Pediatric Weight Management

PWM: Family-Based Counseling (2006)

Pediatric Weight Management: Family Counseling 

Including family counseling as part of a multicomponent pediatric weight management program has become a wide-spread practice. What does the evidence tell us? Click on one of the questions below to see the evidence analysis.

To see how different formats for including parents in pediatric weight management therapy see Effectiveness of Different Family Treatment Formats for Treating Pediatric Obesity

Click here to see related evidence analysis on Parental Modeling

• Intervention
  What is the effectiveness of family-based counseling as a part of an intervention program to treat obesity in adolescents (ages 13-18)?

  • Conclusion

    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.

  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Family-based counseling as a part of an intervention program to treat childhood obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown R, Sothern M, Suskind R, Udall J, Blecker U. Racial differences in the lipid profiles of obese children and adolescents before and after significant weight loss. Clinical Pediatrics 2000; 39: 427-431.
      • Brownell KD, Kelman JH, Stunkard AJ. Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics 1983; 71: 515-23.
      • Chen W, Chen SC, Hsu HS, Lee C. Counseling clinic for pediatric weight reduction: program formulation and follow-up. J Formos Med Assoc 1997; 96 59-62.
      • Coates TJ, Killen JD, Slinkard LA. Parent participation in a treatment program for overweight adolescents. Int J Eat Disord 1982; 1: 37-48.
      • DISC. Efficacy and safety of lowering dietary intake of fat and cholesterol in children with elevated low-density lipoprotein cholesterol. The Dietary Intervention Study in Children (DISC). The Writing Group for the DISC Collaborative Research Group. JAMA 1995;273:1429-35.
      • Eliakim A, Friedland O, Kowen G, Wolach B, Nemet D. Parental obesity and higher pre-intervention BMI reduce the likelihood of a multidisciplinary childhood obesity program to succeed--a clinical observation. J Pediatr Endocrinol Metab. 2004 Aug;17(8):1055-61.
      • Eliakim A, Kaven G, Berger I, Friedland O, Wolach B, Nemet D. The effect of a combined intervention on body mass index and fitness in obese children and adolescents-a clinical experience.  Eur J Pediatr. 2002; 161:449-454
      • Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med 2000; 154 (3):220-6.
      • Epstein LH, Paluch RA, Gordy CC, Saelens BE, Ernst MM. Problem solving in the treatment of childhood obesity.  J Consult Clin Psychol 2000;68:717-21.
      • Epstein LH, Paluch RA, and Raynor HA. Sex Differences in Obese Children and Siblings in Family-based Obesity Treatment. Obesity Research 2001;9:746-753 
      • Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 1990; 264: 2519-2523.
      • Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology. 1994, 13:373-383.
      • Epstein LH, Valoski AM, Vara LS, McCurley J, Wisniewski L, Kalarchian MA, Klein KR, Shrager LR. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children.  Health Psychol 1995;14:109-15.
      • Epstein LH, Wing RR, Koeske R, and Valoski A. Effect of parent weight on weight loss in obese children.  Journal of Consulting and Clinical Psychology.  54(3):  400-401, 1986.
      • Epstein LH, Wing RR, Koeske R, Valoski A. Effects of diet plus exercise on weight change in parents and children. Journal of Consulting and Clinical Psychology 1984; 52:429-437.
      • Epstein LH, Wing RR, Koeske R, Valoski A. A Comparison of Lifestyle Exercise, Aerobic Exercise, and Calisthenics on Weight Loss in Obese Children. Behavior Therapy 1985;16;345-56.
      • Epstein LH, Wing RR, Penner BC, Kress MJ. Effect of diet and controlled exercise on weight loss in obese children.  J Pediatr 1985;107:358-61.
      • Epstein, L, Valoski A, Kalarchian M, et al. Do children lose and maintain weight easier than adults: a comparison of child and parent weight changes from six months to ten years. Obes Res 1995; 3:411-417.
      • Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM. Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993 Feb;147(2):160-6.
      • Flodmark CE, Ohlsson T, Ryden O, Sveger T. Prevention of progression to severe obesity in a group of obese schoolchildren treated with family therapy. Pediatrics 1993; 91: 880-84.
      • Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res 2004;12:357-361.
      • Golan M, Weizman A, Apter A, Fainaru M. Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr 1998;67:1130-1135.
      • Goldfield GS, Epstein LH, Kilanowski CK, Paluch RA, Kogut-Bossler B. Cost-effectiveness of group and mixed family-based treatment for childhood obesity. Int J Obes Relat Metab Disord. 2001 Dec;25(12):1843-9.
      • Graves T, Meyers AW, Clark L. An evaluation of parental problem-solving training in the behavioral treatment of childhood obesity. Journal of Consulting and Clinical Psychology 1988; 56:246-250.
      • Israel AC, Guile CA, Baker JE. An evaluation of enhanced self-regulation training in the treatment of childhood obesity. J Pediatr Psychol 1994; 19:737-49.
      • Kirschenbaum DS, Harris ES, Tomarken AJ. Effects of parental involvement in behavioral weight loss therapy for preadolescents. Behavior Therapy 1984;15:485-500. 
      • Levine, M., Ringham, R., Kalarchian, M., Wisniewski, L., and Marcus, M. Is family-based behavioral weight control appropriate for severe pediatric obesity? Int J Eat Disord. 2001 Nov;30(3):318-28.
      • McDuffie JR, Calis KA, Uswaifo GI, Sebring NG, Fallon EM, Hubbard VS, Yanovski JA. Three-month tolerability of orlistat in adolescents with obesity-related comorbidities. Obes Res 2002;10:642-650. 
      • Mellin LM, Slinkard LA, Irwin CE. Adolescent obesity intervention: validation of the SHAPEDOWN program. J Am Diet Assoc 1987; 87:333-8.
      • Miraglia del Giudice E, Santoro N, Marotta A, Nobili B, Di Toro, Perrone L. Inadequate leptin level negatively affects body fat loss during a weight reduction programme for childhood obesity. Acta Paediatr 2002; 91: 132-135.
      • Nuutinen O, and Knip M. Long-term weight control in obese children: persistence of treatment outcome and metabolic changes. International Journal of Obesity 1992;16:279-287.
      • Nuutinen O. Long-term effects of dietary counseling on nutrient intake and weight loss in obese children. Eur J Clin Nutr. 1991 Jun;45(6):287-97.
      • Obarzanek E, Kimm SY, Barton BA, Van Horn L L, Kwiterovich PO Jr, Simons-Morton DG, Hunsberger SA, Lasser NL, Robson AM, Franklin FA Jr, Lauer RM, Stevens VJ, Friedman LA, Dorgan JF, Greenlick MR; DISC Collaborative Research Group. Long-term safety and efficacy of a cholesterol-lowering diet in children with elevated low-density lipoprotein cholesterol: seven-year results of the Dietary Intervention Study in Children (DISC). Pediatrics. 2001 Feb;107(2):256-64.
      • Sothern, M., Hunter, S., Suskind R., Brown, R., Udall, J. and Blecker, U. Motivating the obese child to move: the role of structured exercise in pediatric weight management. Southern Medical Journal 1999; 92: 577-584.
      • Sothern, M., Despinasse, B., Brown, R., Suskind, R., Udall, J. and Blecker, U. Lipid profiles of obese children and adolescents before and after significant weight loss: differences according to sex. Southern Medical Journal 2000; 93: 278-282.
      • Sothern, M., Loftin, M., Udall, J., Suskind R., Ewing, T., Tang, S., & Blecker, U. Safety, feasibility and efficacy of a resistance training program in preadolescent obese children. American Journal of the Medical Sciences, 2000; 319: 370-375. 
      • Sothern, M., Schumacher, H., von Almen, T., Carlisle, L., & Udall, J. Committed to Kids: an integrated, four level team approach to weight management in adolescents. Journal of the American Dietetic Association 2002;102:S81-S85.
      • Sothern, M., Udall, J. Suskind, R., Vargas, A., & Blecker, U. Weight loss and growth velocity in obese children after very low calorie diet, exercise and behavior modification. Acta Paediatrica, 2000; 89(9): 1036-43.
      • Spieth L, Harnish J, Lenders C, Raezer L, Pereira M, Hangen SJ, Ludwig D. A Low-Glycemic Index Diet in the Treatment of Pediatric Obesity Arch Pediatr Adolesc Med 2000;154:947-951
      • Wadden, T., Stunkard, A., Rich, L., Rubin, C., Sweidel, G, McKinney, S. Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics. 1990, 85(3): 345-352.
  • Search Plan and Results: Treatment Format: Family Format 2004
     
  What is the effectiveness of family-based counseling as a part of an intervention program to treat obesity in children (ages 6-12)?

