Overview Table: Individual and Family Based Interventions

Evidence Summaries for Individual and Family Interventions focus on specific weight loss components (for example, counseling or diet or physical activity recommendations). However, interventions generally include more than one component.

The following table is a summary of the range of studies we analyzed. As you see, most studies examined multi-component interventions. To see our summary of the effectiveness of each component, select the item from the left navigation bar.

Summary Table for Individual and Family Interventions

Intervention may include one or a combination of components: Dietary (D), Physical Activity (PA), Sedentary Activity (SA) or Behavioral (B) components, Family Counseling (F) or Parent Training or Modeling (PT).



Overview Table: Individual and Family Based Interventions

First Author

Year

Study Name Location

Study Population

Duration

Intervention

Components

Description

Outcome Variable/

Measure of Adiposity

Findings Related to Measure of Adiposity

Rating

Randomized Controlled Trials

1) Golan 1998

60 overweight children, 6-11 years of age

12 months

D

B

F

PT

Subjects were randomized to 2 groups: Parent only behavioral sessions, 4 weekly followed by 4 biweekly and then six every sixth week versus child only diet and physical activity instruction, 8 weekly followed by bi-weekly sessions for 10 months---both groups taught by a registered dietician.

Weight, height, %overweight

29 (97%) families in the parent only group behavioral instruction and 21 (70%) in the child diet and physical activity instruction completed the study (p<0.02). Both groups significantly reduced %overweight at 12 months (p<0.001 parent only and p<0.01 child only). Children in the parent only group had a significantly greater reduction in %overweight at 12 months (14.6%) than children in the child only group (8.1% [p<0.03]).

Ø

2) Graves 1988

Location not specified

40 overweight children, 6-12 years

8 week treatment with 6 month follow-up

D

PA

B

F

Children were ranked by %overweight and assigned randomly from stratified blocks 3 groups: behavioral, problem solving, or instruction-only. All groups attended 8 weekly 60-minute sessions including games stories and activities to teach treatment objectives. Traffic light diet and self-monitoring of food and activity in all groups. In the behavioral group, behavioral therapy was conducted for 20 minutes including diet information, exercise information, stimulus control, family support, cognitive restructuring, peer relations and maintenance strategies. In the problem-solving group, 20 minutes of problem solving activity was included in the sessions. In the instruction only group 15 minutes of exercise was included in the session.

Weight, height, %overweight, and BMI

Children in problem solving and behavioral groups decreased weight, %overweight and BMI significantly (p<0.05) at 8 weeks. Differences were significantly different between groups: problem solving > behavioral and instruction (p<0.05). Significant differences were maintained at 3 and 6-month follow-up. Only children in the problem-solving group maintained significant differences in %overweight and BMI at 6 months.

+

3) DISC Study 1995

6 clinical settings: Baltimore, MD, Chicago, IL, Iowa City, Iowa, Newark, NJ, New Orleans, LA, Portland, OR

663 prepubertal overweight children, 8-10 years; mean 9.7 years boys, 9.0 years girls

623 completed the study (95.8%)

3 years

D

B

F

Diet (Low fat: 28% energy from total fat; <8% saturated, <9%polyunsaturated fat; <75 mg/1000 kcal per day cholesterol (<150 mg/d); RDA for energy, protein & micronutrients [similar to NCEP Step II Diet recommended for children with family history of CHD])and Family-based, personalized counseling based on Social Learning Theory and

Social Action Theory versus standard care model

Body Mass Index, skin folds, (triceps, sub scapular, suprailiac), waist and hip circumference

No differences between groups in BMI, skin folds or waist and hip circumference. Primary aim of the study was to reduce LDL-C, not adiposity.

