RCTs evaluating the effects of family based interventions
| Reference | Participants | Interventions, duration | Results | Comments |
|---|---|---|---|---|
| I=intervention; C=control. | ||||
| Health promotion | ||||
| Stolley30 (USA, 1997) | African American girls (aged 7–12 years) and their mothers Mean age: I=9.9 years, C=10.0 years 62% of the mothers and 19% of the daughters were obese | I: 12 week culturally specific obesity prevention programme, focused on adopting a low fat, low calorie diet and stressing the importance of increased activity (n=32) C: general health programme, focused on communicable disease control, effective communication skills, relaxation techniques, and stress reduction (n=33) Both groups led by either a doctoral clinical psychology student or registered dietitian Follow up: 12 months (only 12 week data reported) | Significant between group differences, with treatment mothers consuming less daily saturated fat (–2.1 oz, p<0.05) and a lower percentage of calories from fat (–7.9%, p<0.001) Weight remained unchanged Differences among treatment and control groups were noted for the daughters’ percentage of daily calories from fat (–3.9%, p<0.05) | Random allocation: Method not described Blinding: Children: Unclear Providers: Unclear Outcome assessors: Unclear |
| Epstein31 (USA, 2001) | Non-obese children from families with at least one obese parent Mean age: I=8.6 years, C=8.8 years 65% female | Both groups received same 6 months treatment and followed the “traffic light” diet, but targeted different dietary goals. Treatment meetings were facilitated by therapists I: increased fruit and vegetable intake (n=13) C: Decreased intake of high fat/high sugar foods (n=13) Follow up: One year | Percentage of overweight: Parents in the increased fruit and vegetable group showed significantly greater decreases (p<0.05) in percentage of overweight than parents in the decreased high fat/high sugar group, while children showed a stable percentage of overweight over time | Random allocation: Method not described Blinding: Children: Unclear Providers: Unclear Outcome assessors: Unclear |
| Nova32 (Italy, 2001) | Obese children (at least 20% above ideal weight, aged 3–12 years) and their parents and family paediatricians Mean age: 8.6 years (both groups) 44% female | I1: Family paediatricians provided children and families with leaflets only containing general information regarding obesity and associate risks, general advice on healthy eating, and an invitation to practise some physical activity (n=113) I2: Family paediatricians provided children and families with information on a specific diet (allowing 1400 calories), detailed guidelines regarding physical activity and active parental commitment, and a food diary with instructions for use (n=72) Follow up: One year | Mean (SD) change in % overweight: 0–6 months: I1 (n=92) =–2.95 (8.47), I2 (n=51) =–8.80 (6.62), p=0.0001 0–12 months: I1(n=80) =–2.92 (10.8), I2 (n=50) =–8.50 (9.72), p=0.002 6–12 months: I1 (n=73) =–0.30 (6.19), I2 (n=45) =–0.64 (8.05), p=0.8 | Random allocation: Cluster randomisation by family practitioner Blinding: Children: Unclear Parents: Unclear Outcome assessors: Unclear |
| Physical activity and health promotion | ||||
| Epstein33 (USA, 1984) | Obese children (aged 8–12 years) and their parents Mean age: not given % female | Intervention groups attended 15 education sessions; 8 weekly sessions, the remaining 7 sessions spread out over 20 weeks I1: Traffic light diet (n (baseline, 6 months)=18, 15) I2: Traffic light diet plus increase in exercise programme (n (baseline, 6 months)=18, 15) C: Waiting list control (n (baseline, 6 months)=17, 14) Follow up: 2, 6 and 12 months | At 6 months, children in the treatment groups were significantly (p<0.01) lighter than children in the control group, who gained weight At 6 and 12 months, treatment groups significantly differed in percentage overweight from baseline (p<0.0001 and p>0.05 respectively), but not between treatments | Random allocation: Stratified by relative weight Blinding: Children: Unclear Providers: Unclear Outcome assessors: Unclear |
