reductions in body mass index scores and current program dropout rates (updated March 2010).

Evidence Rating
Suggestive: The evidence consists of anecdotal data on reductions in body mass index and cardiovascular risk factors and post-implementation surveys on patient/family satisfaction. Updated data for program-specific, post-implementation reductions in body mass index are also provided.

Developing Organizations

Brenner Children’s Hospital/Wake Forest University School of Medicine


full-text:
AHRQ Innovations Exchange | Family-Oriented Program Combines Medical Care and Behavioral Counseling, Leading to Health Improvements in Obese Children and Adolescents


Interdisciplinary Family-Oriented Programs Target Childhood Obesity

Jonathan D. Klein, MD, MPH
Associate Executive Director and Director
Julius B. Richmond Center
American Academy of Pediatrics

Obesity and its complications are major health concerns facing children and families. Obesity in childhood leads to childhood and adult type 2 diabetes, heart disease, asthma, sleep apnea, hypertension, and orthopedic problems. Psychological problems can also result, leading to low self-esteem, discrimination, depression, negative body image, and teasing and bullying.

Parents, in collaboration with health care providers, can address this unhealthy trend. Genetic, behavioral, and environmental factors contribute to children becoming overweight. However, the most common reason for unhealthy weight gain is too many calories of food and a lack of exercise. The American Medical Association/Centers for Disease Control and Prevention expert committee recommendations for childhood obesity interventions,1 the American Academy of Pediatrics guidelines, and the Institute of Medicine report calling for interventions based on the best available evidence2 underscore the importance and urgency of responding to this epidemic. The U.S. Preventive Services Task Force childhood obesity counseling recommendations call for moderate intensity counseling for obese children age 6 and up, recognizing the efficacy of prevention in improving children's health.

These three innovation profiles from academic medical centers in Kansas City, KS, Wake Forest, NC, and Boston, MA, provide models of effective family-oriented counseling programs for reducing obesity among children and youth. These programs provide moderate to intense multidisciplinary one-on-one and group education and counseling sessions for up to 1 year. Patients may be referred to these counseling programs by primary care providers, and, in some cases, they may be offered specialty obesity intervention services and ongoing primary care linked to the specialty program. For example, the Boston Children’s Optimal Weight for Life program involves primary care clinician referral of overweight or obese patients. A physician, dietitian, and psychologist provide medical evaluation, treatment and referral, nutritional counseling focusing on healthy eating and dietary modification, and behavior modification.

These programs all include important elements of successful quality improvement interventions: leadership support, engaged teams, and engaged motivated families and patients. All use some variation of multidisciplinary teams and staged approaches with increasingly intense patient and family activities to ensure engagement of motivated participants. Each program has demonstrated effectiveness in helping overweight children lose weight through developing lifestyle and food changes for children and families. The Kansas Healthy Hawks program has specific outcome data, and the Boston Children’s Optimal Weight for Life program has a randomized controlled trial and retrospective cohort data that shows positive effects of their low glycemic index diet on body mass index (BMI), fat mass, body weight, and insulin resistance. Wake Forest’s BrennerFIT program is based on a previously successful model that combines medical care with behavioral counseling and practical strategies. Its efficacy has been tested in other settings.

Children who complete the full course of sessions (and there is substantial attrition), usually experience a reduction in calorie intake and BMI. Parents, when assessed, are satisfied with these programs. This is important because family members exert a strong influence on weight loss efforts for children and adolescents. Moreover, family-based weight management programs are more successful at helping children achieve improvements in BMI than more traditional approaches.

Continued evolution of guidelines for child obesity screening and treatment may help raise clinician’s awareness of and community support for intervention programs that can influence food and lifestyle choices and reduce obesity complications. Numerous resources are available to help change both practice and policy for children's health. As screening for unhealthy weight becomes a routine part of child health supervision, these programs provide encouraging evidence of the role of obesity treatment referral programs in overcoming the barriers to promoting healthy nutrition and physical activity to children and youth.

References

1Davis MM, Gance-Cleveland B, Hassink S, et al. Recommendations for prevention of childhood obesity. Pediatrics. 2007 Dec;120 Suppl 4:S229-S253. [PubMed]

2Koplan JP, Liverman CT, Kraak VI, eds. Preventing childhood obesity: health in the balance. Institute of Medicine, National Academies Press, 2005.

full-text:
AHRQ Innovations Exchange | Expert Commentary: Family-Oriented Program Combines Medical Care and Behavioral Counseling, Leading to Health Improvements in Obese Children and Adolescents