Family members' experiences with adult participation in weight management programs: Triadic perspectives from patients, partners and children

The children of parents who receive treatment for binge-eating disorder experience improvements in disordered eating

OBJECTIVE

Parental eating disorders are associated with disordered eating behaviors and psychopathology in their children, but it is not known whether parent treatment for binge-eating disorder (BED) is associated with changes in child disordered eating behaviors and weight. Benefits or the "ripple" effect of treatment on untreated family members has been described in the obesity literature but not for BED.

METHOD

Participants evaluated for two randomized clinical trials for BED were screened for whether they had children. 76 parents completed baseline assessments about a school-aged child; 62 were randomized to treatment, of whom 41 completed end-of-treatment assessments about their child's eating behaviors and weight (which were not targeted in the parent treatments).

RESULTS

Analyses revealed a significant effect of time on children's binge-eating frequency and perceived weight category and a significant effect of parent medication on perceived weight category. Parental change in binge eating was associated significantly with changes in child secretive eating and food hoarding. Parental change in weight was not associated significantly with change in age/sex-normed child BMI percentile, but had some associations with parent-perceived child weight category.

CONCLUSIONS

Parent changes during their treatment were associated with changes in their children. Future longitudinal research is needed to examine when disordered eating emerges and clarify critical intervention timing related to children's age and parental BED. Further clinical research is also needed to assess the effectiveness of treating disordered eating at the family level.

PUBLIC SIGNIFICANCE

Prior cross-sectional work has found that parents with BED are more likely to have children who engage in binge eating compared to parents without eating-disorder psychopathology. This study was an initial exploration of change in children when parents received treatment in randomized controlled trials for BED. In this study, parent changes in binge eating were associated with reduced child secretive eating and food hoarding.

Postpartum women's experiences in a randomized controlled trial of a web-based lifestyle intervention following Gestational Diabetes: a qualitative study

INTRODUCTION

Gestational diabetes mellitus (GDM) is associated with an increased maternal risk for the development of type 2 diabetes (T2DM). We previously demonstrated in a randomized trial that a web-based postpartum lifestyle intervention program, Balance After Baby, increased weight loss among postpartum women with recent pregnancies complicated by GDM. The aim of this analysis is to identify the impact of the intervention on study participants as assessed by exit interviews after completion of the 12 month study.

METHODS

We conducted structured exit interviews created with a concurrent-contextual design with subjects randomized to the intervention group at the conclusion of their participation (∼12 months) in the Balance After Baby study, with the objectives of 1) understanding the impact of the intervention on participants and their family members, 2) identifying which program components were most and least helpful, and 3) identifying the perceived best timing for diabetes prevention interventions in postpartum women with recent GDM.

RESULTS

Seventy-nine percent (26/33) of eligible intervention participants participated in interviews. Participants noted changes in diet and physical activity as a result of the intervention. Several components of the intervention, particularly the online modules and support from the lifestyle coach, were perceived by intervention participants to have had a positive effect on personal and familial lifestyle change, while other components were less utilized, including the community forum, YMCA memberships, and pedometers. Nearly all participants felt that the timing in the intervention study, beginning about 6 weeks postpartum, was ideal.

DISCUSSION

Results of this study identify the importance of individualized coaching, impact on family members, and demonstrate that postpartum women feel ready to make changes by 6 weeks postpartum. Findings from this study will help inform the development of future technologically-based lifestyle interventions for postpartum women with recent GDM.

Changes in Child Weight, Behaviors, and Family Dynamics during Parental Participation in a Medical Weight Management Program: A Longitudinal Uncontrolled Pilot Study

Background: There is limited evidence of the effects of parental participation in outpatient medical weight management (MWM) programs on children. The aims of the project were to (1) identify time effects from parental participation in the MWM program on changes in child weight trajectories, healthy and unhealthy weight control practices, physical and sedentary activity, parental restrictive feeding and pressure to eat, and family functioning and communication and (2) determine differences based on child factors. Methods: A longitudinal uncontrolled pilot study was conducted, in which parent-child (ages 7-19) dyads completed assessments at parents' MWM program initiation, 3 months (mid-program), 6 months (end of program), and 12 months to determine sustained effects. Repeated measures analysis of variance (ANOVA) was completed using a mixed multilevel modeling approach using Restricted Maximum Likelihood estimation method; each outcome was additionally analyzed with child baseline weight status, age group, and sex as between-subjects factors. Results: Fifty three dyads met inclusion criteria, 23 completed the initial assessment (enrollment: 43.3%), and 13 completed the 12-month assessment (retention: 56.5%). Significant effects over time were observed for decreased parental restrictive feeding (p < 0.038) over 12 months, and group by time effects were observed for increased restrictive feeding for female compared to male children (p = 0.025) over 12 months. Marginally significant group by time effects were found for increased impaired family functioning (p = 0.054) and communication (p = 0.054) for children with overweight/obesity compared to healthy weight children over 12 months. Conclusions: Female children and children with overweight/obesity may experience increased negative family dynamics (restriction of food, family functioning, and communication) through parental MWM programs.

Family Dynamics and Pediatric Weight Management: Putting the Family into Family-Based Treatment

PURPOSE OF REVIEW

The treatment of pediatric obesity entails working with entire families. However, aside from parenting and family health behaviors, family dynamics and relationships are not often incorporated in clinical treatment of obesity.

RECENT FINDINGS

Evidence across several studies suggest a relationship between family dynamics and child weight, with impaired family dynamics associated with higher weight status in children. Evidence is mixed if child age and family function are associated. Unfortunately, there is little evidence that addressing family dynamics (i.e., relationships and overall family system) will improve weight in children with obesity. Notably, few studies target family dynamics specifically. There are several validated measures of family dynamics available for researchers to explore the family system as it relates to child health and behaviors. A deeper understanding of family dynamics and relationships may provide new avenues to address issues of weight in children; accounting for the family, and their underlying functioning, may benefit the clinician and child engaged in weight management.