Extra parental support helps to improve childhood obesity
Extra support for parents led to better weight development in young children with obesity than current standard treatment, researchers from Karolinska Institutet report. The researchers hope that the results, which are published in the journal Pediatrics, can help to improve care for families with very young children with obesity.
Researchers at Karolinska Institutet have studied whether a support programme focusing on parenting practices is an effective method for treating obesity in preschool children. The study included 174 children between the ages of four and six and their parents, recruited from almost 70 child health care clinics in Region Stockholm.
The families were randomly allocated into three groups: one that participated in a ten-week parent support programme for 90 minutes a week with follow-up contact for nine months; one participating in the same programme but without the follow-up contact; and one that was given standard treatment at one of 14 out-patient paediatric clinics.
Provide practical tools to the parents
“The parent programme is designed to provide practical tools to the parents – not just saying what they’re to do but how – to improve communication with their child. For example how to encourage and how to use limit setting strategies,” says the study’s corresponding author Anna Ek, researcher at the Department of Clinical Science, Intervention and Technology, Karolinska Institutet. “A lot of it is about focusing on the behaviour you want to see more of. The treatment is manual based but is adapted to the needs of each group.
The researchers based the parent support programme on an American programme developed by Patricia Chamberlain at the Oregon Social Learning Center, supplementing it with material relevant to weight management, such as advice on portion sizes and screen time. The Swedish study, called More and Less (Mer och Mindre), was supervised by Dr Paulina Nowicka, researcher at Karolinska Institutet and Uppsala University.
The design of the standard treatment varied somewhat, but most often, the parents and their child first had an appointment with a paediatrician and then follow-up appointments with a paediatric nurse.
The standard treatment comprised an average of 5.5 appointments during the year of the study; the group that had follow-up telephone calls had an average of 12 contact occasions (group sessions and telephone calls) while the group without follow-up contact had an average of 6.5 contact occasions a year. The researchers measured the children’s weight and height prior to the study and after three, six and twelve months in order to evaluate its effect on their weight status (calculated as BMI SDS, a standard measure of children’s weight adjusted for age and sex).
Treating obesity from an early age
After twelve months, the children whose parents had participated in the parent programme had improved their weight status more than those who had received the standard treatment. The children in the parent programme group with follow-up had the greatest decrease in BMI SDS: -0.54 compared with -0.11 for the parent group without follow-up and -0.04 for the group receiving the standard treatment.
More of the children whose parents had taken part in the programme also achieved a clinically relevant reduction of their BMI SDS; i.e. a reduction that leads to improved metabolic and cardiovascular health (-0.5). After one year, the probability of reducing the BMI SDS by 0.5 was five times higher for children in the parent group with follow-up compared with the standard treatment group.
“Our results show that treating obesity from an early age in this way is effective,” says Dr Ek. “The treatment needs to be intensive, and it’s enough to meet the parents to bring about a change in the children’s weight development. We can’t say from this study which parts of the programme that caused the effect, but this is something we are examining in follow-up studies.”
Included in the standard treatment
One limitation of the study was the relatively high drop-out rate in the parent support group, although according to the researchers’ calculations this is unlikely to have impacted the outcome.
“A group-based intensive programme doesn’t suit all parents, and so there have to be other types of treatment available,” says Dr. Ek. “But parts of our programme could be included in the standard treatment to help create a more structured form of therapy than is currently provided.”
The study was financed with grants from the Swedish Research Council, Karolinska Institutet’s doctoral financing programme, the Swedish Society of Medicine, Vinnova, the Jerring Fund, the Samariten Foundation for Paediatric Research, the Magnus Bergvall Foundation, the Fredrik and Ingrid Thuring Foundation, the Helge Ax:son Johnson Foundation, the H.R.H. Crown Princess Lovisa Society for Child Care, the Frimurare Barnhuset (Masonic children’s home) Foundation, Foundation for Child Care, the Martin Rind Foundation, the Jane and Dan Olsson Foundations, the Clas Groschinsky Memorial Fund Foundation, the Sigurd and Elsa Golje Memorial Foundation, ìShizu Matsumuraî’s donation and the National Institute on Drug Abuse United States Public Health Service.
Co-author Patricia Chamberlain receives royalties for the development of the basic parent support programme and has acted as a consultant for the study. All other authors have declared no potential conflicts of interest.
Anna Ek, Kathryn Lewis Chamberlain, Kimmo Sorjonen, Ulf Hammar, Mahnoush Etminan Malek, Pernilla Sandvik, Maria Somaraki, Jonna Nyman, Louise Lindberg, Karin Nordin, Jan Ejderhamn, Philip A. Fisher, Patricia Chamberlain, Claude Marcus, Paulina Nowicka.
Pediatrics, online 12 juli 2019, doi: 10.1542/peds.2018-3457.