  • Conclusion

    Using family-based counseling as part of a multi-component clinical treatment program results in significant reductions in weight status and adiposity in children six to 12 years of age.

  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: Family-based counseling as a part of an intervention program to treat childhood obesity
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brown R, Sothern M, Suskind R, Udall J, Blecker U. Racial differences in the lipid profiles of obese children and adolescents before and after significant weight loss. Clinical Pediatrics 2000; 39: 427-431.
      • Brownell KD, Kelman JH, Stunkard AJ. Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics 1983; 71: 515-23.
      • Chen W, Chen SC, Hsu HS, Lee C. Counseling clinic for pediatric weight reduction: program formulation and follow-up. J Formos Med Assoc 1997; 96 59-62.
      • Coates TJ, Killen JD, Slinkard LA. Parent participation in a treatment program for overweight adolescents. Int J Eat Disord 1982; 1: 37-48.
      • DISC. Efficacy and safety of lowering dietary intake of fat and cholesterol in children with elevated low-density lipoprotein cholesterol. The Dietary Intervention Study in Children (DISC). The Writing Group for the DISC Collaborative Research Group. JAMA 1995;273:1429-35.
      • Eliakim A, Friedland O, Kowen G, Wolach B, Nemet D. Parental obesity and higher pre-intervention BMI reduce the likelihood of a multidisciplinary childhood obesity program to succeed--a clinical observation. J Pediatr Endocrinol Metab. 2004 Aug;17(8):1055-61.
      • Eliakim A, Kaven G, Berger I, Friedland O, Wolach B, Nemet D. The effect of a combined intervention on body mass index and fitness in obese children and adolescents-a clinical experience.  Eur J Pediatr. 2002; 161:449-454
      • Epstein LH, Paluch RA, Gordy CC, Dorn J. Decreasing sedentary behaviors in treating pediatric obesity. Arch Pediatr Adolesc Med 2000; 154 (3):220-6.
      • Epstein LH, Paluch RA, Gordy CC, Saelens BE, Ernst MM. Problem solving in the treatment of childhood obesity.  J Consult Clin Psychol 2000;68:717-21.
      • Epstein LH, Paluch RA, and Raynor HA. Sex Differences in Obese Children and Siblings in Family-based Obesity Treatment. Obesity Research 2001;9:746-753 
      • Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 1990; 264: 2519-2523.
      • Epstein LH, Valoski A, Wing RR, McCurley J. Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychology. 1994, 13:373-383.
      • Epstein LH, Valoski AM, Vara LS, McCurley J, Wisniewski L, Kalarchian MA, Klein KR, Shrager LR. Effects of decreasing sedentary behavior and increasing activity on weight change in obese children.  Health Psychol 1995;14:109-15.
      • Epstein LH, Wing RR, Koeske R, and Valoski A. Effect of parent weight on weight loss in obese children.  Journal of Consulting and Clinical Psychology.  54(3):  400-401, 1986.
      • Epstein LH, Wing RR, Koeske R, Valoski A. Effects of diet plus exercise on weight change in parents and children. Journal of Consulting and Clinical Psychology 1984; 52:429-437.
      • Epstein LH, Wing RR, Koeske R, Valoski A. A Comparison of Lifestyle Exercise, Aerobic Exercise, and Calisthenics on Weight Loss in Obese Children. Behavior Therapy 1985;16;345-56.
      • Epstein LH, Wing RR, Penner BC, Kress MJ. Effect of diet and controlled exercise on weight loss in obese children.  J Pediatr 1985;107:358-61.
      • Epstein, L, Valoski A, Kalarchian M, et al. Do children lose and maintain weight easier than adults: a comparison of child and parent weight changes from six months to ten years. Obes Res 1995; 3:411-417.
      • Figueroa-Colon R, von Almen TK, Franklin FA, Schuftan C, Suskind RM. Comparison of two hypocaloric diets in obese children. Am J Dis Child. 1993 Feb;147(2):160-6.
      • Flodmark CE, Ohlsson T, Ryden O, Sveger T. Prevention of progression to severe obesity in a group of obese schoolchildren treated with family therapy. Pediatrics 1993; 91: 880-84.
      • Golan M, Crow S. Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res 2004;12:357-361.
