BACKGROUND:Ultra-processed foods (UPFs) are linked to obesity and cognitive decline, but evidence on their association with executive function (EF) in children is limited. OBJECTIVE:To evaluate the UPFs-EF relationship in parent-child dyads with obesity seeking treatment. METHODS:Secondary analysis of the FRESH trial (NCT01197443) conducted at the University of California, San Diego. A total of 141 Parent-child dyads; parent age = 43 years (6.6), BMI = 32 (6.4); child age = 9.9 years (1.3), BMIz = 2.0 (0.3); 31% Hispanic, 44% White, 25% other completed anthropometric, digit span backward (DSB), stop signal task (SST) and Wisconsin Card Sorting Test (WCST), and dietary assessments. Linear regression models evaluated UPFs-EF associations, controlling for covariates. RESULTS:Parent-child associations were observed for energy β = 0.15, p = 0.024; total UPFs β = 0.20, p = 0.018; savoury snacks β = 0.28, p = 0.018; ultra-processed (UP) meat, β = 0.60, p < 0.001; and sweetened beverages β = 0.24, p = 0.023. Most UPFs-EF associations were null. In children, UP meat predicted lower DSB scores (β = -0.104, 95% CI [-0.197, -0.013], p = 0.013), and in parents, sweetened beverages predicted failed SST (β = 0.606, 95% CI [0.018, 1.210], p = 0.044). CONCLUSIONS:There were a few associations between UPFs intake and EF; however, most were nonsignificant. Future research should involve community samples and children across the weight spectrum.

Accurate self-reported data on social determinants of health (SDoH) are essential for improving prevention initiatives. Beyond survey content and validation, deciding which household member should complete family-level SDoH assessments can affect data quality. Yet, few studies have explored how family members report on various SDoH, especially in the Latino/Hispanic community experiencing greater health challenges. This study not only examined intra-household agreement on family-level SDoH items but also assessed combined individual SDoH linked to agreement in Southern California, which hosts one of the largest Latino/Hispanic communities in the USA. We analyzed data from 277 adult pairs (n = 554) across Southern California who completed the National Institute on Minority Health and Health Disparities Common Data Elements questionnaire. Each respondent answered 19 household-level items across four domains: Demographics, Economics, Health and Clinical Care, and Housing. Agreement was evaluated using simple or weighted Cohen’s Kappa (range, ≤ 0 to 1). Modified Poisson regression examined associations between agreement and combined individuals’ health literacy, employment, sex at birth, age, birthplace, and ethnicity. Tests were corrected for multiple comparisons. Among respondents, 56.3

Abstract Introduction Adult weight management interventions are complex; better understanding of the intervention components that may impact eating disorder (ED) risk is required. Methods Weight management randomized controlled trials (RCTs) for adults with overweight/obesity that measured ED risk were systematically searched in four databases and two trial registries. A project-specific codebook was used to code 84 delivery features and 89 intervention strategies of trials. Individual strategies were grouped into 20 clusters which were further grouped into five broad categories. Trial investigators verified coding and narrative synthesis using descriptive statistics of findings was reported. Results Of 14,880 identified, 58 eligible trials were coded, of which 26 trials with 64 intervention arms were verified and therefore included. Intervention arms included a mean (SD) of 24 (11) intervention strategies. Commonly used intervention strategy clusters were nutrition education (91%), dietary behavior change strategies (84%), physical activity education (81%), and dietary self-monitoring (80%). Few interventions used strategies in the category of psychological components (13–41%). The median (range) intervention duration was 27 (4–104) weeks, and contacts with participants typically included a staged approach of weekly to monthly contact. Conclusion Adult weight management interventions are multifactorial with varying delivery features and intervention strategies. Despite this, psychological (e.g. weight stigma) and sleep-health related strategies are either rarely used or are underreported. Breaking down intervention components using our framework can help identify which strategies influence outcomes, including eating disorder risk, and inform the design and reporting of future interventions. Plain English summary Some adults seeking weight management for obesity may have an eating disorder or disordered eating behaviors. Research shows most people who take part in behavioral weight management programs have an improvement in eating disorder symptoms, however a small number may experience worsening symptoms. In this study, we break down behavioral weight management programs that measure eating disorder risk to better understand the features they use. We found that these programs vary widely in the number and type of strategies they use, as well as in how they are delivered, such as the length of the program. Strategies that focus on psychological factors (for example, addressing weight stigma) and sleep health were rarely used or reported. These findings are useful in guiding the design and reporting of future behavioral weight management programs. They can also be used in future research to determine which specific program features improve or worsen outcomes such as eating disorder risk.

