Parents in peer delivery of family-based behavioral pediatric weight management: the SHIFT randomized noninferiority trial.

Abstract

This trial examined the noninferiority of family-based behavioral pediatric weight management treatment (FBT) delivered by peers relative to professionals. Children (n = 127) aged 7 to 11 years with BMI > 85th percentile for age and sex and at least one parent with BMI > 25 kg/m² were randomly assigned to receive FBT delivered by parents who had previously received FBT from professionals. Child and parent anthropometrics and child quality of life were measured prior to FBT, at treatment end, and at 12-month follow-up. Treatment fidelity, adherence, and costs were examined by delivery mode. Peer FBT delivery was noninferior to professional FBT delivery (margin of 0.072 in child BMI z score change) at treatment end and at 12-month follow-up; however, superiority testing suggested that professional FBT delivery resulted in better child BMI z score change. No differential changes were observed in child quality of life or parental BMI by FBT delivery mode. Peer-delivered FBT was well received, with peers providing personal examples of behavior change success but less skills-focused content. Peer FBT delivery was about one-quarter the cost of professional FBT delivery. This study informs new strategies for sustaining the delivery of pediatric obesity interventions by involving trained parents.