| Epstein35,36 (USA, 1985) | Obese children (aged 8–12 years) and at least one parent Mean age: not given 60% female | I1: Diet plus programmed aerobic exercise (walk, run, cycle or swim) (n=13) I2: Diet plus “lifestyle” exercise programme (not instructed to exercise at a particular intensity) (n=12) I3. Diet plus calisthenic exercise programme (3 times per week) (n=10) 8 weekly sessions of treatment and 10 monthly maintenance sessions. Participants also followed a 1200 kcal/d diet, based on the “traffic light diet” and sessions included behaviour modification Follow up: 12 and 24 months | Percentage overweight: Baseline: I=47.8, I2=48.3, I3=48 12 months: I=31.5, I2=32.2, I3=30.5 24 months: I=41, I3=30.3, I3=40.8 At 24 months, percentage overweight was significantly smaller (p<0.05) in lifestyle group than the aerobic or calisthenic group Change in percentage overweight at 10 years36: I1=–19.7; I2=–10.9; I3=+12.2 | Random allocation: Method not described Blinding: Children: Unclear Providers: Unclear Outcome assessors: Unclear |
| Epstein34 (USA, 1985) | Obese girls (aged 8–12 years) and at least one parent Mean age: not given 100% female | Intensive 8 week treatment programme followed by 10 monthly maintenance sessions. Sessions incorporated diet and nutrition education, exercise education (group 1 only) and behavioural procedures I1: Diet plus aerobic exercise programme (n=not given) I2: Diet without exercise (n=not given) Follow up: 6 and 12 months | Mean percentage overweight: Baseline: I1=48 , I2=48.1; 6 months: I1=20.5 , I2=29.3. Both groups significantly different from baseline (p<0.01). Significant between group difference p<0.05 12 months: I1(n=10) =22.6 , I2 (n=9) =29.4. Both groups significantly different from baseline (p<0.01) | Random allocation: Stratified by age, % overweight and physical work capacity Blinding: Children: Unclear Providers: Unclear Outcome assessors: Unclear |
| Epstein37 (USA, 1995) | Obese children (aged 8–12 years) and their parents Mean age: 10.1 years 73% female | Comparisons of diet and physical activity reinforcement regimes I1: Reinforcing a reduction in sedentary behaviours (n=not given) I2: Reinforcing an increase in physical activity (n=not given) I3: Reinforcing a reduction in sedentary behaviours and an increase in physical activity (n=not given) All groups received 4 months treatment and followed the “traffic light” diet Follow up: One year | Change in percentage overweight: One year: I1=–18.7, I2=–10.3, I32=–8.7. Significantly larger decrease in intervention than control groups (p<0.05) Change in percentage of body fat: I1=–4.7, I2/I3=–1.3 (p<0.05) | Random allocation: Method not described Blinding: Children: Unclear Providers: Unclear Outcome assessors: Unclear |
| Johnson57 (USA, 1997) | Obese children (aged 8–17 years) and their parents Mean age: 11.0 years 72% female | I1: 7 week nutrition and eating habit intervention, followed by 7 week aerobic exercise intervention (n=9) I2: 7 week aerobic exercise intervention followed by 7 week nutrition and eating habit intervention (n=10) C: 14–week education on diet and exercise with instructions for behavioural changes (n=9) Follow up: 9 weeks, 16 weeks and 5 years (n=6 in each group at 5 year follow up) | Mean weight (kg): Week 1: I1=73.2, I2=72.0, C=68.6 Week 9: I1=72.0, I2=73.4, C=68.5 Week 16: I1=70.8, I2=71.0, C=68.9 Change in weight over weeks 1–16 significant for I1 (p<0.01) Change over weeks 9–16 significant for I2 (p<0.01) Mean % of ideal body weight (pretreatment, 5 year follow up): I1=168.8, 137.3 I2=153, 137.8 C=186.5, 175.2 I1 and I2 both significantly lower than C (p<0.01) | Random allocation: Method not described Blinding: Children: Unclear Providers: Unclear Outcome assessors: Unclear |
| Epstein38 (USA, 2000) | Obese children (aged 8–12 years) ) and at least one parent Mean age: 10.5 years 68% female | I: Increasing physical activity (high dose, n=19 low dose, n=18) C: Decreasing sedentary behaviour (high dose, n=20; low dose, n=19) Both groups received 6 months treatment and followed the “traffic light” diet Follow up: 12 and 24 months | Change in percentage overweight from baseline (mean, SD): 0–6 months: I: low dose=–25.6 (8.1), high dose=–26.4 (10.5) C: low dose=–22.4 (12.6), high dose=–27.4 (10.7) All significant (p<0.01) 0–24 months: I: low dose=–12.4 (13.3), high dose=–13.2 (16.4) C: low dose=–11.6 (21.9), high dose=–14.3 (16.9) All significant (p<0.01) | Random allocation: Families stratified by gender and degree of child and parent obesity Blinding: Children: Unclear Providers: Unclear Outcome assessors: Unclear |