OBJECTIVE:To understand delivery features and intervention strategies of adolescent weight management interventions which may influence eating disorder risk. METHODS:Systematic searches in four databases and two trial registries to identify randomised controlled trials in adolescents with overweight/obesity measuring eating disorder risk pre- and post-intervention. Delivery features and intervention strategies were coded from published descriptions using a project-specific codebook, validated by trial investigators and narratively synthesised. RESULTS:Of 11 860 records screened, 23 trials, with 54 intervention arms, were included in the analysis. Most interventions focused on weight loss and maintenance (54%) and were informed by a cognitive behavioural framework (43%). Interventions commonly targeted an individual with a support person (70%). Median intervention duration was 26 weeks, with weekly (35%) or staged (e.g., weekly, then monthly) visit (41%) frequency. Interventions had a mean (SD) of 30 (16.1) intervention strategies. Most included healthy eating education (89%), physical activity education (89%) and problem-solving barriers to dietary change (80%). Few included mental health strategies (17%). Interventions included 'dietary prescription' (65%), and 78% promoted 'healthful/helpful eating behaviours'. CONCLUSION:Weight management interventions are complex and vary in delivery approach and strategies used to change behaviors. Characterising interventions is a critical first step to understanding how weight management interventions' influence eating disorder risk.

Abstract Background Food insecurity (FI) is associated with poorer physical and mental health outcomes, exacerbation of chronic diseases, and decreased access to healthcare. Children experiencing FI face additional risks, including lower psychosocial functioning and reduced academic achievement. Although national initiatives call for integrating nutrition support services into healthcare, clinical workflows for FI screening and referral remain inconsistently implemented and difficult to sustain. The goal of this study is to refine, adapt, and optimize a comprehensive FI screening and referral program, and identify effective implementation strategies for pediatric healthcare systems. Methods We will use a RollOut Implementation and Optimization (ROIO) trial design to iteratively implement and refine the implementation strategies for our FI screening and referral program (I-FRESH: Implementing Food Referrals for Equity and Sustained Health) across 4 pediatric clinics. I-FRESH includes: (1) FI screening; (2) assessment of family needs and readiness to access services; (3) referral and navigation support to community nutrition programs; and (4) follow-up to assess fit, utilization, and ongoing needs. The Pragmatic, Robust Implementation and Sustainability Model (PRISM) will guide adaptation and evaluation of contextual determinants, while RE-AIM will guide assessment of outcomes (implementation feasibility and acceptability, fidelity, adoption, reach, effectiveness, and maintenance). We will identify several implementation strategies to increase the likelihood that I-FRESH can be successfully implemented and sustained in a pediatric healthcare system. We will enroll 240 participants and assess preliminary effectiveness on family‑level food security and pediatric nutrition‑related health outcomes (e.g. weight status, blood pressure, lipids, HbA1c, liver function tests). The information gathered in this trial will be utilized in the development of a fully powered Type 2 Hybrid Effectiveness-Implementation Trial that will test the effectiveness of the identified implementation strategies and impact of the FI program on clinical outcomes. Discussion By integrating PRISM and RE-AIM within an iterative ROIO design, this study will generate a scalable, contextresponsive implementation model for addressing FI in pediatric healthcare settings. Findings will inform sustainable strategies that link families to highquality nutrition support programs and improve nutritionrelated health outcomes for lowincome children. Trial registration NCT06661538.

