Pediatric Weight Management (PWM) Family Participation in Treating Pediatric Obesity in Children and Adolescent Obesity Treatment
Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.
PWM: Family Participation - Children Six to 12 Years Old
Parent or caregiver should be included in multi-component pediatric weight-management programs as an agent of change when treating children ages six to 12. A strong body of research indicates that including parents and caregivers as agents of change in the treatment of their child's obesity is associated with both short-term and longer-term (more than one year) improvements in weight status. A more limited body of research indicates that treating six- to 12-year-old children without parental participation is not effective.
PWM: Family Participation - Adolescents
Parent or caregiver may be included in multi-component pediatric weight-management programs when treating adolescents. A limited body of research indicates that programs with or without parent or caregiver participation may be effective for improvements in weight status and adiposity in adolescents.
PWM: Family Participation - Treatment Format
If parent or caregiver participation is included in child and adolescent weight-management programs, health professionals should tailor the format (e.g., group vs. individual format, parent or caregiver with child vs. parent or caregiver and child separate, etc.) to meet individual, family and program needs. Research does not show a clear superiority of one format vs. another for parent or caregiver participation.
Risks/Harms of Implementing This Recommendation
Conditions of Application
- Multi-component weight-management programs must have adequate staffing and appropriate training materials to educate parents so that they may support their child's weight management
- Clinically supervised multi-component weight-management programs require the participation of professional staff with expertise in distinct areas: Behavioral interventions, dietary interventions and physical activity interventions. Adequate screening process are also needed to address and assess the above factors.
- Organizational barriers may limit options for family participation in a multi-component program, including lack of space for physical activity and trained staff to conduct components of the intervention program
- Adequate screening for eating disorders, depression and family risk factors are necessary. Program success may be limited by the above factors.
Potential Costs Associated with Application
- Organizational costs may be increased in order to incorporate a family counseling component
- Because of the time commitment required of parents, program participation may be limited by parent schedules
- If organizational and program costs are passed on to participants, this could limit program access
- The absence of health insurance coverage for weight management could limit program access.
Recommendation: Children (Ages Six to 12 Years)
A strong body of research (21 studies exclusively of children and 12 studies of mixed children and adolescent subjects) on programs that include a family counseling component as part of a multi-component treatment program for pediatric obesity indicates that family counseling is associated with improvements in child adiposity, both post-treatment and in the longer term (more than one year). See What is the effectiveness of family-based counseling as a part of an intervention program to treat obesity in children (ages 6-12)? (Grade I).
The body of research that directly compares the inclusion of a family counseling component to a child-alone approach is more limited (only five studies). See Is counseling children (ages six to 12) for weight loss in the absence of their parents effective? (Grade III). This research is limited because:
- Treatment of younger children in the absence of their parents is not the norm, so it is not surprising that so few studies use a child-only approach for treating overweight in this population
- The studies are older (three studies are between 10 and 22 years old) and family counseling techniques have developed during the intervening period
- The more recent studies are of neutral quality.
Additionally, the research comparing different methods of family involvement is quite limited and does not afford us the ability to judge what method of family counseling is best.
In sum, while we can confidently assert that including family counseling as part of a multi-component child weight-management program is associated with improved adiposity outcomes, we can be much less confident that omitting family counseling will have negative consequences. Also, we cannot tell from the research which formats or methods for family counseling are most strongly associated with improvements in child adiposity.
Recommendation: Adolescents (13 to 18 years)
Unlike the research on children (ages six to 12), evidence is lacking for the superiority of programs that include family participation in multi-component weight-management programs. Research indicates that adolescents are likely to improve adiposity status both in the short term and the longer term (more than one year), when they are treated with or without family participation in a multi-component weight-management program.
While the research does indicate benefits in including family participation in adolescent weight management programs (see What is the effectiveness of family-based counseling as a part of an intervention program to treat obesity in adolescents (ages 13-18)? (Grade III), research also indicates that adolescents demonstrate improvements in adiposity when treated without parents (see Is counseling of adolescents for weight loss in the absence of their parents effective?) (Grade II). Thus, while including family members in the treatment of adolescent obesity may have added benefits over treatment without family members, the research is not clear on this point.
Research comparing different formats for including family participation in treating adolescent obesity is both limited and dated. So, we cannot conclude that one format for including parental participation is better than any other in the treatment of adolescent obesity. (See the evidence analysis under Effectiveness of Different Family Treatment Formats for Treating Pediatric Obesity)
Recommendation: Family-Based Counseling
There is a strong association between the inclusion of family-based counseling as part of the childhood obesity treatment program and reductions in weight status or adiposity in children ages six to 12. See What is the effectiveness of family-based counseling as a part of an intervention program to treat obesity in children (ages 6-12)? (Grade I).
Inclusion of family counseling as part of a multi-component adolescent weight-management program may provide beneficial effects. However, definite conclusions are hampered by the fact that evidence is limited to a small number of older studies, studies of weak design and inconsistent results. See What is the effectiveness of family-based counseling as a part of an intervention program to treat obesity in adolescents (ages 13-18)? (Grade III).
Recommendation Strength Rationale
Recommendation - Children Ages Six to 12
The strength and consistency of the research on the association between the inclusion of family counseling as a part of a multicomponent child weight management program justifies a strong rating.
Recommendation - Adolescents
Research on adolescent weight-management programs indicates adiposity improvement with or without including family members in the treatment process.
Recommendation - Treatment Format
Research was inadequate to make any recommendations about the format or content of family participation.
- Risks/Harms of Implementing This Recommendation
The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).
Is counseling children (ages 6 to 12) for weight loss in the absence of their parents effective?
How does child-only treatment of obesity compare to interventions with both children (ages 6-12) and their parents (together)?
How does child-only treatment of obesity in children ages 6-12 compare to treating both child and parent in a mixed treatment format (sometimes together sometimes separate)?
How does treatment of childhood obesity in children ages 6-12 by interventions with parents and children together compare to interventions with parents and children separate?
How does child-only treatment of obesity compare to interventions with both children (ages 6-12) and their parents (separately)?
What is the effectiveness of family-based counseling as a part of an intervention program to treat obesity in children (ages 6-12)?
Is counseling of adolescents for weight loss in the absence of their parents effective?
How does adolescent-only treatment of obesity compare to interventions with both adolescents and their parents (together)?
How does adolescent-only treatment of obesity compare to interventions including both adolescent and parent in a mixed treatment format (sometimes together sometimes separate)?
How does treatment of adolescent obesity by interventions with parents and adolescents together compare to interventions with parents and adolescents separate?
How does adolescent-only treatment of obesity compare to interventions with both adolescents and their parents (separately)?
What is the effectiveness of family-based counseling as a part of an intervention program to treat obesity in adolescents (ages 13-18)?
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References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process