+

4) Obarzanek 2001

6 clinical settings: Baltimore, MD, Chicago, IL, Iowa City, Iowa, Newark, NJ, New Orleans, LA, Portland, OR

663 prepubertal overweight children, 8-10 years; mean 9.7 years boys, 9.0 years girls

623 completed the study (95.8%). Follow-up at 7 years in 580 subjects (87%)

3 years with 7 year follow-up

D

B

F

Diet (Low fat: 28% energy from total fat; <8% saturated, <9%polyunsaturated fat; <75 mg/1000 kcal per day cholesterol (<150 mg/d); RDA for energy, protein & micronutrients [similar to NCEP Step II Diet recommended for children with family history of CHD])and Family-based, personalized counseling based on Social Learning Theory and

Social Action Theory versus standard care model

Body Mass Index, skin folds, (triceps, sub scapular, suprailiac), waist and hip circumference

Height and weight were not significantly different between groups

+

5) Epstein, Valoski 1995, Obesity Research

Pittsburgh, PA

Final sample: 113 families with 8-12 year old overweight children; original sample, withdrawals/dropouts were not specified

children: 81 female, 32 male

parents: 85 female, 28 male

6 months with 10 year follow-up

D

PA

B

F

PT

Weekly treatment meetings for 8 weeks followed by monthly meetings for 6-12 months; 1200-1500 and Traffic Light Diet. The long-term (10 year) weight loss results were then compared between adults and children

Body Mass Index; Percent overweight; some self-report data

Significant differences in percentage of children versus adults who had decrease of at least 20% overweight at 6, 60 and 120 months.

Ø

6) Epstein 2001

Pittsburgh, PA

Sixty-seven families with 8-12 year old overweight children and 89 siblings

12 months

D

PA

B

F

PT

16 weekly meetings followed by 2 biweekly meetings and 2 monthly meetings during the 6-month intensive treatment and a 12-month follow-up. Traffic Light Diet and specific behavior change techniques. Treatment group received increased physical activity and reductions in sedentary behavior. Control group received increased physical activity.

Body Mass Index; Percent overweight; Self-report data = 7.8% of reports and was adjusted.

Boys in experimental group had significantly greater percent overweight changes than girls. No sex differences in the control group.

+

7) Epstein 1986

Pittsburgh, PA

41 families with 8-12 year old overweight children; follow-up on 38 families (93%)

12 months

with 3-year follow-up

D

PA

B

F

PT

8 weekly treatment meetings and 10 monthly meetings. Families were randomly assigned to two treatment conditions (parent control or child self-control. 1200 kcal diet and life-style exercise program. Point economy to regulate child eating and exercise habits.

BMI and %overweight.

At one year, only children with non obese parents had %overweight significantly lower than baseline (p<0.01) and had 2.1 times the change in percentage overweight (-16.3) versus children with obese parents (7.7% [p<0.01]). At 3 years neither group had %overweight different from baseline.

+

8) Epstein, 1984

Pittsburgh, PA

53 families with 8-12 year old overweight children; final sample 47 families (89%) at 6 months; 34 families at one year (64%)

6 months with 12 month follow-up

D

PA

B

F

PT

Families were assigned to 3 different groups: diet, diet plus lifestyle exercise and waiting list control. Treatment subjects participated in 8 weekly, 3 bi-weekly and 4 monthly meetings. Traffic light diet and point economy system.

Weight, height, BMI

Both treatment groups had significantly lower BMI at 6 months than control group and significantly lower than baseline. No significant differences between treatment groups at 6 months or 1-year.

+

9) Epstein 1989

Location not specified

51 obese children (35 treatment, 16 control) for 6 months; 28 children for 5-year follow-up

8-12 years

Ethnicity not specified

6 months with 5-year follow-up

D

PA

B

F

PT

Families were assigned to 3 different groups: diet, diet plus lifestyle exercise and waiting list control. Treatment subjects participated in 8 weekly and 4 monthly meetings. (Long-term follow-up of Epstein, 1984)

Weight, height, % overweight

Significant decreases in % overweight were observed at 6 months. No differences from baseline in % overweight at 5 years.

+

10) Epstein 1985

Pittsburgh, PA

35 families; 21 overweight girls and 14 overweight boys, 8-12 years of age

12 months with a 24 month follow-up

D

PA

B

F

PT

Families were randomized to 3 groups: diet plus programmed aerobic exercise, diet plus lifestyle, and diet plus calisthenics. Subjects participated in 8 weekly and 10 monthly sessions. Traffic light diet; Self-monitoring, modeling, contingency and contracting and parent management/

Weight, height, % overweight, BMI

Significant decreases in % overweight were observed at 2, 6 and 12 months in all 3 groups. No difference in % overweight at 12 months between groups. At 24 months only the lifestyle group maintained relative weight changes in %overweight.