Autistic children have higher rates of overweight and obesity (OW/OB) compared to nonautistic children. Family-based behavioral treatment (FBT) is the standard of care for children with obesity and is delivered to both the parent and the child. Common autism characteristics, such as sensory sensitivities, social communication challenges, and behavioral rigidity, can limit the feasibility of providing FBT to both parent and child. Our team developed a parent-based treatment (PBT) model that is delivered only to the parent of an autistic child with OW/OB. Our published pilot data established the initial feasibility, acceptability and initial weight-loss efficacy of this program. This paper presents a protocol for an ongoing two-arm randomized controlled trial comparing the effect of a telehealth PBT program tailored for families with an autistic child (PBT-A) with a health education (HE) comparator on the child's weight over 18 months. We aim to recruit 150 families with an autistic child with OW/OB and randomize them to either six-months of telehealth PBT-A or HE treatment delivered to the parent only. The primary outcome is change in child body size, assessed by BMIz and percent of the 95th percentile, over the 18 months of the study. Secondary outcomes include parent BMI, dietary intake for both parent and child, child mealtime behavior, physical activity levels, parenting style, and parental self-efficacy. This ongoing study may provide a scalable, cost-effective intervention for families with an autistic child with OW/OB. Clinical trials # NCT05741840.

BACKGROUND:Pediatric overweight and obesity continue to be major public health issues. Loss of control (LOC) eating and overeating are two obesity-related phenotypes affecting approximately 30 % of adolescents with overweight/obesity that may undermine weight control treatment outcome. Cognitive-behavioral therapy (CBT) has promising effects on dysregulated eating, but effects on weight are modest, access is limited, and developmental changes in self-regulation (which may limit implementation of treatment skills) are often ignored. METHODS:In the current proposal, we will apply human-centered design methods to design and test a novel CBT-based digital intervention, augmented with content and features to improve self-regulation, for weight gain prevention and dysregulated eating in adolescents. The first phase will involve design activities with adolescents (n = 25-30) who have body mass index (BMI; kg/m2) ≥ 75th percentile for age and sex and report dysregulated eating, to understand desired presentation, features, and barriers/facilitators to engagement. Research activities will include a needs assessment and iterative prototyping, usability testing, and refinement of the digital intervention. The second phase will be a multisite single arm open trial involving 50 adolescents who have or are at risk for overweight/obesity and report LOC and/or overeating to investigate intervention feasibility and preliminary efficacy, as well as putative treatment mechanisms and targets. CONCLUSIONS:Results of the study will inform the design of an adequately powered randomized controlled trial. The project has clear potential to significantly impact public health via development of a relevant, accessible, and scalable intervention for adolescents at risk for adverse physical and mental health outcomes. CLINICAL TRIAL REGISTRATION NUMBER:NCT06819813.

Obesity is a heterogeneous disease influenced by individual behavioral factors, environment, genes, and neural processes. Behavioral weight loss (BWL), the current gold-standard treatment for overweight and obesity (OW/OB), does not produce sustained weight loss for all individuals. Appetitive traits, such as food responsiveness (FR), are risk factors that could account for differences in how individuals interact with today's food environment and increase susceptibility for overeating and weight gain. Research shows that individuals high in FR have attenuated weight loss in BWL programs. We developed the Regulation of Cues (ROC) program to reduce overeating through improving sensitivity to hunger and satiety cues and decreasing FR. In this study, we combined ROC with BWL recommendations (ROC+BWL), a treatment approach that may address the unique needs of this phenotype. The current study is a 3-arm randomized controlled trial comparing the ROC+BWL program to BWL and an active comparator on body mass index. Two hundred ninety-three adults with high FR and OW/OB were randomized to 1 of 3 treatment arms and will complete 6 months of treatment and assessment visits over 18 months: baseline, during treatment, post-treatment (6 months), 6-month follow-up (12 months) and 12-month follow-up (18 months). This study could provide important evidence regarding the ROC+BWL program among individuals with high FR and OW/OB and may inform future precision medicine approaches for OW/OB. Clinical trials # NCT05004883.

