{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T03:50:29Z","timestamp":1792813829800,"version":"4.5.0"},"reference-count":55,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Family-based behavioral treatment (FBT) is recommended for childhood obesity treatment; however, it is not effective for all families. Since parenting training (PT) has been associated with healthy weight and eating behaviors, intensive PT may augment delivery of behavior change strategies and improve child weight loss outcomes.<\/jats:p><\/jats:sec>Objective<\/jats:title>To compare the efficacy of child overweight or obesity treatment that adds intensive PT to standard FBT with the efficacy of FBT alone.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This 2-arm randomized clinical trial (Reinforced, Enhanced, Families, Responsibility, Education, Support, and Health [ReFRESH]) conducted from April 2017 to November 2022 at an academic center in San Diego, California, included children aged 7 to 12 years with overweight or obesity (body mass index [BMI]\u226585th to &amp;lt;99.9th percentile) and one of their parents.<\/jats:p><\/jats:sec>Interventions<\/jats:title>Parent-child dyads were randomized 1:1 to the intervention group, which received FBT plus PT, or the control group, which received FBT alone. Both groups received twenty 60-minute sessions over 6 months with separate parent and child groups led by staff and nine 20-minute behavior change coaching sessions. The FBT plus PT group sessions incorporated additional intensive parenting skills training in an interactive format.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The primary outcome was change from baseline in child BMI z<\/jats:italic> score and BMI as a percentage of the 95th BMI percentile (BMIp95) after treatment (month 6) and at 6- and 12-month follow-up. Secondary outcomes included the proportion of children who attained clinically meaningful weight loss (ie, reduction of \u22650.20 BMI z<\/jats:italic> score units) and intervention dropout rates. Intention-to-treat analysis was conducted using linear mixed models and logistic regression.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 140 parent-child dyads were included, with 70 in each treatment arm. Mean (SD) child age was 9.91 (1.54) years, and baseline BMI z<\/jats:italic> score was 2.28 (0.80); 71 children (50.7%) were female. There were no significant between-group differences in BMI z<\/jats:italic> score or BMIp95 after treatment or at the follow-up time points. Both groups had significant decreases in weight status after treatment (combined BMI z<\/jats:italic> score: \u03b2, \u22120.14 [95% CI, \u22120.21 to \u22120.07]; P<\/jats:italic>\u2009&amp;lt;\u2009.001; combined BMIp95: \u03b2, \u22123.46 [95% CI, \u22125.41 to \u22121.51]; P<\/jats:italic>\u2009&amp;lt;\u2009.001). More children in the FBT plus PT arm compared with the FBT arm had a reduction of at least 0.20 BMI z<\/jats:italic> score units (34 [48.6%] vs 22 [31.4%]; P<\/jats:italic>\u2009=\u2009.01) after treatment (adjusted odds ratio, 2.10 [95% CI, 1.01-4.47]). Both treatments were well accepted, with no between-group differences in risk of dropout (hazard ratio, 1.01 [95% CI, 0.72-1.43]).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this randomized clinical trial examining the effect of parenting training on child weight status, there were no significant differences in weight status between groups; children in both groups had a significant reduction in weight status. However, more children had clinically meaningful weight loss in the FBT plus PT group. Further work is needed to determine factors associated with treatment response and changes in parenting skills.