Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Pediatric Review
  • Published:

Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management

Abstract

Family-based approaches to pediatric obesity treatment are considered the ‘gold-standard,’ and are recommended for facilitating behavior change to improve child weight status and health. If family-based approaches are to be truly rooted in the family, clinicians and researchers must consider family process and function in designing effective interventions. To bring a better understanding of family complexities to family-based treatment, two relevant reviews were conducted and are presented: (1) a review of prominent and established theories of the family that may provide a more comprehensive and in-depth approach for addressing pediatric obesity; and (2) a systematic review of the literature to identify the use of prominent family theories in pediatric obesity research, which found little use of theories in intervention studies. Overlapping concepts across theories include: families are a system, with interdependence of units; the idea that families are goal-directed and seek balance; and the physical and social environment imposes demands on families. Family-focused theories provide valuable insight into the complexities of families. Increased use of these theories in both research and practice may identify key leverage points in family process and function to prevent the development of or more effectively treat obesity. The field of family studies provides an innovative approach to the difficult problem of pediatric obesity, building on the long-established approach of family-based treatment.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Figure 1
Figure 2
Figure 3
Figure 4

Similar content being viewed by others

References

  1. Ogden CL, Carroll MD, Kit BK, Flegal KM . Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA 2012; 307: 483–490.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Olshansky SJ, Passaro DJ, Hershow RC, Layden J, Carnes BA, Brody J et al. A potential decline in life expectancy in the United States in the 21st century. N Engl J Med 2005; 352: 1138–1145.

    Article  CAS  PubMed  Google Scholar 

  3. Krebs NF, Himes JH, Jacobson D, Nicklas TA, Guilday P, Styne D . Assessment of child and adolescent overweight and obesity. Pediatrics 2007; 120(Suppl 4): S193–S228.

    Article  PubMed  Google Scholar 

  4. Dietz WH . Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998; 101: 518–525.

    CAS  PubMed  Google Scholar 

  5. Schwimmer JB, Burwinkle TM, Varni JW . Health-related quality of life of severely obese children and adolescents. JAMA 2003; 289: 1813–1819.

    Article  PubMed  Google Scholar 

  6. Wang G, Dietz WH . Economic burden of obesity in youths aged 6 to 17 years: 1979-1999. Pediatrics 2002; 109: E81–E81.

    Article  PubMed  Google Scholar 

  7. Hampl SE, Carroll CA, Simon SD, Sharma V . Resource utilization and expenditures for overweight and obese children. Arch Pediatr Adolesc Med 2007; 161: 11–14.

    Article  PubMed  Google Scholar 

  8. Whitlock EP, O'Connor EA, Williams SB, Beil TL, Lutz KW . Effectiveness of weight management interventions in children: a targeted systematic review for the USPSTF. Pediatrics 2010; 125: e396–e418.

    Article  PubMed  Google Scholar 

  9. Brownell KD, Kelman JH, Stunkard AJ . Treatment of obese children with and without their mothers: changes in weight and blood pressure. Pediatrics 1983; 71: 515–523.

    CAS  PubMed  Google Scholar 

  10. Epstein LH, Valoski A, Wing RR, McCurley J . Ten-year follow-up of behavioral, family-based treatment for obese children. JAMA 1990; 264: 2519–2523.

    Article  CAS  PubMed  Google Scholar 

  11. Epstein LH, Valoski A, Wing RR, McCurley J . Ten-year outcomes of behavioral family-based treatment for childhood obesity. Health Psychol 1994; 13: 373–383.

    Article  CAS  PubMed  Google Scholar 

  12. Golan M, Crow S . Targeting parents exclusively in the treatment of childhood obesity: long-term results. Obes Res 2004; 12: 357–361.

    Article  PubMed  Google Scholar 

  13. Janicke DM, Sallinen BJ, Perri MG, Lutes LD, Huerta M, Silverstein JH et al. Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project STORY. Arch Pediatr Adolesc Med 2008; 162: 1119–1125.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Golan M, Fainaru M, Weizman A . Role of behaviour modification in the treatment of childhood obesity with the parents as the exclusive agents of change. Int J Obes Relat Metab Disord 1998; 22: 1217–1224.