Latino children are disproportionally affected by overweight and obesity (OW/OB). Family-based behavioral treatment (FBT) is the most empirically supported treatment for children with OW/OB and traditionally includes a child and a caregiver. Very few FBT programs have been tested among Latino families, and to date, outcomes are inconsistent and/or show small effects. Familismo is a core value in Latino culture highlighting the importance of family functioning over any individual members, and it is possible that by adapting the treatment and including other family members, FBT outcomes could be enhanced for Latino families. Randomized trials show that parent-only FBT programs (PBT) are similarly effective to FBT and can be easier to disseminate and cost less. The current trial is a two-arm randomized controlled trial comparing the effect of a telehealth PBT program tailored to Latino families (PBT-LC) with a health education (HE) comparator on the child's weight over the 18 months of the study. We randomized 167 Latino families with a child with OW/OB to either six-months of telehealth PBT-LC or HE treatment delivered to the parent and additional caregiver in English or Spanish with 12-months of follow-up. This ongoing study may provide a translatable evidence-based cost-effective program tailored for Latino families with a child with OW/OB. Clinical trials # NCT05437406.

Importance 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. Objective To compare the efficacy of child overweight or obesity treatment that adds intensive PT to standard FBT with the efficacy of FBT alone. Design, Setting, and Participants 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]>= 85th to <99.9th percentile) and one of their parents. Interventions 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. Main Outcomes and Measures The primary outcome was change from baseline in child BMI z 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 >= 0.20 BMI z score units) and intervention dropout rates. Intention-to-treat analysis was conducted using linear mixed models and logistic regression. Results 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 score was 2.28 (0.80); 71 children (50.7%) were female. There were no significant between-group differences in BMI z 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 score: beta, -0.14 [95% CI, -0.21 to -0.07]; P < .001; combined BMIp95: beta, -3.46 [95% CI, -5.41 to -1.51]; P < .001). More children in the FBT plus PT arm compared with the FBT arm had a reduction of at least 0.20 BMI z score units (34 [48.6%] vs 22 [31.4%]; P = .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]). Conclusions and Relevance 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. Trial Registration ClinicalTrials.gov Identifier: NCT02976636