<\/jats:p><\/jats:sec>Trial Registration<\/jats:title>ClinicalTrials.gov Identifier: NCT02976636<\/jats:ext-link><\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.8398","type":"journal-article","created":{"date-parts":[[2025,5,5]],"date-time":"2025-05-05T15:00:34Z","timestamp":1746457234000},"page":"e258398","source":"Crossref","is-referenced-by-count":7,"title":["Parenting Training Plus Behavioral Treatment for Children With Obesity"],"prefix":"10.1001","volume":"8","author":[{"given":"Kyung E.","family":"Rhee","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takisha","family":"Corbett","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shamin","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dawn M.","family":"Eichen","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R.","family":"Strong","sequence":"additional","affiliation":[{"name":"Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eastern","family":"Kang-Sim","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl A.M.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bess H.","family":"Marcus","sequence":"additional","affiliation":[{"name":"Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerri N.","family":"Boutelle","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Diego School of Medicine, La Jolla"},{"name":"Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla"},{"name":"Department of Psychiatry, University of California, San Diego School of Medicine, La Jolla"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,5,5]]},"reference":[{"issue":"2","key":"zoi250306r1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060640","article-title":"Clinical practice guideline for the evaluation and treatment of children and adolescents with obesity.","volume":"151","author":"Hampl","year":"2023","journal-title":"Pediatrics"},{"issue":"3","key":"zoi250306r2","doi-asserted-by":"publisher","first-page":"226","DOI":"10.1001\/jama.2024.11146","article-title":"Interventions for high body mass index in children and adolescents: US Preventive Services Task Force recommendation statement.","volume":"332","author":"Nicholson","year":"2024","journal-title":"JAMA"},{"issue":"6","key":"zoi250306r3","doi-asserted-by":"publisher","DOI":"10.1111\/ijpo.12621","article-title":"Defining and identifying predictors of rapid response to pediatric obesity treatment.","volume":"15","author":"Eichen","year":"2020","journal-title":"Pediatr Obes"},{"issue":"2","key":"zoi250306r4","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1002\/oby.22367","article-title":"Long and short of it: early response predicts longer-term outcomes in pediatric weight management.","volume":"27","author":"Gross","year":"2019","journal-title":"Obesity (Silver Spring)"},{"issue":"7","key":"zoi250306r5","doi-asserted-by":"publisher","first-page":"626","DOI":"10.1016\/j.brat.2010.03.015","article-title":"An 8-year follow-up of treated obese children: children\u2019s, process and parental predictors of successful outcome.","volume":"48","author":"Moens","year":"2010","journal-title":"Behav Res Ther"},{"issue":"2","key":"zoi250306r6","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1002\/oby.23071","article-title":"Children with severe obesity in family-based obesity treatment compared with other participants: conclusions depend on metrics.","volume":"29","author":"Hayes","year":"2021","journal-title":"Obesity (Silver Spring)"},{"issue":"2","key":"zoi250306r7","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1007\/s13679-024-00566-z","article-title":"Update on pediatric anti-obesity medications\u2014current landscape and approach to prescribing.","volume":"13","author":"Ahn","year":"2024","journal-title":"Curr Obes Rep"},{"issue":"3","key":"zoi250306r8","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1037\/0033-2909.113.3.487","article-title":"Parenting style as context: an integrative model.","volume":"113","author":"Darling","year":"1993","journal-title":"Psychol Bull"},{"key":"zoi250306r9","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1177\/0002716207308400","article-title":"Childhood overweight and the relationship between parent behaviors, parenting style, and family functioning.","author":"Rhee","year":"2008","journal-title":"Ann Am Acad Pol Soc Sci"},{"key":"zoi250306r10","doi-asserted-by":"publisher","first-page":"2119","DOI":"10.3389\/fpsyg.2018.02119","article-title":"General parenting styles and children\u2019s obesity risk: changing focus.","volume":"9","author":"Larsen","year":"2018","journal-title":"Front Psychol"},{"key":"zoi250306r12","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1016\/j.appet.2015.02.012","article-title":"How