A clinical trial co-led by WashU Medicine researcher Denise Wilfley, PhD, found that adding family-based behavioral treatment to specialized pediatric care helped nearly half of children with obesity reach a healthier weight. The approach coaches parents to change habits and routines at home, where lasting change begins.
Childhood obesity affects one in five children in the U.S., yet most families have limited access to specialized weight-management programs for children. Now, a large clinical trial led by researchers at Washington University School of Medicine in St. Louis, the University of Rochester Medical Center, the LSU Pennington Biomedical Research Center and the American Academy of Pediatrics (AAP) has shown that an effective, family-based treatment model can be delivered in primary care settings to treat children and adolescents with obesity.
Looking at more than 700 children with obesity across four states and 41 primary care practices, the team found that nearly half of the children receiving the family-based intervention achieved a clinically meaningful reduction in weight associated with better heart health and lower diabetes risk. The benefit persisted at an 18-month follow-up, six months after treatment ended.
The findings appear July 27 in JAMA Pediatrics.
“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, PhD, the Scott Rudolph University Professor in the WashU Medicine Department of Psychiatry and one of the study’s two principal investigators, who helped develop the treatment and establish its evidence base. “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. The answer is yes.”
The intensive family-based behavioral treatment exemplifies the approach recommended by the U.S. Preventive Services Task Force (USPSTF) and the AAP for childhood obesity. Despite its robust evidence base, access has remained limited. This trial represents an important advance in offering the intervention in primary care and demonstrating that it can be implemented effectively in routine clinical practice across the full age range studied, from 6 to 15 years.
“Our results show that an established, effective obesity treatment for children and adolescents can be successfully delivered in their pediatrician’s office,” said first author Amanda Staiano, PhD, director of the Pediatric Obesity and Health Behavior Laboratory at Pennington Biomedical. “What makes this study especially meaningful is that we worked alongside healthcare practices and insurance providers to create a model that supports real-world delivery. By building treatment into existing clinical teams, we demonstrated an approach that is sustainable well beyond a clinical trial and can expand access for families who need it most.”
Family-based treatment meets patients where they already access care
Conducted from 2019 to 2024, the trial included 730 children ages 6 to 15 with obesity who were seen at any of 41 primary care practices in Missouri, Illinois, Louisiana and New York. The participants were randomly assigned to one of two groups for a year, then followed for an additional six months.
One group received enhanced standard of care, a less-intensive intervention in which patients had follow-up obesity treatment visits with their primary care provider focused on individualized behavioral counseling and medical management. The treatment also includes the flexibility to intensify care based on a child’s response and family’s motivation.
Children in the family-based behavioral treatment group also received enhanced standard of care, plus up to 33 sessions with a trained interventionist, typically a registered dietitian or behavioral health provider. The sessions were attended by the child and a parent.
In the family-based approach, families learn to monitor eating, physical activity and weight; set goals; modify the home environment to support those goals; and use positive reinforcement, praise and parental modeling. The treatment also helps families establish supportive routines and strengthen family and peer relationships that promote lasting behavior change.
On average, families attended about 17 family treatment sessions — fewer than the program offered — and still experienced meaningful benefits. And because the study counted every child who enrolled, regardless of how many sessions the family attended, the results may understate what’s possible when families can come more often.
Children in both groups experienced weight reductions, but those who received family-based behavioral treatment saw greater benefit. Both groups started around 77% above a healthy weight. After a year, the family-based group had come down to about 70%, compared with about 74% for enhanced care, and the gap continued to widen after the intervention ended. By the six-month follow up, about 42% of the family-based group had lost an amount of weight associated with better heart and metabolic health, roughly 1.5 times the rate of children receiving enhanced care alone.
Parents in the family-based group also reported greater improvements in their child’s weight-related quality of life and in their family’s nutrition and physical activity routines than did parents in the enhanced care group.
Because much of the trial occurred during the COVID-19 pandemic, more than 75% of family-based behavioral sessions were delivered by telehealth. Families who participated through telehealth achieved outcomes comparable to those seen exclusively in person, highlighting the potential of flexible delivery models to reduce access barriers.
“We designed the treatment to provide the full number of sessions recommended for effective care and to have them delivered by licensed providers in their primary care office,” said Stephen Cook, MD, an associate professor of pediatrics at the University of Rochester and one of the study’s two principal investigators. “They might be part of a behavioral health or nutrition team integrated into the primary care practice, making this more practical for real-world settings.”
Reaching a range of families
A defining feature of the trial was its focus on practical implementation for a broad range of patients. Roughly half of participating families were covered by Medicaid, and about one in five reported food insecurity. The study included patients with common medical and behavioral health problems, such as ADHD or anxiety, who are typically excluded from these studies, but who constitute a meaningful portion of the population pediatricians actually see. The treatment offered was billable to Medicaid and private insurance by primary care providers and behavioral interventionists, many of whom were existing clinic employees. This design, the researchers said, was central to demonstrating the effectiveness and feasibility of integrating family-based behavioral treatment into routine clinical operations.
“The study has shown that delivering lifestyle behavioral treatment for obesity to a diverse patient population can be successful in a primary care setting,” said Sandra Hassink, MD, Medical Director of the AAP’s Institute of Healthy Childhood Weight and past president of the AAP. “This is an important trial because health behavior and lifestyle treatment is the foundation for comprehensive obesity treatment.”
As GLP-1 medications reshape the conversation around obesity, the researchers point out that family-based behavioral treatment can be used alone or alongside medication to provide children and parents with skills and supportive environments needed for lasting health behavior change. The team plans to follow up with trial participants at five and 10 years to learn how durable the benefits prove long-term.
“Every family-based behavioral treatment session provides additional benefit on top of enhanced care, and the message we want families to hear is that every session can make a difference,” said Wilfley, who also directs of the Center for Healthy Weight and Wellness at WashU Medicine. “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.”