    Article  CAS  PubMed  Google Scholar 

  15. Golan M, Weizman A, Apter A, Fainaru M . Parents as the exclusive agents of change in the treatment of childhood obesity. Am J Clin Nutr 1998; 67: 1130–1135.

    Article  CAS  PubMed  Google Scholar 

  16. Spear BA, Barlow SE, Ervin C, Ludwig DS, Saelens BE, Schetzina KE et al. Recommendations for treatment of child and adolescent overweight and obesity. Pediatrics 2007; 120(Suppl 4): S254–S288.

    Article  PubMed  Google Scholar 

  17. Davis MM, Gance-Cleveland B, Hassink S, Johnson R, Paradis G, Resnicow K . Recommendations for prevention of childhood obesity. Pediatrics 2007; 120(Suppl 4): S229–S253.

    Article  PubMed  Google Scholar 

  18. Kirk S, Zeller M, Claytor R, Santangelo M, Khoury PR, Daniels SR . The relationship of health outcomes to improvement in BMI in children and adolescents. Obes Res 2005; 13: 876–882.

    Article  PubMed  Google Scholar 

  19. Savoye M, Shaw M, Dziura J, Tamborlane WV, Rose P, Guandalini C et al. Effects of a weight management program on body composition and metabolic parameters in overweight children: a randomized controlled trial. JAMA 2007; 297: 2697–2704.

    Article  CAS  PubMed  Google Scholar 

  20. Skelton JA, Demattia LG, Flores GA . Pediatric weight management program for high-risk populations: a preliminary analysis. Obesity (Silver Spring) 2008; 16: 1698–1701.

    Article  Google Scholar 

  21. Beech BM, Klesges RC, Kumanyika SK, Murray DM, Klesges L, McClanahan B et al. Child- and parent-targeted interventions: the Memphis GEMS pilot study. Ethn Dis 2003; 13: S40–S53.

    PubMed  Google Scholar 

  22. Munsch S, Roth B, Michael T, Meyer AH, Biedert E, Roth S et al. Randomized controlled comparison of two cognitive behavioral therapies for obese children: mother versus mother-child cognitive behavioral therapy. Psychother Psychosom 2008; 77: 235–246.

    Article  PubMed  Google Scholar 

  23. Ostbye T, Zucker NL, Krause KM, Lovelady CA, Evenson KR, Peterson BL et al. Kids and adults now! Defeat obesity (KAN-DO): rationale, design and baseline characteristics. Contemp Clin Trials 2011; 32: 461–469.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Wadden TA, Stunkard AJ, Rich L, Rubin CJ, Sweidel G, McKinney S . Obesity in black adolescent girls: a controlled clinical trial of treatment by diet, behavior modification, and parental support. Pediatrics 1990; 85: 345–352.

    CAS  PubMed  Google Scholar 

  25. West F, Sanders MR, Cleghorn GJ, Davies PS . Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change. Behav Res Ther 2011; 48: 1170–1179.

    Article  Google Scholar 

  26. Kitzmann KM, Beech BM . Family-based interventions for pediatric obesity: methodological and conceptual challenges from family psychology. J Fam Psychol 2006; 20: 175–189.

    Article  PubMed  Google Scholar 

  27. Pinelli L, Elerdini N, Faith MS, Agnello D, Ambruzzi A, De Simone M et al. Childhood obesity: results of a multicenter study of obesity treatment in Italy. J Pediatr Endocrinol Metab 1999; 12(Suppl 3): 795–799.

    PubMed  Google Scholar 

  28. Skelton JA, Beech BM . Attrition in paediatric weight management: a review of the literature and new directions. Obesity Rev 2011; 12: e273–e281.