parental dietary behavior and food parenting practices affect children\u2019s dietary behavior: interacting sources of influence?","volume":"89","author":"Larsen","year":"2015","journal-title":"Appetite"},{"issue":"4","key":"zoi250306r13","doi-asserted-by":"publisher","first-page":"818","DOI":"10.1038\/oby.2009.324","article-title":"Parenting characteristics in the home environment and adolescent overweight: a latent class analysis.","volume":"18","author":"Berge","year":"2010","journal-title":"Obesity (Silver Spring)"},{"issue":"4","key":"zoi250306r14","doi-asserted-by":"publisher","first-page":"331","DOI":"10.1016\/j.jadohealth.2009.08.004","article-title":"Parenting style as a predictor of adolescent weight and weight-related behaviors.","volume":"46","author":"Berge","year":"2010","journal-title":"J Adolesc Health"},{"issue":"6","key":"zoi250306r15","doi-asserted-by":"publisher","first-page":"2047","DOI":"10.1542\/peds.2005-2259","article-title":"Parenting styles and overweight status in first grade.","volume":"117","author":"Rhee","year":"2006","journal-title":"Pediatrics"},{"issue":"2","key":"zoi250306r16","doi-asserted-by":"publisher","first-page":"94","DOI":"10.1089\/chi.2015.0127","article-title":"Warm parenting associated with decreasing or stable child BMI during treatment.","volume":"12","author":"Rhee","year":"2016","journal-title":"Child Obes"},{"key":"zoi250306r17","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyl080","article-title":"Perceived parenting style and practices and the consumption of sugar-sweetened beverages by adolescents.","author":"van der Horst","year":"2006","journal-title":"Health Educ Res"},{"issue":"6","key":"zoi250306r19","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1017\/S0007114511001048","article-title":"Association between parenting styles and own fruit and vegetable consumption among Portuguese mothers of school children.","volume":"106","author":"Franchini","year":"2011","journal-title":"Br J Nutr"},{"issue":"1","key":"zoi250306r20","doi-asserted-by":"publisher","first-page":"93","DOI":"10.1080\/03670244.2014.953248","article-title":"Associations between parenting styles and children\u2019s fruit and vegetable intake.","volume":"54","author":"Alsharairi","year":"2015","journal-title":"Ecol Food Nutr"},{"issue":"3","key":"zoi250306r21","doi-asserted-by":"publisher","first-page":"826","DOI":"10.1016\/j.appet.2011.05.318","article-title":"Relationships between parenting style, feeding style and feeding practices and fruit and vegetable consumption in early childhood.","volume":"57","author":"Blissett","year":"2011","journal-title":"Appetite"},{"issue":"12","key":"zoi250306r22","doi-asserted-by":"publisher","first-page":"1170","DOI":"10.1016\/j.brat.2010.08.008","article-title":"Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change.","volume":"48","author":"West","year":"2010","journal-title":"Behav Res Ther"},{"issue":"3","key":"zoi250306r23","doi-asserted-by":"publisher","first-page":"517","DOI":"10.1542\/peds.2006-1746","article-title":"Twelve-month effectiveness of a parent-led, family-focused weight-management program for prepubertal children: a randomized, controlled trial.","volume":"119","author":"Golley","year":"2007","journal-title":"Pediatrics"},{"issue":"23","key":"zoi250306r24","doi-asserted-by":"publisher","first-page":"2417","DOI":"10.1001\/jama.2017.6803","article-title":"Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.","volume":"317","author":"Grossman","year":"2017","journal-title":"JAMA"},{"issue":"197","key":"zoi250306r25","first-page":"1","article-title":"Evaluation of alternative body mass index (BMI) metrics to monitor weight status in children and adolescents with extremely high BMI using CDC BMI-for-age growth charts.","author":"Hales","year":"2022","journal-title":"Vital Health Stat 1"},{"key":"zoi250306r28","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2024.107562","article-title":"A randomized controlled trial examining general parenting training and family-based behavioral treatment for childhood obesity: the ReFRESH study design.","volume":"142","author":"Rhee","year":"2024","journal-title":"Contemp Clin