Family factors, caregiver participation, & outcomes in pediatric obesity treatment

Current data indicate that one of every three American children is overweight or obese, and more likely than not, those who are obese as children will be obese in adulthood. Though many pediatric obesity interventions have lead to statistically significant and clinically meaningful improvements in children's weight, a great number of children still show limited response to treatment, if at all. Expert recommendations for the treatment of pediatric overweight and obesity advocate for staged, multidisciplinary approaches that are family-based in nature. However, from the vast number of studies investigating family-based programs, most describe interventions with mother-child dyads, and there is rare mention of other caregivers and family members in the treatment process. Given the known familial link to weight status and the undeniable influence of family on children's behaviors, there is an intuitive need to focus on the role that family members play in the health behaviors of children, not exclusively mothers. The goal of this study was to examine patients and their families enrolled in a tertiary-care pediatric obesity treatment program (Brenner FIT) in an effort to identify associations between caregiver and family attendance and change in children's BMI z-scores. This study was a retrospective chart review utilizing patient data extracted from the Brenner FIT clinical database and medical records maintained electronically through Wake Forest Baptist Health.;Nearly a third of patients were from single caregiver families, mostly single mothers, who had no assistance from additional caregivers. All others were from dual-caregiver families, most of which included both a maternal and paternal caregiver. The population studied was severely obese and identified a number of socio-economic and stress issues that are pertinent in family-based pediatric obesity treatment. However, few differences were discovered based on demographic and mental health factors. Caregiver and family attendance were the focal points of this study, but were not found to be significantly associated with change in BMI z-score after four months of treatment.;The number of reported stressors in the family, as well as increased mean paternal caregiver and sibling attendance were associated with higher odds of improving BMI z-score after four months of family-based obesity treatment. We conclude that there are few socio-demographic contributors to treatment attendance among caregivers and families, and no clear caregiver-related predictors of BMI z-score improvement. Further study of stress and paternal caregiver and sibling involvement in treatment is needed to determine how these family factors influence weight outcomes in obese children.