+

11) Epstein Valoski, 1994

and Epstein, 1993

Pittsburgh, PA

185 families with 8-12 year old overweight children; Final sample was 158 (85%)

12 month with 10 year follow-up

D

PA

B

F

PT

Reports on several studies that were initially 8-12 weeks of weekly treatment meetings 6-12 months of monthly meetings. Traffic light diet; Contingency management was used in the child only versus parent-child study; diet only versus diet plus lifestyle; lifestyle versus aerobic and calisthenics; parental weight status

Weight, height, BMI percent above 50th BMI; self-report (18%)

Parent and child group has significantly greater changes than control at 5 (p<0.001) and 10 p<0.009) years. Children decreased %overweight by15.3% and control by 7.6% at 10 years. Child only versus parent and child were significantly different at 5 (p<0.025) but not 10 years. Percent overweight in diet only (-8.4%) versus diet plus exercise (-10.0%) were both significantly lower at 10 years but not from each other. Percent overweight decreased significantly in lifestyle exercise (-19.7), aerobic (-10.9%) but not calisthenics (+12.2%). Change from 5-10 years was significantly different as follows: lifestyle (p<0.009) and aerobic (p<0.04) from calisthenics.

+

12) Epstein 1990

Pittsburgh, PA

55 of the 76 families with overweight children enrolled initially in the study (72% retention)

12 months with 5 and 10 year follow-up

D

PA

B

F

PT

8 weekly treatment and 6 monthly meetings. Families were randomized to 3 groups: child and parent target, child target, or non-specific target (control); Traffic light diet, exercise (aerobic and stretching); contracting, self-monitoring, social reinforcement & modeling; contingency management

Weight, height, %overweight self-report (adjusted) in 4 subjects

Children in the child & parent group showed significantly greater decreases in %overweight after 5 (-11.2%) and 10 (-7.5%) years than children in the nonspecific control group (+7.9 and +14.3%, respectively). Children in the child only group showed increases in %overweight after 5 (+2.7%) and 10 +(4.5%) years.

+

13) Epstein Valoski, 1995, Health Psychology

Pittsburgh, PA

92 families screened, 61 enrolled, overweight children, 8-12 years

4 months with 12 month follow-up

D

PA

SA

B

F

PT

Weekly meetings for 4 months and 2 monthly meetings thereafter; Traffic Light Diet; Physical activity and targeted reductions of sedentary activities were reinforced with a 5 level system. Personalized system of instruction for behavioral principles, e.g. self-monitoring, etc.

Weight, height, %overweight, %body fat (BIA)Waist to Hip Ratio

Significant differences between groups in %overweight at 4 months (Reducing sedentary sign < physical activity; p<0.05) and 12 month (Reducing sedentary < physical activity and both; p<0.05). Significant differences in rate of change over time in %body fat; at 4 mos. No difference between groups. At 12 months, reducing sedentary significantly < physical activity and both.

+

14) Epstein 1985

Pittsburgh, PA

22 families, 23 overweight children (1 family with 2 study children), 8-12 years

12 months

D

PA

B

F

PT

Subjects were randomized to 2 groups: diet only and diet plus 6 weeks of structured exercise. Traffic light diet. Self monitoring, modeling contracting. Subjects attended 8 weekly intensive plus 10 monthly maintenance sessions with child and parent(s) treated separately.

Weight, height, %overweight

Significant differences in weight and %overweight at 6 months (p<0.05) with diet plus exercise < diet only. Both groups reduced weight and %overweight significantly (p < 0.01) at 2 and 6 months. Only diet plus exercise reduced weight significantly (p<0.01) at 12 months; both groups reduced %overweight at 12 months (p<0.01).

+

15) Epstein 2000a

Pittsburgh, PA

398 families replied to advertisement, 162 families were screened and 67 met entrance criteria. Final sample: 62 families with 62 parents and 62 overweight children, 8-12 years.

24 month: 6 month treatment plus 6 month maintenance, 12 and 24-month follow-up.