Trials"},{"key":"zoi250306r29","doi-asserted-by":"publisher","first-page":"S164","DOI":"10.1542\/peds.2007-2329C","article-title":"Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.","volume":"120","author":"Barlow","year":"2007","journal-title":"Pediatrics"},{"key":"zoi250306r31","doi-asserted-by":"publisher","first-page":"551","DOI":"10.1016\/S0005-7894(73)80006-1","article-title":"Effects of videotape and instructional feedback on nonverbal marital interactions: an analogue study.","volume":"4","author":"Eisler","year":"1973","journal-title":"Behav Ther"},{"issue":"5","key":"zoi250306r32","doi-asserted-by":"publisher","first-page":"479","DOI":"10.1007\/BF00911103","article-title":"Enhancing the effectiveness of self-administered videotape parent training for families with conduct-problem children.","volume":"18","author":"Webster-Stratton","year":"1990","journal-title":"J Abnorm Child Psychol"},{"issue":"2","key":"zoi250306r34","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1037\/0022-006X.49.2.245","article-title":"The dyadic parent-child interaction coding system: standardization and validation.","volume":"49","author":"Robinson","year":"1981","journal-title":"J Consult Clin Psychol"},{"key":"zoi250306r35","doi-asserted-by":"publisher","DOI":"10.1016\/j.appet.2019.104488","article-title":"Responding positively to \u201cchildren who like to eat\u201d: parents\u2019 experiences of skills-based treatment for childhood obesity.","volume":"145","author":"Ek","year":"2020","journal-title":"Appetite"},{"issue":"7","key":"zoi250306r36","doi-asserted-by":"publisher","first-page":"2693","DOI":"10.1073\/pnas.1010076108","article-title":"A gradient of childhood self-control predicts health, wealth, and public safety.","volume":"108","author":"Moffitt","year":"2011","journal-title":"Proc Natl Acad Sci U S A"},{"issue":"246","key":"zoi250306r37","first-page":"1","article-title":"2000 CDC growth charts for the United States: methods and development.","author":"Kuczmarski","year":"2002","journal-title":"Vital Health Stat 11"},{"key":"zoi250306r38","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1016\/j.jpeds.2021.02.072","article-title":"A longitudinal comparison of alternatives to body mass index z-scores for children with very high body mass indexes.","volume":"235","author":"Freedman","year":"2021","journal-title":"J Pediatr"},{"issue":"5","key":"zoi250306r39","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1017\/S0007114519002046","article-title":"Distance and percentage distance from median BMI as alternatives to BMI z score.","volume":"124","author":"Freedman","year":"2020","journal-title":"Br J Nutr"},{"key":"zoi250306r40","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1186\/1479-5868-11-15","article-title":"Development of the Comprehensive General Parenting Questionnaire for caregivers of 5-13 year olds.","volume":"11","author":"Sleddens","year":"2014","journal-title":"Int J Behav Nutr Phys Act"},{"issue":"14","key":"zoi250306r41","doi-asserted-by":"publisher","first-page":"1661","DOI":"10.1001\/jama.298.14.1661","article-title":"Efficacy of maintenance treatment approaches for childhood overweight: a randomized controlled trial.","volume":"298","author":"Wilfley","year":"2007","journal-title":"JAMA"},{"issue":"1","key":"zoi250306r47","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1177\/1094428117703686","article-title":"Multiple imputation of missing data for multilevel models: simulations and recommendations.","volume":"21","author":"Grund","year":"2018","journal-title":"Organ Res Methods"},{"issue":"11","key":"zoi250306r48","doi-asserted-by":"publisher","first-page":"1152","DOI":"10.1038\/s41366-023-01373-7","article-title":"A long-term follow-up of treatment for young children with obesity: a randomized controlled trial.","volume":"47","author":"Ek","year":"2023","journal-title":"Int J Obes (Lond)"},{"issue":"3","key":"zoi250306r50","doi-asserted-by":"publisher","first-page":"e621","DOI":"10.1542\/peds.2011-1568","article-title":"Early childhood family intervention and long-term obesity prevention among high-risk minority