Importance:Cognitive behavioral therapy (CBT) has the most empirical support for treatment of binge eating. Appetitive traits, including food responsiveness and satiety responsiveness, impact how individuals interact with the current obesogenic environment. The regulation of cues (ROC) plus behavioral weight loss (BWL) intervention was specifically developed to target food responsiveness, satiety responsiveness, and energy reduction. Objective:To evaluate the feasibility and efficacy of ROC+BWL and CBT over 5 months of treatment and 6 months of follow-up and to explore whether clinical binge eating was a moderator of outcomes. Design, Setting, and Participants:This randomized clinical trial was conducted from March 2019 to April 2023 among veterans at a university clinic. Eligible participants were veterans who met criteria for Binge Eating Disorder (BED) or subthreshold BED, had a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45, were aged 18 to 65 years, and were free of other exclusionary criteria. Data were analyzed from January 2024 to June 2025. Intervention:The ROC+BWL intervention uniquely targets food responsiveness, satiety responsiveness, and energy reduction. CBT focuses on disrupting the dietary restraint/binge eating cycle by changing maladaptive thoughts and behaviors. Participants were randomized to receive either ROC+BWL or CBT for 5 months. Main Outcomes and Measures:The main outcomes were feasibility and change in binge eating (measured as loss of control) and body weight, assessed at midtreatment (2.5 months), posttreatment (5 months), and a 6-month follow-up (11 months). Results:A total of 1853 veterans inquired about participation and 1724 were excluded or declined to participate. The final sample included 129 veterans (mean [SD] age, 47.1 [11.3] years; 76 [59%] male; mean [SD] BMI, 34.8 [4.7]), with 63 randomized to ROC+BWL and 66 to CBT. A total of 123 veterans (95%) provided data posttreatment, and 115 veterans (89%) provided data at the 6-month follow-up. Attendance and acceptability ratings did not differ between treatments. ROC+BWL resulted in a greater reduction in risk of binge eating than CBT at midtreatment (difference in probability, -0.20; 95% credible interval [CrI], -0.30 to -0.11), posttreatment (difference in probability, -0.23; 95% CrI, -0.22 to -0.19), and at the 6-month follow-up (difference in probability, -0.21; 95% CrI, -0.21 to -0.18). ROC+BWL also resulted in greater weight loss at midtreatment (difference in BMI change, -0.68; 95% CrI, -1.23 to -0.12) and posttreatment (difference in BMI change, -0.71; 95% CrI, -1.40 to -0.01) assessments than CBT, but significant differences were no longer observed at the 6-month follow-up (difference in BMI change, -0.22; 95% CrI, -0.98 to 0.54). Results were more pronounced among veterans with BED. Conclusions and Relevance:In this randomized clinical trial among veterans with binge eating and obesity, ROC+BWL resulted in greater decreases in binge eating compared with CBT. Although ROC+BWL resulted in greater weight loss compared with CBT during treatment, these differences were not maintained. Thus, ROC+BWL could be an alternate model to treat BED among veterans, but effects on weight need further research. Trial Registration:ClinicalTrials.gov Identifier: NCT03678766.

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. To compare the efficacy of child overweight or obesity treatment that adds intensive PT to standard FBT with the efficacy of FBT alone. 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]≥85th to <99.9th percentile) and one of their parents. 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. The primary outcome was change from baseline in child BMI z 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 ≥0.20 BMI z score units) and intervention dropout rates. Intention-to-treat analysis was conducted using linear mixed models and logistic regression. 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 score was 2.28 (0.80); 71 children (50.7%) were female. There were no significant between-group differences in BMI z 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 score: β, −0.14 [95% CI, −0.21 to −0.07]; P < .001; combined BMIp95: β, −3.46 [95% CI, −5.41 to −1.51]; P < .001). More children in the FBT plus PT arm compared with the FBT arm had a reduction of at least 0.20 BMI z score units (34 [48.6%] vs 22 [31.4%]; P = .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]). 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. ClinicalTrials.gov Identifier: NCT02976636

