Family treatment improves pediatric obesity

Adding family-based behavioral treatment to enhanced primary care improved pediatric obesity outcomes.
*Pragmatic randomized clinical trial; Level 2 (OCEBM).

Citation

Staiano AE, Cook SR, Stein RI, et al. Family-Centered Child Obesity Treatment: The TEAMUP Randomized Clinical Trial. JAMA Pediatrics. Published online July 27, 2026. doi:10.1001/jamapediatrics.2026.3067

Background

Childhood obesity is common and worsens heart-metabolic risk and quality of life. Intensive family-centered lifestyle treatment is recommended, but access through primary care is limited.

Patients

730 children aged 6 to 15 years with obesity at 41 primary care practices. Exclusions included significant eating-disorder symptoms, medical inappropriateness, or conditions or medicines substantially affecting growth, appetite, weight, or activity.

Intervention

Enhanced primary care plus family-based behavioral treatment for nutrition, activity, parenting, and home or social cues.

Control

Enhanced primary care alone, using intensified counseling based on response.

Outcome

Primary: change in percent median body mass index. Other outcomes included Pediatric Quality of Life Inventory (0-100) and Sizing Them Up weight-related quality of life (0-100).

Follow-up Period

18 months; treatment lasted 12 months.

Results

Outcome Significant result favoring family treatment
Percent median body mass index at 12 months (primary) −3.8 units between groups; family treatment −6.4 vs enhanced care −2.6
Percent median body mass index at 18 months −4.3 units between groups
Clinically meaningful body mass index z-score reduction, at least 0.25 Higher odds at 6, 12, and 18 months
Weight-related quality of life at 12 months +2.0 points between groups

The z-score threshold of 0.25 is considered clinically meaningful. Analyses were intention-to-treat. Enhanced care was guideline-concordant current primary care. No trial-related adverse events occurred.

Limitations

COVID-19 disrupted recruitment and delivery. Average family-treatment attendance was below the intended dose and was lower among African American, Medicaid-insured, and food-insecure families, raising access concerns. Some measurements used remote or medical-record data.

Funding

Public/nonprofit funding; no funder role reported.

Clinical Application

Offer or refer for family-based behavioral treatment when available; it adds meaningful benefit beyond enhanced primary care alone.