youth.","volume":"129","author":"Brotman","year":"2012","journal-title":"Pediatrics"},{"issue":"3","key":"zoi250306r51","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1002\/oby.23663","article-title":"Sex differences in response to lifestyle intervention among children and adolescents: systematic review and meta-analysis.","volume":"31","author":"Mast","year":"2023","journal-title":"Obesity (Silver Spring)"},{"issue":"6","key":"zoi250306r52","doi-asserted-by":"publisher","DOI":"10.1111\/ijpo.12620","article-title":"Sex as a moderator of body composition following a randomized controlled lifestyle intervention among Latino youth with obesity.","volume":"15","author":"Vander Wyst","year":"2020","journal-title":"Pediatr Obes"},{"issue":"5","key":"zoi250306r53","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1016\/j.jadohealth.2017.12.002","article-title":"Sex as a moderator of adolescents\u2019 weight loss treatment outcomes.","volume":"62","author":"Rancourt","year":"2018","journal-title":"J Adolesc Health"},{"issue":"4","key":"zoi250306r54","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1007\/s40615-019-00694-6","article-title":"Impact of race and ethnicity on weight-loss outcomes in pediatric family-based obesity treatment.","volume":"7","author":"Eichen","year":"2020","journal-title":"J Racial Ethn Health Disparities"},{"issue":"5","key":"zoi250306r55","doi-asserted-by":"publisher","first-page":"S112","DOI":"10.1016\/j.amepre.2007.01.022","article-title":"The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent ehealth interventions.","volume":"32","author":"Collins","year":"2007","journal-title":"Am J Prev Med"},{"key":"zoi250306r18","first-page":"135","volume-title":"Childhood Obesity and Health Research","author":"Musher-Eizenman","year":"2006"},{"key":"zoi250306r42","volume-title":"Longitudinal Data Analysis","author":"Hedeker","year":"2006"},{"key":"zoi250306r43","volume-title":"Generalized, Linear, and Mixed Models","author":"McCulloch","year":"2001"},{"key":"zoi250306r44","volume-title":"Hierarchical Linear Models: Applications and Data Analysis Methods","author":"Raudenbush","year":"2002","edition":"2nd ed"},{"key":"zoi250306r45","author":"Webster-Stratton","year":"1998"},{"key":"zoi250306r11","doi-asserted-by":"crossref","unstructured":"Patrick? H, Hennessy? E, McSpadden? K, Oh? A. Parenting styles and practices in children\u2019s obesogenic behaviors: scientific gaps and future research directions. Child Obes. 2013;9(suppl 1):S73-S86. doi:10.1089\/chi.2013.0039","DOI":"10.1089\/chi.2013.0039"},{"key":"zoi250306r26","unstructured":"ResearchMatch. Home page. Accessed March 25, 2025. https:\/\/www.researchmatch.org\/"},{"key":"zoi250306r27","unstructured":"blockrand: Randomization for block random clinical trials. R. Version 1.5. R Project for Statistical Computing; 2020. Accessed January 5, 2021. https:\/\/cran.r-project.org\/package=blockrand"},{"key":"zoi250306r30","unstructured":"US Dept of Agriculture. MyPlate. Accessed April 1, 2020. https:\/\/www.myplate.gov\/"},{"key":"zoi250306r33","unstructured":"The Incredible Years. The Incredible Years series: evidence-based parenting programs. Accessed March 25, 2025. https:\/\/www.incredibleyears.com\/early-intervention-programs\/parents"},{"key":"zoi250306r46","unstructured":"jomo: A package for multilevel joint modelling multiple imputation. R. Version 4.4. R Project for Statistical Computing; 2023. Accessed October 18, 2024. https:\/\/CRAN.R-project.org\/package=jomo"},{"key":"zoi250306r49","unstructured":"Centers for Disease Control and Prevention, US Dept of Health and Human Services. CDC-recognized family health weight programs. Accessed May 1, 2023. https:\/\/www.cdc.gov\/family-healthy-weight\/php\/recognized-programs"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2833516\/rhee_2025_oi_250306_1749128503.43153.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,11]],"date-time":"2025-06-11T15:00:56Z","timestamp":1749654056000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2833516"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,5,5]]},"references-count":55,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2025,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.8398","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,5]]}}}