Written by Hannah Harp
Spoon Feed
Guided self-help family-based behavioral treatment (gshFBT) for pediatric obesity is non-inferior to traditional group-based FBT and helps to mitigate the cost and time burden of weekly meetings on staff and families.
Less is more
As rates of pediatric obesity continue to rise, learning more about which treatments have the highest yield is a must. When it comes to lifestyle changes, structured group programs that include education, behavioral therapy, and exercise are effective, but they are also resource intensive with limited capacity.
This randomized controlled trial evaluated whether gshFBT is noninferior to traditional FBT for pediatric obesity. 150 children aged 7-12.9 years with BMI 85th-99.9th percentile were randomized to 6 months of gshFBT or traditional FBT. gshFBT provided the same recommendations in 5.3 direct contact hours (20 min. meetings every other week with written materials) vs. 23 contact hours in FBT. BMI z-scores and percentiles were assessed post-treatment and at 6 and 12 month follow-ups. Results showed gshFBT achieved similar weight loss (ΔBMIz = −0.02, 90%CI −0.08 to 0.05, P = .65) at a lower cost ($1,498 vs. $2,775 per dyad), and retention rates and acceptance scores were similar.
Findings support gshFBT as a cost-effective alternative with increased reach to patients who are otherwise limited by time and transportation constraints. This study specifically looked at grade-school children with BMI percentile less than 99.9%, so its results can’t be extrapolated to include adolescents or those with higher weight. One major complication for this study was the onset of the COVID-19 pandemic, which shifted all sessions to a remote setting and brought with it a slew of unhealthy behaviors that contributed to pediatric obesity.
How will this change my practice?
I want this option in my community! I have had a handful of patients successfully complete a group FBT course, and it was effective for most of them (and fun for the kids). But for every 20 families I refer to such a program, only 1 family can manage the time, transportation, and childcare needs it takes to follow through all 6 months of treatment. I could even see gshFBT working in our community clinic, since the space, time, and staff requirements are so much lower.
Source
Guided Self-Help vs Group Treatment for Children With Obesity: A Randomized Clinical Trial. Pediatrics. 2025 Jan 29:e2024066561. doi: 10.1542/peds.2024-066561. Epub ahead of print. PMID: 39875096