D

PA

B

F

PT

Subjects were randomized to 3 groups: Problem solving taught to parent and child, problem solving to child only and no problem solving (control). Subjects attended weekly meetings for 4 months plus 2 monthly meetings. Parents and children were counseled together followed by monthly meetings for 6 months in which child and parent were counseled separately and provided workbooks for home use. Lifestyle exercise with workbooks. Preplanning, self-monitoring, stimulus control, positive reinforcement.

BMI z-score5 children and 3 parents self-reported (adjusted) at 24 months.

No significant differences in BMI z score between groups at 6 months (all decreased). At 24 months Problem solving parent and child significantly reduced BMI z score > both problem solving to child and control.

+

16) Epstein 2000b

Location not specified

76 overweight children and parents

8-12 years

Ethnicity not specified

6 month treatment plus 12 and 24 month follow-up

D

PA

B

F

PT

Families randomly assigned to 4 groups that varied by targeted behaviors and dose: sedentary behaviors reduced to no more than 10 hours/week, sedentary behaviors reduced to no more than 20 hours/week, physical activity increased to equivalent of 10 miles/week, or physical activity increased to equivalent of 20 miles/week. Parents and children met with individual therapist and then attended separate parent and child group meetings. Traffic light diet and behavior modification strategies used.

BMI

% overweight

% body fat

No significant differences in adiposity measures between groups. Significant decrease in % overweight from baseline to 6 month though 2 years (p<.001). Intent-to-treat analysis showed decrease in % overweight of 22.7% at 6 months and 10.9% at 2 years (p<.001)

+

17) Israel 1994

Location not specified

36 families with overweight children, 8-13 years.

female/male not specified

6 month treatment with 3 year follow-up

B

F

PT

Families randomly assigned to 2 groups: standard treatment (ST) and enhanced child involvement (ECI). Both groups followed four-component model of self-regulation, including goal setting, self-monitoring, self-evaluation, and self-consequation [?] for 8 weekly 90-minute sessions and 9 biweekly sessions. ST emphasized parent responsibility; ECI focused on children’s management of own weight loss efforts.

Weight, height, %overweight,

triceps skin folds thickness

All groups significantly decreased %overweight and triceps skin folds at 6 months (p<0.01). %overweight increased above post-treatment levels in all groups at 3 year follow-up

+

18) Kirschenbaum 1984

Madison, WI

40 overweight children, 9-13 years enrolled. Final sample 23 children

9 week plus 3 and 12 month follow-up

B

F

PT

Subjects were randomly assigned to 3 groups: parent plus child, child only and waiting list control and attended 9 weekly, 90-min treatment sessions and a 3 and 12 month follow-up measure. Cognitive behavioral treatment including self-monitoring, increasing exercise, nutrition education, stimulus control, planning, coping, managing negative self-statement, assertion and relaxation training.

Weight, height, adjusted weight using Edwards 1978 weight index, %overweight

Both parents and children in parent plus child group and child only group significantly reduced weight, %overweight and weight index compared to the control group (p<0.01) at post treatment and 3-month follow-up.

+

19) Flodmark 1993

Lund, Switzerland

94 overweight children, 10-11 years

14-18 months with follow-up was 1 year after the end of treatment

D

PA

B

F

PT

Subjects received no intervention (control n=48), conventional treatment (N=19) or Family therapy (N= 20). Both treatment groups received dietary counseling (1500-1700 kcal diet) and medical checkups for 14-18 months. Family group also received family therapy including self-monitoring, stimulus control, reducing the rate of eating, nutrition education, cognitive. restructuring and increased physical activity.

Weight, height, BMI, Skin folds

Family group had a significantly lesser increase in BMI than CT group (0.66% vs. 2.31%; p<0.042) and greater decrease in skin folds (-16.8 vs. +6.8%; p<0.034) at the end of treatment. One year following the end of treatment BMI was significantly lower (p<0.046) in the family group compared to control group. A significantly smaller increase in BMI was observed between the family group (+5.1) and the control group (+12.1 [p<0.022]). BMI did not significantly differ between family and CT or controls and CT at one year. The family group significantly reduced skin folds compared to CT group (not measured in controls)

+

20) Brownell 1983

Williamsport, PA

42 overweight adolescents, aged 12-16 years

16 weeks with 1 year follow-up

D

PA

B

F

PT

Mother-Child together versus Mother-Child separately versus Child alone. All groups received diet, exercise and social support instruction.

