OBJECTIVES Our aim was to compare the effect of 2 treatment models on attendance and child weight status: a less intense guided self-help (GSH) program delivered in the primary care setting versus traditional family-based behavioral treatment (FBT) delivered in an academic center. METHODS We conducted a randomized clinical trial among 164 children between 5 and 13 years old with a BMI ≥85th percentile and their parents. The intervention group (GSH) received 14 individual sessions over 6 months, with 5.3 hours of treatment. The control group (FBT) received 20 group-based sessions over 6 months, with 20 hours of treatment. Main outcomes included proportion of sessions families attended and change in child BMI z-score (BMIz), percentage from the 95th BMI percentile, difference from the 95th BMI percentile at the end of treatment, and 6-month follow-up. RESULTS Mean age of children was 9.6 years, BMI z-score 2.1, 49% female, and >90% Latino. The odds of attending GSH compared to FBT was 2.2 (P < 0.01). Those assigned to GSH had a 67% reduced risk of attrition (hazard ratio = 0.33, 95% confidence interval 0.22-0.50, P < .001). Intent-to-treat analysis showed no between-group differences in change in BMIz and percentage from the 95th BMI percentile over time. Combined, there was a significant reduction in BMIz from baseline to posttreatment (β = -0.07 (0.01), P < .01, d: 0.60) and a slight increase from posttreatment to follow-up (β = 0.007 (0.13), P = .56). CONCLUSIONS This study provides support for a novel, less intense GSH model of obesity treatment, which can be implemented in the primary care setting. Future studies should examine effective approaches to dissemination and implementation of GSH in different settings to increase access to treatment.

中文翻译：

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初级保健中儿科肥胖的引导式自助：一项随机临床试验。

目标 我们的目的是比较 2 种治疗模式对出勤率和儿童体重状况的影响：初级保健机构提供的强度较低的引导式自助 (GSH) 计划与学术机构提供的传统基于家庭的行为治疗 (FBT)中央。方法 我们对 164 名 5 至 13 岁 BMI ≥ 85% 的儿童及其父母进行了一项随机临床试验。干预组 (GSH) 在 6 个月内接受了 14 次单独的治疗，治疗时间为 5.3 小时。对照组（FBT）在 6 个月内接受了 20 次基于小组的治疗，治疗时间为 20 小时。主要结果包括家庭参加的会议比例和儿童 BMI z 评分 (BMIz) 的变化、与第 95 个 BMI 百分位数的百分比、与治疗结束时第 95 个 BMI 百分位数的差异，和 6 个月的随访。结果 儿童的平均年龄为 9.6 岁，BMI z 评分为 2.1，49% 为女性，>90% 为拉丁裔。与 FBT 相比，参加 GSH 的几率为 2.2 (P < 0.01)。分配到 GSH 的患者减员风险降低了 67%（风险比 = 0.33，95% 置信区间 0.22-0.50，P < .001）。意向治疗分析显示，随着时间的推移，BMIz 和从 BMI 第 95 个百分位开始的百分比变化没有组间差异。综合来看，BMIz 从基线到治疗后显着降低 (β = -0.07 (0.01), P < .01, d: 0.60)，从治疗后到随访略有增加 (β = 0.007 (0.13), P = .56)。结论 本研究为一种新的、强度较低的 GSH 肥胖治疗模型提供了支持，该模型可以在初级保健环境中实施。