Family-based behavioral treatment combined with an enhanced standard of care achieved greater weight loss in children with obesity in primary care than standard of care alone, a practical randomized trial found.

Reporting results from the multicenter TEAM UP study in JAMA Pediatrics, Amanda E. Staiano, PhD, and colleagues also found that the strategy could be implemented across diverse geographic and socioeconomic groups.

“We chose the two most commonly used approaches, both of which align with clinical practice guidelines and recommendations, to see which is more effective when delivered via primary care,” Staiano, a psychologist and director, Pediatric Obesity & Health Behavior Laboratory, Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, told Medscape Medical News. 

The two treatments involved different time commitments for the families and healthcare providers, with different intensities of support. “It was important to know which treatment was more effective so we can provide this information to families, doctors, and insurance companies,” she said.

Between 2019 and 2024, the study enrolled parent-child dyads including 730 children ages 6 to 15 at 41 primary care sites in Louisiana, New York, Missouri, and Illinois. The children had body mass indexes (BMIs) equal to or greater than the 95th percentile. The mean age overall was 10.8 years, 53.5% were girls, and 52.3% were White. Almost half (47%) of the dyads had Medicaid coverage, and 22% reported food insecurity. The majority of parents also had overweight or obesity.

Both study arms experienced weight loss, but reduction in percent median BMI was greater in the combination arm: -6.4 units (95% CI, -8.29 to -4.43) vs -2.6 (95% CI, -4.46 to -0.71), for a mean intergroup difference of -3.8 units (95% CI, -6.20 to -1.34, P = .002). There were no adverse events, and children in both arms reported improved quality of life.

The Protocol

“The family-based approach focuses on household-level changes and routines that benefit all members of the household without singling out one child,” Staiano said.

Families met regularly with their primary care practitioner (PCP), focusing on collaboratively setting realistic health behavior goals for nutrition and physical activity, with visits billed to insurance. 

Half of the dyads were randomized to also meet regularly with a family-based behavioral treatment professional: a registered dietitian, social worker, or community health worker. These meetings involved 26 to 33 in-person or telehealth sessions over a year and were often delivered by clinic staff.

The family-based treatment promoted high-nutrition, lower-calorie foods and fostered more physical activity. Parents learned how to model desirable behavior, modify the home to support stimulus control, and create a positive family and peer environment. Children were schooled in goal setting and problem solving as well as managing negative interactions with family and peers such as teasing.

“We saw excellent adherence,” said Staiano. “Overall, the families attended about four visits with their PCP over a year, and those with an FBT [family-based treatment] coach attended on average 17 sessions.” This was a diverse group of families, half insured by Medicaid. 

Commenting on the TEAM UP study for Medscape Medical News, Joseph A. Skelton, MD, MS, professor of pediatrics and epidemiology and prevention at Wake Forest University School of Medicine in Winston-Salem, North Carolina, called the study “quite remarkable” for two reasons.

“Weight management was implemented in primary care, with great outcomes. That is very unique and without much precedent,” he said. The treatment was intensive, aiming to reach the 26-plus contact hours recommended by the US Preventive Services Task Force statement on interventions for child obesity. “That has been difficult to achieve in tertiary care and specialty programs, so it’s impressive they were attempting to implement it in primary care.”

Institutional support and new technologies, such as virtual care, helped overcome previous obstacles, Skelton said. 

“The PCP has tremendous influence in helping families develop healthier habits and reach health goals,” said Staiano. “TEAM UP was successful across 41 unique primary care practices in 4 states, including federally qualified health centers and in clinics exclusively serving Medicaid patients.” 

She is now heading a new trial that has integrated a licensed social worker into the program to connect every family to community resources to improve access to healthy foods and other social needs. 

“GLP-1 medications are the buzz, but intensive health behavior and lifestyle treatment remain the bedrock of comprehensive obesity care,” Staiano said. 

This study was supported by multiple research-funding bodies, including the Patient-Centered Outcomes Research Institute (PCORI), Louisiana Blue, Louisiana Healthcare Connections, the National Institutes of Health, the Washington University Institute of Clinical and Translational Sciences (ICTS), the Pennington Biomedical Research Center, and the University of Rochester. Staiano reported support from PCORI, Louisiana Blue, Louisiana Healthcare Connections, and the National Institutes of Health. Numerous coauthors reported similar support from various research-funding bodies. Coauthor Wilfley disclosed consulting fees from Novo Nordisk outside of the submitted work. Skelton disclosed no relevant conflicts of interest.