Study: Family-based behavioral treatment developed at UB for children who are overweight or obese can prevent metabolic disease later in life

BUFFALO, N.Y. – Every parent wants to raise healthy kids who then grow up to become healthy adults. But when a third of children in the U.S. are either overweight or obese, that goal seems increasingly elusive.

A new University at Buffalo study, covering 40 years of data and more than 1,000 families in different regions in the U.S., reveals that the family-based behavioral treatment developed at UB for children and parents who are overweight or obese can prevent children from developing metabolic disease when they grow up.

The treatment focuses on behavioral treatment of both the child and their parents, using the Traffic Light Diet and Activity program — also developed at UB — as well as positive parenting, behavioral skills training for both parent and child, and stimulus control, which involves arranging a shared family environment that promotes healthy eating and activity. 

Published in Health Psychology, the UB study applies new criteria to evaluate the data from 16 randomized controlled trials, most of them funded by the National Institutes of Health, of family-based behavioral treatment conducted over the past 40 years by Leonard H. Epstein, PhD, corresponding author and SUNY Distinguished Professor in the Department of Pediatrics in the Jacobs School of Medicine and Biomedical Sciences at UB.

Epstein is internationally known for pioneering a behavioral, evidence-based, family-focused approach to childhood obesity targeted to children who are obese or overweight and their parents.

The criteria used in the new UB study was published last year by researchers at Karolinska Institute in Sweden. They established that -0.25 zBMI — the measurement of a child’s body mass index based on age and growth — is the change in BMI in a child that is needed to prevent the child from developing the following conditions as an adult: diabetes, dyslipidemia (high cholesterol or triglycerides), hypertension or need for bariatric surgery.

“We applied these criteria to our data gathered over four decades to show how many of the children who participated in our studies would, as a result, not go on to develop cardiometabolic disease,” says Epstein, who is also chief of the Division of Behavioral Medicine in the UB Department of Pediatrics.

The study was a mega-analysis, which pools individual participant data across multiple studies. Across the combined databases, as many as 70% of children in UB’s family-based behavioral treatment met the criteria necessary to prevent metabolic disease in adulthood and almost half reversed their obesity status and maintained it during the follow-up period of 5-10 years. 

“This is brand new data that proves the clinical effectiveness of our program,” Epstein says. “This finding of clinical effectiveness over the long term is a critical aspect, as that is what corresponds directly to clinical improvements in health versus statistical significance.”

It’s an important distinction, Epstein notes. “Statistical significance means that the results of two treatments are different, and not likely to be different by chance, but that does not mean that either treatment will result in improvements in health,” he says. “By contrast, these results strongly suggest that our family-based behavioral treatment is associated with clinically meaningful effects using the new criteria based on long-term health outcomes.”

The family-based behavioral treatment studies covered in the current publication included 382 families treated with 12-month follow-up, 574 families with 24-month follow-up, and 142 families with 60- and 120-month follow-up. These are among the longest follow-up periods in clinical trials of pediatric obesity.

Epstein points out that beyond the impact on the child and parent being treated, family-based behavioral treatment has also been found to improve the weight and health of siblings who aren’t being treated. His studies also show that the younger the child is when treatment starts, the more significant the improvement is in their weight.

Implementing family-based behavioral treatment in a community health setting requires hiring behaviorally trained staff, Epstein adds, noting that these staff members can also address other problems that regularly occur in families.

And since family-based behavioral treatment is associated with changes in child, parent and sibling weight, it is far more economical than treating each person separately.

The next step in the research is to find ways to extend its benefits to the rest of the family, including siblings and other parents. Epstein envisions this treatment benefiting families with food insecurity and with other transgenerational diseases as well, such as diabetes and other cardiovascular diseases, so that while the adult is being treated for the disease, the child can be prevented from developing it.  

“Obesity runs in families, and it is important to have parents model healthy eating and activity, use positive parenting methods (not acting like the food police) and change the shared family environments to promote healthy eating, exercise and healthy body image,” says Epstein.

UB co-authors are Nicholas V. Neuwald, PhD, postdoctoral associate in the Division of Behavioral Medicine and Rocco Paluch, biostatistician, both in the Department of Pediatrics; and Molly D. Moore, doctoral candidate in the Department of Counseling, School and Educational Psychology in the Graduate School of Education. Denise E. Wilfley, PhD, of the Department of Psychiatry in the Washington University in St. Louis School of Medicine, is also a co-author.