Managing Obesity in Young Children: A Multiple Methods Study Assessing Feasibility, Acceptability, and Implementation of a Multicomponent, Family-Based Intervention

Title: A Qualitative Systematic Review of Parental Perceptions, Motivators, and Barriers to Management of Childhood Obesity

Background

Childhood obesity is a global epidemic affecting millions worldwide. Children living with obesity face increased risks of health-related and psychosocial problems extending into adulthood. Parents and carers play a crucial role in cultivating healthy habits in their children. This review aims to synthesize qualitative research on parental perceptions, motivators, and barriers in managing childhood obesity and their views on weight management programs.

Methods

This systematic review was performed in accordance with the guidelines established by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A variety of electronic databases were explored for qualitative studies published between 2006 and 2023. The CASP checklist was employed to assess the quality of the studies. Data extraction and synthesis were carried out utilizing thematic content analysis.

Results

The search identified 20 peer-reviewed studies meeting the inclusion criteria. Key themes were mapped into five distinct groups: perceptions, facilitators and barriers influencing the management of childhood obesity, as well as facilitators and barriers to enrolment into a weight management program. Parents often perceived obesity as a temporary condition, genetically determined and believed it should not be considered as a major health concern. Identified facilitators included the restriction of screen time, school involvement, goal setting, and enhanced child-parent communication. Conversely, barriers included lack of child motivation, peer influence, easy access to junk food, as well as parental denial, insufficient knowledge or control and logistical challenges.

Conclusion

To tackle childhood obesity, it is essential to adopt a comprehensive strategy that fosters a supportive family environment. Successful initiatives should encompass nutritional education for both parents and children, increase access to healthy food choices, implement home-based programs, and improve the infrastructure that encourages physical activity. Additionally, cultural factors and technological advancements should be considered when designing these interventions.

Systematic Review Registration Number

PROSPERO (CRD42024514219).

Family-Based Interventions for Pediatric Obesity: A Comprehensive Systematic Review and Meta-Analysis of Their Effectiveness

Genetics can influence obesity, and when it affects both parents and children, there is a high risk of developing cardiometabolic diseases. Studies have indicated that family-based treatment (FBT) is a cost-effective and successful option for achieving significant weight changes in both children and parents. While specialized clinics offer FBT, primary care settings, where most pediatric care takes place, may not have the necessary resources or expertise to provide intensive behavioral interventions for childhood obesity. Based on early findings, FBT could potentially have a positive impact on siblings as well, as when treated children and parents experience behavioral changes, it can also have a beneficial effect on their untreated siblings. Parents play a crucial role in shaping their children's behavior, and siblings often have a stronger influence on them than their parents or friends. For our meta-analysis, we utilized three graphical models created using RevMan 5.4, based on the selected articles. To develop our systematic review, we thoroughly analyzed a total of 10 articles. The subgroup analysis within these studies assessed the effectiveness of FBT for overweight children, revealing no significant differences between groups (p=0.77). This suggests that based on their BMI, FBT may not have a statistically significant impact on weight loss in overweight children. However, each study reviewed showed statistical significance (p<0.05). The findings of our meta-analysis underscore the need for more robust evidence and larger randomized controlled trials (RCTs) to enhance our understanding of FBT's benefits in pediatric obesity. This will be crucial for reducing the rising prevalence of obesity and maintaining lower incidence rates.

Designing, Implementing, and Evaluating a Home-Based, Multidisciplinary, Family-Centered Pediatric Obesity Intervention: The ProxOb Program

Although family-based interventions have been suggested as promising approaches for preventing and treating pediatric obesity, available studies failed to include the whole family in its own natural environment and routine. This paper aims to detail the development, implementation, and evaluation phases of the ProxOb home-based, family-centered program and present its feasibility and early results. ProxOb provides families with a 6-month multidisciplinary, home-based, and family-centered intervention followed by an 18-month maintenance phase. A global psychosocial, clinical, and behavior evaluation was conducted at baseline (T0) at the end of the 6-month intervention (T1) and after the 18-month maintenance phase (T2). A total of 130 families with at least one child with obesity completed the ProxOb program so far, and more than 90% of them also presented at least one parent with overweight or obesity. Being part of a single-parent family seemed to increase the chance of completing the intervention (63.0% vs. 33.3% in the drop-outers subgroup, p = 0.03). The BMI z-score for children with obesity (T0 = 4.38 ± 1.05; T1 = 4.06 ± 1.07; T2 = 4.29 ± 1.12) significantly decreased between T0 and T1, followed by weight regain at T2. ProxOb proposes a feasible and replicable real-life approach to address childhood obesity while involving the children’s family.