      • Golan M, Weizman A, Apter A, Fainaru M. Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr 1998;67:1130-1135.
      • Goldfield GS, Epstein LH, Kilanowski CK, Paluch RA, Kogut-Bossler B. Cost-effectiveness of group and mixed family-based treatment for childhood obesity. Int J Obes Relat Metab Disord. 2001 Dec;25(12):1843-9.
      • Graves T, Meyers AW, Clark L. An evaluation of parental problem-solving training in the behavioral treatment of childhood obesity. Journal of Consulting and Clinical Psychology 1988; 56:246-250.
      • Israel AC, Guile CA, Baker JE. An evaluation of enhanced self-regulation training in the treatment of childhood obesity. J Pediatr Psychol 1994; 19:737-49.
      • Kirschenbaum DS, Harris ES, Tomarken AJ. Effects of parental involvement in behavioral weight loss therapy for preadolescents. Behavior Therapy 1984;15:485-500. 
      • Levine, M., Ringham, R., Kalarchian, M., Wisniewski, L., and Marcus, M. Is family-based behavioral weight control appropriate for severe pediatric obesity? Int J Eat Disord. 2001 Nov;30(3):318-28.
      • McDuffie JR, Calis KA, Uswaifo GI, Sebring NG, Fallon EM, Hubbard VS, Yanovski JA. Three-month tolerability of orlistat in adolescents with obesity-related comorbidities. Obes Res 2002;10:642-650. 
      • Mellin LM, Slinkard LA, Irwin CE. Adolescent obesity intervention: validation of the SHAPEDOWN program. J Am Diet Assoc 1987; 87:333-8.
      • Miraglia del Giudice E, Santoro N, Marotta A, Nobili B, Di Toro, Perrone L. Inadequate leptin level negatively affects body fat loss during a weight reduction programme for childhood obesity. Acta Paediatr 2002; 91: 132-135.
      • Nuutinen O, and Knip M. Long-term weight control in obese children: persistence of treatment outcome and metabolic changes. International Journal of Obesity 1992;16:279-287.
      • Nuutinen O. Long-term effects of dietary counseling on nutrient intake and weight loss in obese children. Eur J Clin Nutr. 1991 Jun;45(6):287-97.
      • Obarzanek E, Kimm SY, Barton BA, Van Horn L L, Kwiterovich PO Jr, Simons-Morton DG, Hunsberger SA, Lasser NL, Robson AM, Franklin FA Jr, Lauer RM, Stevens VJ, Friedman LA, Dorgan JF, Greenlick MR; DISC Collaborative Research Group. Long-term safety and efficacy of a cholesterol-lowering diet in children with elevated low-density lipoprotein cholesterol: seven-year results of the Dietary Intervention Study in Children (DISC). Pediatrics. 2001 Feb;107(2):256-64.
      • Sothern, M., Hunter, S., Suskind R., Brown, R., Udall, J. and Blecker, U. Motivating the obese child to move: the role of structured exercise in pediatric weight management. Southern Medical Journal 1999; 92: 577-584.
      • Sothern, M., Despinasse, B., Brown, R., Suskind, R., Udall, J. and Blecker, U. Lipid profiles of obese children and adolescents before and after significant weight loss: differences according to sex. Southern Medical Journal 2000; 93: 278-282.
      • Sothern, M., Loftin, M., Udall, J., Suskind R., Ewing, T., Tang, S., & Blecker, U. Safety, feasibility and efficacy of a resistance training program in preadolescent obese children. American Journal of the Medical Sciences, 2000; 319: 370-375. 
      • Sothern, M., Schumacher, H., von Almen, T., Carlisle, L., & Udall, J. Committed to Kids: an integrated, four level team approach to weight management in adolescents. Journal of the American Dietetic Association 2002;102:S81-S85.
      • Sothern, M., Udall, J. Suskind, R., Vargas, A., & Blecker, U. Weight loss and growth velocity in obese children after very low calorie diet, exercise and behavior modification. Acta Paediatrica, 2000; 89(9): 1036-43.
      • Spieth L, Harnish J, Lenders C, Raezer L, Pereira M, Hangen SJ, Ludwig D. A Low-Glycemic Index Diet in the Treatment of Pediatric Obesity Arch Pediatr Adolesc Med 2000;154:947-951
      • Wadden, T., Stunkard, A., Rich, L., Rubin, C., Sweidel, G, McKinney, S. Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics. 1990, 85(3): 345-352.
  • Search Plan and Results: Treatment Format: Family Format 2004