    Article  CAS  Google Scholar 

  29. Skelton JA, Cook SR, Auinger P, Klein JD, Barlow SE . Prevalence and trends of severe obesity among US children and adolescents. Acad Pediatr 2009; 9: 322–329.

    Article  PubMed Central  PubMed  Google Scholar 

  30. Oude Luttikhuis H, Baur L, Jansen H, Shrewsbury VA, O'Malley C, Stolk RP et al. Interventions for treating obesity in children Evid.-Based Child Health. Cochrane Rev J 2009; 4: 1571–1729.

    Google Scholar 

  31. Alderson P . The importance of theories in health care. BMJ 1998; 317: 1007–1010.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  32. Rhee KE, Lumeng JC, Appugliese DP, Kaciroti N, Bradley RH . Parenting styles and overweight status in first grade. Pediatrics 2006; 117: 2047–2054.

    Article  PubMed  Google Scholar 

  33. White JM, Klein DM . The Systems Framework. Family Theories. Third Edition edn Sage Publications: Thousand Oaks, CA, 2008; pp 151–177.

    Google Scholar 

  34. Bertalanffy LV . Theoretical models in biology and psychology. In: Krech D, Klein GS (eds) Theoretical Models and Personality Theory. Duke University Press: Durham, NC, 1953.

    Google Scholar 

  35. Broderick CB . Understanding Family Process: Basics of Family Systems Theory. Sage Publications: Newbury Park, CA, 1993.

    Google Scholar 

  36. Kitzman-Ulrich H, Wilson DK, George SM, Lawman H, Segal M, Fairchild A . The integration of a family systems approach for understanding youth obesity, physical activity, and dietary programs. Clin Child Fam Psychol Rev 2010; 13: 231–253.

    Article  PubMed Central  PubMed  Google Scholar 

  37. Berge JM . A review of familial correlates of child and adolescent obesity: what has the 21st century taught us so far? Int J Adolesc Med Health 2009; 21: 457–483.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Berge JM, Everts JC . Family-based interventions targeting childhood obesity: a meta-analysis. Child Obes 2011; 7: 110–121.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Olson DH . Circumplex model of marital and familiy systems. J Fam Ther 2000; 22: 144–167.

    Article  Google Scholar 

  40. Olson DH, Gorall DM . Circumplex Model of Marital & Family Systems. In: Walsh F (ed) Normal Family Processes. 3rd edn. Guilford: New York, 2003. pp 514–547.

    Google Scholar 

  41. Tubiana-Rufi N, Moret L, Czernichow P, Chwalow J . The association of poor adherence and acute metabolic disorders with low levels of cohesion and adaptability in families with diabetic children. The PEDIAB Collaborative Group. Acta Paediatr 1998; 87: 741–746.

    Article  CAS  PubMed  Google Scholar 

  42. Herzer M, Godiwala N, Hommel KA, Driscoll K, Mitchell M, Crosby LE et al. Family functioning in the context of pediatric chronic conditions. J Dev Behav Pediatr 2010; 31: 26–34.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Gundersen C, Mahatmya D, Garasky S, Lohman B . Linking psychosocial stressors and childhood obesity. Obes Rev 2010; 12: e54–e63.

    Article  PubMed  Google Scholar 

  44. Puder JJ, Munsch S . Psychological correlates of childhood obesity. Int J Obes (Lond) 2010; 34(Suppl 2): S37–S43.

    Article  Google Scholar 

  45. Hill R . Families Under Stress: Adjustment to the Crises of War Separation and Reunion. Harper & Brothers: New York, 1949.

    Google Scholar 

  46. Hill R . Generic features of families under stress. Soc Casework 1958; 49: 139–150.

    Article  Google Scholar 

  47. McCubbin HI, Patterson JM . Family adaptation to crisis. In: McCubbin HI, Cauble AE, Patterson JM (eds) Family Stress, Coping, and Social Support. Charles C. Thomas: Springfield, IL, 1982.

