Families seeking help for childhood obesity are often referred to specialty programs that may be expensive, far away or difficult to fit into everyday life. New research suggests an established family treatment can also work when delivered through the primary care practices children already visit.
In a randomized clinical trial involving 730 children with obesity, those offered a yearlong family behavioral program through pediatric practices experienced greater improvements in their weight trajectories than those receiving enhanced pediatric obesity care alone. Benefits remained six months after the treatment period ended.
The intervention was more intensive than counseling during a routine checkup. Families were offered as many as 33 sessions with a trained professional, usually a registered dietitian or behavioral health provider, in addition to care from their primary care clinician.
The study was published in JAMA Pediatrics. It was primarily supported by the Patient-Centered Outcomes Research Institute, with additional support from the National Institutes of Health, Louisiana Blue and Louisiana Healthcare Connections. The two Louisiana organizations are health insurers, making their involvement relevant to the study’s focus on reimbursement and real-world delivery.
One study author reported consulting for Novo Nordisk outside the submitted research. Several authors received grants connected to the trial, while others reported grants or research relationships outside this work.
Childhood obesity affects about one in five children in the U.S., but access to intensive behavioral treatment remains limited. The American Academy of Pediatrics and the U.S. Preventive Services Task Force recommend comprehensive programs that provide repeated contact with children and families, rather than relying on brief advice alone.
“Family-based behavioral treatment is a robust, evidence-based treatment that has been established and validated through more than four decades of research,” said Denise Wilfley, one of the trial’s principal investigators and a professor of psychiatry at Washington University School of Medicine in St. Louis.
“The critical question in this study was not whether family-based behavioral treatment can work in specialty research settings, but whether it can be integrated effectively and sustainably into the primary care settings where children and families already receive care,” Wilfley said. “The answer is yes.”
The trial was conducted from 2019 through 2024 at 41 primary care practices in Missouri, Illinois, Louisiana and New York. Participants were ages 6 to 15 and had obesity at the beginning of the study.
Researchers randomly assigned families to one of two groups. Both received enhanced obesity care through their pediatric practice, including follow-up visits, individualized behavioral counseling and medical management.
The second group also received family-based behavioral treatment for one year. A parent attended the sessions with the child.
Families learned to monitor eating, physical activity and weight, set realistic goals and adjust the home environment to support those goals. The program also used praise, positive reinforcement and parental modeling to build routines that could be maintained across the household.
The approach was not designed to single out or punish a child. It treated parents and the home environment as important parts of long-term behavior change.
Families were offered as many as 33 sessions but attended about 17 on average. The researchers included every enrolled child in the analysis, regardless of how many sessions the family completed.
Both groups experienced improvements, but the children receiving family treatment had greater changes.
At the beginning of the trial, children in both groups had body mass index measurements about 77% above the median expected for their age and sex. After one year, that figure declined to approximately 70% in the family-treatment group and 74% in the enhanced-care group.
The gap continued to widen during the six months after treatment ended.
At the 18-month follow-up, about 42% of children in the family-treatment group had achieved a degree of weight reduction associated with better cardiometabolic health. That was approximately 1.5 times the proportion seen with enhanced care alone.
This does not mean 42% of the children reached the conventional “healthy weight” range or that obesity resolved. Children are still growing, so pediatric obesity trials often evaluate how BMI changes relative to expected growth rather than focusing only on pounds lost.
The results are better understood as improvements in weight trajectory. On average, children in the family program moved closer to the expected BMI range than those who received enhanced care alone.
Parents in the family-treatment group also reported greater improvements in their children’s weight-related quality of life and in household nutrition and physical activity routines.
Those outcomes matter because the value of pediatric obesity treatment cannot be judged only by a number on the scale. A program that improves family routines, confidence and quality of life may offer benefits even when weight changes are modest.
“Our results show that an established, effective obesity treatment for children and adolescents can be successfully delivered in their pediatrician’s office,” said Amanda Staiano, the study’s first author and director of the Pediatric Obesity and Health Behavior Laboratory at Pennington Biomedical Research Center.
Still, “in the pediatrician’s office” should not be mistaken for a few extra minutes of nutrition advice during an annual visit.
The program depended on trained dietitians or behavioral health professionals, repeated appointments, clinic coordination and insurance reimbursement. Practices without those resources may not be able to offer the same treatment immediately.
The trial was designed with practical implementation in mind. About half of participating families were covered by Medicaid, and approximately one in five reported food insecurity.
Researchers also included children with common health and behavioral conditions, such as ADHD and anxiety, who are sometimes excluded from tightly controlled clinical trials. That makes the participants more representative of the families pediatricians regularly treat.
Much of the study also occurred during the COVID-19 pandemic. More than 75% of family-treatment sessions were conducted through telehealth.
Families using telehealth achieved results comparable to those treated entirely in person, according to the researchers. That suggests remote appointments could help reduce transportation and geographic barriers.
Telehealth does not remove every obstacle. Families still need time, reliable technology, privacy and coverage for repeated visits. Even with flexible delivery, participants attended only about half of the sessions offered.
The study does not explain all the reasons families missed appointments or whether some groups faced greater barriers than others.
The follow-up period was also relatively short. The benefits lasted six months after treatment ended, but researchers do not yet know whether the differences will persist throughout adolescence or into adulthood. The team plans to assess participants again after five and 10 years.
The trial also began before GLP-1 medications became a larger part of pediatric obesity care. Family behavioral treatment can be used by itself or alongside medication, but this study did not compare the program with GLP-1 treatment or test whether combining the approaches produced greater benefits.
Wilfley reported consulting for Novo Nordisk outside the study and participating in other obesity-care research, including a project involving semaglutide. Those relationships do not show that medication companies influenced this trial, but they are relevant context in a rapidly changing treatment landscape.
The results offer a practical but measured message. Family-based treatment does not need to remain confined to specialty weight-management centers but bringing it into primary care requires more than asking pediatricians to provide additional advice.
Clinics need trained professionals, protected appointment time, administrative support and reliable payment for repeated sessions. Families also need treatment that is flexible enough to fit around work, school, transportation and other demands.
When those supports are available, the study suggests primary care can become a meaningful access point for family-centered obesity treatment.
“Every family-based behavioral treatment session provides additional benefit on top of enhanced care,” Wilfley said. “When children and parents develop skills together and the home and social environments reinforce those changes, the benefits can extend across the household and support lasting change as the child grows.”
The trial was supported primarily by the Patient-Centered Outcomes Research Institute, with additional support from Louisiana Blue, Louisiana Healthcare Connections and several NIH institutes, centers and training programs.
Several authors reported grants related to the trial. One author reported grants from Washington University School of Medicine during the study and NIH and CDC grants outside the work. Another reported outside subcontracts from several health and research organizations. Wilfley reported consulting fees from Novo Nordisk and involvement in several externally funded obesity and eating-disorder research projects outside the submitted study.