BUFFALO, N.Y. – Primary care treatment of overweight and
obese preschoolers works better when treatment targets both parent
and child compared to when only the child is targeted, according to
research published this week in Pediatrics and conducted at the
University at Buffalo and Women and Children’s Hospital of
Children enrolled in this study were overweight or obese and had
one parent who participated in the study who also was overweight or
obese, according to body mass index (BMI) measurements, calculated
based on height and weight.
During the course of the study, children who were treated
concurrently with a parent experienced more appropriate weight gain
while growing normally in height. Children in the intervention
group gained an average of 12 pounds over 24 months compared to
children in the control group who gained almost 16 pounds.
This more appropriate weight accrual resulted in a decrease
of 0.21 percent over BMI from baseline to 24 months.
Parents in the intervention group lost an average of 14 pounds,
resulting in a BMI decrease of over 2 units while the weight of
parents in the control group was essentially unchanged.
“Our results show that the traditional approach to
overweight prevention and treatment focusing only on the child is
obsolete,” says Teresa A. Quattrin, MD, senior author and UB
Distinguished Professor, chair of the Department of Pediatrics in
the School of Medicine and Biomedical Sciences and
pediatrician-in-chief at Women and Children’s Hospital of
“This study is important because while we know that it is
critical to begin treating overweight or obese children early,
there has been limited data on what works best in preschool-aged
children,” she says.
The research was part of Buffalo Healthy Tots, a novel
family-based, weight control intervention in preschool children
that Quattrin directed in urban and suburban pediatric practices in
Western New York.
When funded in 2010 with a $2.6 million grant by the National
Institutes of Health, Buffalo Healthy Tots was the first of its
kind in the U.S. The goal was to compare traditional approaches
where only the child is treated to family-based, behavioral
treatment implemented in pediatric primary care practices.
The study of 96 children ages 2–5 found that when
overweight and obese youth and their parents were treated in a
primary care setting with behavioral intervention, parents and
children experienced greater decreases in body mass index (BMI)
than did the children who received the traditional treatment,
focusing only on the child. Weight loss for both parent and child
was sustained after a 12-month followup.
Quattrin notes that an important feature of the study was the
use of practice enhancement assistants, trained in psychology,
nutrition or exercise science. These assistants worked with the
families both during treatment and education sessions and afterward
The intervention was delivered through the parents, who were
instructed about the appropriate number of food servings for
children and appropriate calorie values. They were taught to avoid
“high-energy” foods, such as those with high sugar
content, more than 5 grams of fat per serving or artificial
Parents monitored the number of servings in each food category,
using a simple diary to cross off icons pertaining to the food
consumed or type of physical activity performed. Parents also were
taught to record their own and their child’s weight on a
Weight loss goals for children were 0.5 to 1 pound per week and
for parents it was at least 1 pound per week.
Quattrin says that the study results suggest that overweight or
obese children and their parents can be successfully treated in the
primary care setting with the assistance of practice enhancers.
“Instead of the more traditional approach of referring
these patients to a specialty clinic, the patient-centered medical
home in the pediatrician’s office may be an ideal setting for
implementing these family-based treatments,” she says.
“We have entered a new era where students, trainees and
specialists have to learn how to better interact with primary care
providers and implement care coordination. This paper suggests
that, indeed, family-based strategies for any chronic disorder,
including obesity, can be successful in primary care. The
pediatrician’s office can become a ‘family-centered
medical home.’ ”
In addition to Quattrin, other co-authors are Leonard H.
Epstein, PhD, SUNY Distinguished Professor, Michelle A. Ecker, RD,
CDE and Rocco Paluch, all of the UB Department of Pediatrics; James
N. Roemmich, PhD, of the UB Department of Pediatrics and the
USDA/ARS Grand Forks Human Nutrition Research Center; and Jihnhee
Yu, PhD, of the UB Department of Biostatistics.