Percent overweight and body mass index

Percent overweight and body mass index changes were significantly greater in the Mother-Child separately group compared to other groups at 16 weeks (p<.01 and p<.04, respectively) and at 1 year (p<.05 and p<.01, respectively).

+

21) Ebbeling 2003

Sixteen overweight adolescents aged 13-21 years.

6 months with 1 year follow-up

D

PA

B

F?

PT?

Reduced glycemic load diet versus reduced fat diet. Both groups received exercise and behavioral counseling based on Social Cognitive Theory.

Body composition by DEXA, Body Mass Index

BMI (p<0.03) and fat mass by DEXA (Pp<0.02) decreased in the low GL group after 12 months but not in the control low fat diet group.

+

22) Becque 1988

36 overweight adolescents, age ???

20 weeks

D

PA

B

F?

PT?

Diet, behavior change and exercise versus diet and behavior only versus no intervention

Weight

Percent fat by underwater weighting

Percent fat changes were noteworthy but not significantly different between groups.

Significant change in total number of risk factors, of which percent fat was included, between groups (p<0.01)

+

23) Gutin 2002

80 overweight 13-16 year olds

8 months

PA

Children were randomized to 3 treatments: biweekly lifestyle exercise education, lifestyle plus moderate intensity exercise and lifestyle plus vigorous exercise.

%fat by DEXA, visceral adipose tissue (VAT) and subcutaneous abdominal adipose tissue (SAAT) by MRI

No significant differences in %fat, VAT and SAAT between the lifestyle plus moderate and lifestyle plus vigorous exercise. Percent fat and VAT decreased significantly in the combined lifestyle plus exercise group compared to the lifestyle alone group, which showed increased %fat (p<0.0???).

+

24) Owens 1999

81 overweight children, age ??? were enrolled and 74 children completed the study

4 months

PA

Children were randomized to control and exercise groups. The exercise group attended 40-min. exercise session, 5 days per week at 70-75% of max heart rate using exercise machines for 20 minutes and games for 20 minutes.

Total body mass, total body fat mass (TFM), total body fat-free mass (FFM) and %fat by DEXA. Visceral adipose tissue (VAT) and subcutaneous abdominal adipose tissue (SAAT) by MRI in a subset of 60 subjects.

The physical training group had a significantly greater decline in TFM, VAT and SAAT and increase in FFM (p<0.0???).

+

25) Rocchini 1988

72 overweight adolescents 10-17 years of age and ten non-overweight adolescents 10-14 years (baseline measures only). Final sample was 62 overweight subjects.

20 weeks

D

PA

B

F?

PT?

Subjects were randomly assigned to 3 groups: with exercise (3 classes per week, 1 hour at 70-75% of max HR; duration was 15 minutes initially gradually increasing to 40 minutes over the 20 weeks), without exercise and control. Both treatment groups had behavioral counseling and diet.

Weight, height, %fat by hydrostatic weighting.

Compared to overweight control group, both treatment groups reduced body weight and %fat significantly (p<0.01).

+

26) Schwingshandl 1999

Graz, Austria

30 overweight children

17 female, 13 male

mean age for Group A: 11.0 years

mean age for Group B: 12.2 years

12 weeks

D

PA

F?

PT?

Subjects were randomly assigned to 2 groups: with individualized exercise training 2/week and without exercise. Both groups received standard dietary advice with visits at 4, 8 and 12 weeks

Weight, height, BMI standard deviation score (BMI-SDS), fat mass (FM) and fat free mass (FFM) by BIA

BMI-SDS was significantly decreased in both groups (p=0.0003 in Group A, p=0.01 in Group B). Weight was not significantly reduced in either group. FFM increased significantly in exercise group (p=0.02) but not without exercise group and change was significantly different between groups (p=0.015).

Ø

27) Saelens 2002

44 overweight adolescents, 12-16 years, mean age 14.2 years

16 weeks with follow-up at ???

D

PA

B

Healthy Habits (HH) subjects participated in computer interaction and physician counseling including the traffic light diet in the pediatric primary care clinic followed by a clinic session 1 week later and weekly contact for 8 weeks and biweekly for 2 months by telephone and mail which included behavioral strategies. Typical care (TC) subjects received one counseling session including instruction on food guide pyramid and physical activity recommendations for adolescents (60 minutes of moderate intensity).