Cognitive behavioral therapy (CBT) has the most empirical support for treatment of binge eating. Appetitive traits, including food responsiveness and satiety responsiveness, impact how individuals interact with the current obesogenic environment. The regulation of cues (ROC) plus behavioral weight loss (BWL) intervention was specifically developed to target food responsiveness, satiety responsiveness, and energy reduction. To evaluate the feasibility and efficacy of ROC+BWL and CBT over 5 months of treatment and 6 months of follow-up and to explore whether clinical binge eating was a moderator of outcomes. This randomized clinical trial was conducted from March 2019 to April 2023 among veterans at a university clinic. Eligible participants were veterans who met criteria for Binge Eating Disorder (BED) or subthreshold BED, had a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45, were aged 18 to 65 years, and were free of other exclusionary criteria. Data were analyzed from January 2024 to June 2025. The ROC+BWL intervention uniquely targets food responsiveness, satiety responsiveness, and energy reduction. CBT focuses on disrupting the dietary restraint/binge eating cycle by changing maladaptive thoughts and behaviors. Participants were randomized to receive either ROC+BWL or CBT for 5 months. The main outcomes were feasibility and change in binge eating (measured as loss of control) and body weight, assessed at midtreatment (2.5 months), posttreatment (5 months), and a 6-month follow-up (11 months). A total of 1853 veterans inquired about participation and 1724 were excluded or declined to participate. The final sample included 129 veterans (mean [SD] age, 47.1 [11.3] years; 76 [59%] male; mean [SD] BMI, 34.8 [4.7]), with 63 randomized to ROC+BWL and 66 to CBT. A total of 123 veterans (95%) provided data posttreatment, and 115 veterans (89%) provided data at the 6-month follow-up. Attendance and acceptability ratings did not differ between treatments. ROC+BWL resulted in a greater reduction in risk of binge eating than CBT at midtreatment (difference in probability, −0.20; 95% credible interval [CrI], −0.30 to −0.11), posttreatment (difference in probability, −0.23; 95% CrI, −0.22 to −0.19), and at the 6-month follow-up (difference in probability, −0.21; 95% CrI, −0.21 to −0.18). ROC+BWL also resulted in greater weight loss at midtreatment (difference in BMI change, −0.68; 95% CrI, −1.23 to −0.12) and posttreatment (difference in BMI change, −0.71; 95% CrI, −1.40 to −0.01) assessments than CBT, but significant differences were no longer observed at the 6-month follow-up (difference in BMI change, −0.22; 95% CrI, −0.98 to 0.54). Results were more pronounced among veterans with BED. In this randomized clinical trial among veterans with binge eating and obesity, ROC+BWL resulted in greater decreases in binge eating compared with CBT. Although ROC+BWL resulted in greater weight loss compared with CBT during treatment, these differences were not maintained. Thus, ROC+BWL could be an alternate model to treat BED among veterans, but effects on weight need further research. ClinicalTrials.gov Identifier: NCT03678766

BACKGROUND AND OBJECTIVES Family-based behavioral treatment (FBT) for children with obesity is provided in weekly parent and child groups over 6 months. A guided self-help FBT program (gshFBT) is provided to the dyad in short meetings. Both interventions provide the same content; however, gshFBT provides this content in less time (FBT = 23 hours, gshFBT = 5.3 hours). This study aimed to evaluate whether gshFBT is noninferior to FBT on child weight loss and cost-effectiveness. METHODS 150 children aged between 7.0 and 12.9 years with a BMI between the 85th and 99.9th percentile and their parent were recruited and randomized to a 6-month program of gshFBT (n = 75) or FBT (n = 75) and were followed 12 months post-treatment. RESULTS A total of 150 children (mean age = 10.1 years, 49% female, mean BMIz = 2.09) and their parent (mean age = 41.5 years, 87% female, 45% Hispanic, 37% White non-Hispanic, 9.7% Asian, 4.8% Black, 7.3% other) were recruited from the San Diego Metropolitan area. Joint LME models showed that gshFBT was noninferior to FBT on child weight loss (ΔBMIz = −0.02 [90% credible interval [CI] −0.08–0.05, P = .65]; ΔBMIp95% = −1.57 [90% CI –4.46–1.31, P = .28]) and cost less (cost/dyad gshFBT = $1498; FBT = $2775). CONCLUSION The gshFBT program provided similar weight losses for children with less contact hours and with lower cost than FBT. The reduced time and ease of scheduling for the family in gshFBT will allow for an increased reach of treatment to a greater proportion of families in need.