    Google Scholar 

  48. McCubbin HI, Patterson JM . Family stress and adaptation to crises: a Double ABCX Model of family behavior. In: Olson DH, MIller RC (eds) Family Studies Review Yearbook vol. 1 Sage: Beverly Hills, CA, 1983. pp 87–106.

    Google Scholar 

  49. McCubbin HI, Patterson JM . The family stress process: the Double ABCX Model of family adjustment and adaptation. In: McCubbin HI, Sussman M, Patterson JM (eds) Social Stress and the Family: Advances and Developments in Family Stress Theory and Research. Haworth: New York, 1983. pp 7–37.

    Google Scholar 

  50. Conger RD, Conger KJ, Elder GH, Lorenz FO, Simons RL, Whitbeck LB . A family process model of economic hardship and adjustment of early adolescent boys. Child Dev 1992; 63: 526–541.

    Article  CAS  PubMed  Google Scholar 

  51. Conger RD, Ge X, Elder GH, Lorenz FO, Simons RL . Economic stress, coercive family process, and developmental problems of adolescents. Child Dev 1994; 65: 541–561.

    Article  CAS  PubMed  Google Scholar 

  52. Conger RD, Donnellan MB . An interactionist perspective on the socioeconomic context of human development. Annu Rev Psychol 2007; 58: 175–199.

    Article  PubMed  Google Scholar 

  53. Schor EL . Family pediatrics: report of the Task Force on the Family. Pediatrics 2003; 111: 1541–1571.

    PubMed  Google Scholar 

  54. Lee H, Harris KM, Gordon-Larsen P . Life course perspectives on the links between poverty and obesity during the transition to young adulthood. Popul Res Policy Rev 2009; 28: 505–532.

    Article  PubMed Central  PubMed  Google Scholar 

  55. Hill R . Life cycle stages for types of single parent families: of family development theory. Fam Relations 1986; 35: 19–20.

    Article  Google Scholar 

  56. Rodgers RH . Toward a theory of family development. J Marriage Fam 1964; 26: 262–270.

    Article  Google Scholar 

  57. Duvall E . Family development’s first forty years. Fam Relations 1988; 37: 127–134.

    Article  Google Scholar 

  58. Mead H . Mind, Self, and Society. Chicago University Press: Chicago, 1934.

    Google Scholar 

  59. Duvall E . Family Development. J. H. Lippencott: New York, 1957.

    Google Scholar 

  60. Barnhill LR, Longo D . Fixation and regression in the family life cycle. Fam Process 1978; 17: 469–478.

    Article  CAS  PubMed  Google Scholar 

  61. Bronfenbrenner U . Ecology of the family as a context for human development: research perspectives. Dev Psychol 1986; 22: 723–742.

    Article  Google Scholar 

  62. Bronfenbrenner U, Morris PA . The ecology of human developmental processes. In: Damon W, Eisenberg N (eds) The Handbook of Child Psychology. John Wiley & Sons: New York, 1988. pp 993–1027.

    Google Scholar 

  63. Tudge JRH, Mokrova I, Hatfield BE, RB. Karnik . Uses and misuses of Bronfenbrenner's Bioecological Theory of human development. J Fam Theory Rev 2009; 1: 198–210.

    Article  Google Scholar 

  64. Davison KK, Birch LL . Childhood overweight: a contextual model and recommendations for future research. Obes Rev 2001; 2: 159–171.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  65. Stewart L, Chapple J, Hughes AR, Poustie V, Reilly JJ . Parents’ journey through treatment for their child’s obesity: a qualitative study. Arch Dis Child 2008; 93: 35–39.

    Article  CAS  PubMed  Google Scholar 

  66. Eliadis EE . The role of social work in the childhood obesity epidemic. Soc Work 2006; 51: 86–88.

    Article  PubMed  Google Scholar 

  67. Kitzman-Ulrich H, Hampson R, Wilson DK, Presnell K, Brown A, O'Boyle M . An adolescent weight-loss program integrating family variables reduces energy intake. J Am Diet Assoc 2009; 109: 491–496.

