Family weight-loss program to treat more than 1,000 parents and children

Weight-loss programs for children and parents are far more successful when the whole family is treated together. The problem is, such programs are usually located in specialty clinics, unavailable to the general public.

Now, Leonard Epstein, SUNY Distinguished Professor in the Jacobs School of Medicine and Biomedical Sciences who pioneered the family-based approach to weight loss, has been awarded an $8.8 million grant from the National Institutes of Health to start making such successful family-based weight-loss programs more widely available.

The weight-loss programs will begin in spring 2017 in primary care offices located in Buffalo and Rochester, Columbus, Ohio, and St. Louis, Missouri. The five-year grant will allow the programs to treat more than 500 families, reaching more than 1,000 overweight or obese children and parents, as well as more than 200 siblings who are overweight or obese.

“The purpose of this grant is to implement and evaluate highly successful, family-based obesity treatment in the primary care setting, an optimal setting given the established relationship between patients and their primary care providers,” Epstein says.

He is division chief of behavioral medicine in the Department of Pediatrics at the Jacobs School of Medicine and Biomedical Sciences, an internationally recognized expert on childhood weight control and family intervention, and one of the most productive investigators in behavioral medicine and nutrition. During one 10-year study of overweight children who had participated in Epstein’s research, the percentage able to maintain a healthy weight at 10-year follow-up was 50 percent, far higher than the usual percentage, which is typically 10 percent or less.

Steven Lana, managing partner of Delaware Pediatrics, one of the Buffalo practices that will participate, explains there is a compelling need for interventions that promote weight loss and maintenance in children. “The UB study of family-based behavioral treatment offers us a unique opportunity to provide an evidence-based, multicomponent intervention to improve treatment outcomes for our patients. We are eager to support this project because we witness the early start of obesity complications that can significantly influence the children and families in our practice,” Lana says.

Amherst-based Integrity Health Group and Williamsville Pediatric Center are the other participating primary care practices located in Western New York.

The new study will compare two weight-control approaches in more than a dozen primary care providers’ offices. One group will get an enhanced version of the standard treatment, where parent and child receive information on healthy eating and are seen by the physician four times over two years.

Families receiving the intervention will be seen in the doctor’s office by their own physician, as well as by health counselors trained to deliver family-based weight-control programs tailored to the needs of each family.

“With this grant, we are placing health coaches on the front lines,” Epstein says.

A key goal of the grant is to find out how primary care providers’ offices can best deliver weight-control assistance to their patients.

 “We want to know how to overcome some of the barriers — such as staffing, space, funding and attitudes — that primary care practices may face when using empirically tested research in treatment programs,” Epstein says. “We will have to find ways to help them provide services that they traditionally haven’t had the time to provide at the pace the families need for ultimate success and on a flexible schedule that can best accommodate patients.”

The grant is an example of translational research that aims to accelerate or “translate” findings from the laboratory into the real-world clinical setting. That was the focus of the $16 million Clinical and Translational Science Award (CTSA) received last fall by UB and its partners, which put UB into a select group of medical schools nationwide that are leading translational research.

Epstein notes his current grant will take a multidisciplinary “team science” approach, which is characteristic of translational research. He is partnering with Teresa Quattrin, chair of the Department of Pediatrics, A. Conger Goodyear Professor of Pediatrics and chief of the Division of Endocrinology/Diabetes and Pediatrics at Women and Children’s Hospital of Buffalo. She also is president of UBMD Pediatrics.

Quattrin’s research also underscores the success of family-based, weight-loss treatment. Her 2014 study in Pediatrics showed that preschoolers in a family weight-control program experienced normal weight gain while peers in a control group gained more weight. At the same time, parents in the family weight-loss program lost an average of 14 pounds, while parents in the control group didn’t lose weight.

“That pivotal trial demonstrated that family-based treatment can be implemented in the primary care setting, leading to more weight loss in children and parents compared to treating the child alone,” Quattrin says. “In this new phase, we will further extend this experience to answer the challenge of translating this experience across different clinical realities around the country in a multicenter trial treating 6- to 12-year-old children and parents who are overweight or obese.”