BACKGROUND:Children with overweight or obesity (OW/OB), relative to healthy weight (HW), have lower cognitive performance and hippocampal volumes. Whether this extends to children with HW at familial risk for future OW/OB is unknown. OBJECTIVES:To compare memory performance and hippocampal subfield volumes between HW children at high risk (HR) and low risk (LR) for OW/OB. METHODS:HW children (n = 95, aged 8-11), classified as HR (n = 43, both parents with OW/OB) or LR (n = 52, both parents with HW), underwent structural magnetic resonance imaging and memory testing (Verbal List Learning Test-Food-Child Version (VLLT-Food-C) and Child Memory Scale subtests: word pairs, dot locations). Linear models tested group differences in memory scores, hippocampal and subfield (CA1, CA3, dentate gyrus (DG), subiculum) volumes. RESULTS:Groups did not differ on demographics except body mass index (HR > LR, p = 0.003), despite all children being HW. LR children performed better on VLLT-Food-C short- ( β $$ \beta $$  = 0.34, p < 0.01) and long-delay cued recall ( β $$ \beta $$  = 0.21, p = 0.04) and word pairs delayed recall ( β $$ \beta $$  = 0.21, p = 0.04). Children with HR had smaller bilateral whole hippocampus, CA1, DG and right CA3 volumes (ps < 0.05); only the right DG remained significant ( β $$ \beta $$  = 0.15, p = 0.04) after intracranial volume adjustment. CONCLUSIONS:Memory and hippocampal volume differences may reflect underlying familial risk of OW/OB in HW children.

Overweight and obesity affect >40% of adolescents. Family-based behavioral treatment (FBT) is the most efficacious behavioral treatment for weight management among youth and consists of nutrition and physical activity education, behavior change skills, and parent skills training. However, the efficacy of FBT decreases for youth as they get older. Increased emotional lability and limited emotion regulation skills may contribute to the reduced efficacy of FBT for adolescents. To date, there are no treatments for overweight or obesity specifically adapted for the needs of adolescents. We developed a treatment that integrates components from Dialectical Behavior Therapy and Emotion Focused Therapy with FBT (FBT+ER or FBT-ER) to address the specific needs of adolescents. The current study randomized 166 adolescents (BMI = 32.8; 14.3 years; 57% female; 32% Hispanic, 50% Non-Hispanic White, 18% Non-Hispanic and Non-White) and one of their parents (BMI = 32.9; 45.3 years; 85% female; 27% Hispanic, 57% Non-Hispanic White, 16% Non-Hispanic and Non-White) to 6 months of either standard FBT or FBT+ at 2 sites. Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12) and 12-month follow-up (month 18). Primary outcomes are adolescent weight (BMIz/%BMIp95), emotion regulation skills, and emotional eating behaviors. Given the public health concern of adolescent obesity, FBT+ could prove extremely useful to provide more targeted and effective intervention for adolescents with overweight or obesity. Clinical trials: # NCT03674944

ObjectiveSelf-monitoring dietary intake is a critical component of family-based intensive health behavior and lifestyle treatment for pediatric obesity, but adherence rates are often low. This study identifies predictors of parent self-monitoring rates during treatment.MethodsA secondary analysis of parent self-monitoring data from a randomized controlled trial involving 150 parent-child dyads. Patterns of self-monitoring were identified using a latent class mixed model approach. Logistic regression analyses evaluated predictors of self-monitoring patterns.ResultsLatent class models identified two trajectory groups: a high consistent self-monitoring group and a low-decreasing self-monitoring group. When compared to parents in the low group, parents in the high group lost more weight throughout treatment. Children in the high group had a similar trajectory for weight loss; however, the groups were not statistically different. Higher levels of family chaos and poorer family problem-solving skills were associated with higher odds of being in the low group.ConclusionThis study identified two patterns of rates of parent self-monitoring, which were associated with parent weight loss and were differentiated by family chaos and poor problem-solving. These findings suggest that families with high levels of chaos and poor problem-solving could benefit from early intervention to improve outcomes in pediatric obesity treatment programs.Trial RegistrationClinicaltrials.gov Identifier: NCT01197443.