Weight, height, BMI, BMI z-score

The change in BMI z score was significantly greater in HH versus TC subjects at post testing and follow-up; HH subject decreased BMI z score significantly but TC increased significantly (p<0.03) at post testing.

+

28) Sondike 2003

New York City, NY

39 overweight children 12-18 years

12 weeks

D

PA

F?

PT?

Subjects were randomly assigned to low fat (LF) diet or low carbohydrate (LC) diet. Both groups followed traffic light plan and were recommended to exercise for 30 minutes 3/week at home.

Weight, height, BMI, BMI t score

Subjects in the LC group significantly reduced weight (9.9 kg) and BMI (3.3) compared to the LF group (4.1 kg, 1.7 [p<0.04; p<0.05]) and BMI t-scores (p<0.04)

+

29) Wadden 1990

Philadelphia, PA

58 overweight African American girls, 12-16 years; 31 girls in follow-up

16 weeks with 6 month follow-up

D

PA

B

F

PT

Subjects were randomly assigned to Child alone (CA), Mother, child together (MCT) and Mother child separately (MCS). All received the Weight Reduction and Pride (WRAP) program including 1000-1500 kcal daily, behavioral counseling, increasing physical activity

Weight, height, BMI, Body fat by hydrostatic weighing

Weight was significantly reduced in all groups: CA (-1.6 kg), MCT (-3.7 kg) and MCS (-3.1 kg.) with no differences between groups at 16 weeks. Body fat decreased equally in all subjects (from mean of 37.1 to 35.1 kg). CA group increased weight from baseline by 3.0 kg, MCT by 1.7 kg and MCS by 3.5 kg. at 6-month follow-up. BMI was not significantly different from baseline in subjects combined. Subjects whose mothers regularly attended treatment sessions lost twice as much weight as those with poor attendance.

+

Other Trials

30) Chen 1997

Taiwan

68 obese children, 5-18 years of age (mean 10 years)

(39 boys, 29 girls)

9 weeks, 1 year follow-up

D

PA

B

F

PT

Weight reduction program involving 6 sessions (3 weekly, 3 biweekly) focusing on parental/family involvement and including the five-lamp diet (promoting low energy dense foods), 25% reduction in energy intake, lifestyle exercise and behavioral modification)

Weight for length index (WLI)

Mean WLI declined (p<0.0001); 97% of participants were below baseline WLI at end of treatment and 80% were below baseline WLI 1 year after treatment.

+

31) Levine 2001

Pittsburgh, PA

24 obese children

9-12 years of age (mean 10.2 years)

(54.2% male)

25% African American

1.5 years, mean of 8 months follow-up

D

PA

B

F

PT

Weight reduction program involving 10-12 sessions

Weight, BMI, %IBW

24 families (89%) completed treatment, 16 families (67%) complete follow-up measures. Children who completed the program lost significant amount of weight during treatment (-2.5 kg, p=.01); similar declines in BMI (p=.003) and %IBW (p=.007). Weight loss not maintained over follow-up period. BMI did not change significantly from pretreatment through follow-up.

+

32) Brown 2000

New Orleans, LA

50 overweight children (16 African American and 34 Caucasian), 7-17 years; mean age 12.27 years

10 weeks

D

PA

B

F

PT

All subjects and families attended weekly 2-hour sessions. Protein sparing modified fast diet and/or balanced hypo caloric diet (based on initial weight status), moderate intensity progressive exercise and behavior modification based on Social Cognitive Therapy (Committed to Kids and Trim Kids approach).

Weight, height, %overweight

Both Caucasian and African American subjects reduced weight and %IBW significantly at 10 weeks (p<0.016)

+

33) Resnicow 2000

4 housing projects in an inner-city neighborhood (city not stated)

56 overweight African American girls, 13.5 years

2 years

D

PA

B

F?

PT?

Non-randomized non-controlled weight reduction program involving four 6-month sessions targeting increased fruit and vegetable intake, decreased fat intake, decreased fast food intake, decreased TV viewing, and increased physical activity

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