Food cue reactivity (FCR) is an appetitive trait associated with overeating and weight gain. We developed a laboratory craving assessment to objectively evaluate cognitive aspects of FCR. This study examined the preliminary construct and criterion validity of this craving assessment and evaluated 4 different interventions, 2 of which incorporated cue-exposure treatment for food, on craving over treatment and follow-up. 271 treatmentseeking adults with overweight/obesity (body mass index = 34.6[5.2]; age = 46.5[11.8]; 81.2% female; 61.6% non-Latinx White) completed the Food Cue Responsivity Scale and the laboratory craving assessment, during which they alternated holding and smelling a highly craved food and provided craving ratings over 5 min. Participants were subsequently randomized to 26 treatment sessions over 12-months of ROC, Behavioral Weight Loss (BWL), a combined arm (ROC+) and an active comparator (AC), and repeated the craving assessment at post-treatment and 12-month follow-up. Linear mixed-effects models assessed associations between trial type (holding vs. smelling), trial number, pre-treatment FCR, treatment arm, assessment time point, and craving. Cravings were greater when smelling vs. holding food (b = 0.31, p < 0.001), and cravings decreased over time (b = -0.02, p < 0.001). Participants with higher pre-treatment FCR reported elevated cravings (b = 0.29, p < 0.001). Longitudinally, we observed a significant 3-way interaction in which treatment arm modified the relationship between pre-treatment FCR and craving over time (F(17,5122) = 6.88, p < 0.001). An attenuated FCRcraving relationship was observed in ROC+ and BWL from baseline to post-treatment but was only sustained in BWL at follow-up. This attenuation was also observed in ROC and AC from post-treatment to follow-up. The preliminary validity of this laboratory craving assessment was supported; however, greater craving reductions over time in ROC/ROC+ compared to BWL and AC were not consistently observed, and thus do not appear to fully account for the moderating effect of FCR on weight losses observed in the trial.

Background: Primary care providers (PCPs) are expected to provide weight management counseling despite having low confidence in their ability to be effective. This analysis examined change in weight status between children who received usual care from their PCP and those who received one of two structured weight management programs in a randomized control trial.Methods: Data from parent-child dyads who were referred to the Guided Self-Help Obesity Treatment in the Doctor's Office study, but did not participate, were examined to determine change in weight status compared with those who participated in the trial. Families were divided into four groups: Group 1, structured treatment with high attendance; Group 2, structured treatment with low attendance; Group 3, PCP/usual care with some weight management counseling; and Group 4, PCP/usual care with no counseling. Anthropometric data and PCP delivery of weight management counseling were abstracted from the electronic health record. Main outcomes were changes in child BMI z-scores, BMI as a percentage relative to the 95th percentile, and BMI as a difference relative to the 95th percentile at the end of treatment and 6-month follow-up for each group.Results: Groups 1 and 2 showed significant decreases in weight status over time, with Group 1 showing the greatest decrease. Groups 3 and 4 remained relatively stable. Changes in weight status in Groups 2, 3, and 4 were significantly different from Group 1 at post-treatment.Conclusions: While structured weight management programs have a significant impact on weight status, those who received some counseling by their PCP did not show significant increases in weight status and were relatively weight stable. Efforts should be broadened to support PCPs as they provide weight management counseling in the office.

Family-based behavioral treatment (FBT) is one of the most effective treatments for childhood obesity. These programs include behavior change strategies and basic parenting training to help parents make healthy diet and physical activity changes for their children. While effective, not all families respond to this program. Additional training on how to effectively deliver these behavior change strategies may improve outcomes. The authoritative parenting style is associated with many positive academic and socio-emotional outcomes in children, and is characterized by displays of warmth and support while also being consistent with setting limits and boundaries. This parenting style has also been associated with normal weight status. Furthermore, parenting training programs that promote this parenting style for children with behavioral issues have shown unintended effects on decreasing child weight status. Therefore, our goal was to examine the effect of adding more intensive parenting training to FBT on child weight status. We randomized 140 children and their parent to either FBT or FBT + Parenting Training (FBT + PT). Assessments were conducted at baseline, mid-treatment (month 3), post-treatment (month 6), 6-month follow-up (month 12), and 12-month follow-up (month 18). Primary outcome was change in child weight status. Secondary outcomes were rates of drop-out, treatment adherence, and acceptability. If effective, this program may provide another alternative for families to help improve outcomes in childhood obesity management.