    Article  PubMed  Google Scholar 

  68. Galvez MP, Pearl M, Yen IH . Childhood obesity and the built environment. Curr Opin Pediatr 2010; 22: 202–207.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Goetz DR, Caron W . A biopsychosocial model for youth obesity: consideration of an ecosystemic collaboration. Int J Obes Relat Metab Disord 1999; 23(Suppl 2): S58–S64.

    Article  PubMed  Google Scholar 

  70. Ellis DA, Janisse H, Naar-King S, Kolmodin K, Jen KL, Cunningham P et al. The effects of multisystemic therapy on family support for weight loss among obese African-American adolescents: findings from a randomized controlled trial. J Dev Behav Pediatr 2010; 31: 461–468.

    PubMed  Google Scholar 

  71. Naar-King S, Ellis D, Kolmodin K, Cunningham P, Jen KL, Saelens B et al. A randomized pilot study of multisystemic therapy targeting obesity in African-American adolescents. J Adolesc Health 2009; 45: 417–419.

    Article  PubMed  Google Scholar 

  72. Von Almen TK . Behavioral and psychological assessment tools. In: Sothern MS, Gordon ST, Von Almen TK (eds) Handbook of Pediatric Obesity: Clinical Management. CRC Taylor & Francis: Boca Raton, 2006. pp 105–111.

    Chapter  Google Scholar 

  73. Franko DL, Thompson D, Bauserman R, Affenito SG, Striegel-Moore RH . What's love got to do with it? Family cohesion and healthy eating behaviors in adolescent girls. Int J Eat Disord 2008; 41: 360–367.

    Article  PubMed  Google Scholar 

  74. De Santis-Moniaci D, Altshuler L . Comprehensive behavioral treatment of overweight and the pediatric practice. Pediatr Ann 2007; 36: 102–108.

    Article  PubMed  Google Scholar 

  75. Eisler I, Dare C, Hodes M, Russell G, Dodge E, Le Grange D . Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. J Child Psychol Psychiatry 2000; 41: 727–736.

    Article  CAS  PubMed  Google Scholar 

  76. Mellin AE, Neumark-Sztainer D, Story M, Ireland M, Resnick MD . Unhealthy behaviors and psychosocial difficulties among overweight adolescents: the potential impact of familial factors. J Adolesc Health 2002; 31: 145–153.

    Article  PubMed  Google Scholar 

  77. Robin AL, Siegel PT, Moye A . Family versus individual therapy for anorexia: impact on family conflict. Int J Eat Disord 1995; 17: 313–322.

    Article  CAS  PubMed  Google Scholar 

  78. Hauser ST, Jacobson AM, Lavori P, Wolfsdorf JI, Herskowitz RD, Milley JE et al. Adherence among children and adolescents with insulin-dependent diabetes mellitus over a four-year longitudinal follow-up: II. Immediate and long-term linkages with the family milieu. J Pediatr Psychol 1990; 15: 527–542.

    Article  CAS  PubMed  Google Scholar 

  79. Hanson CL, De Guire MJ, Schinkel AM, Kolterman OG . Empirical validation for a family-centered model of care. Diabetes Care 1995; 18: 1347–1356.

    Article  CAS  PubMed  Google Scholar 

  80. Pritchett R, Kemp J, Wilson P, Minnis H, Bryce G, C. Gillberg . Quick simple measures of family relationships for use in clinical practice and research. A systematic review. Fam Pract 28: 172–187.

    Article  PubMed  Google Scholar 

  81. Robinson TN . Treating pediatric obesity: generating the evidence. Arch Pediatr Adolesc Med 2008; 162: 1191–1192.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported in part by a grant from The Duke Endowment No. 6110-SP and NICHD/NIH Mentored Patient-Oriented Research Career Development Award K23 HD061597 (JAS), and by a grant from The Kate B. Reynolds Charitable Foundation (MBI). We would like to thank Karen Klein (Research Support Core, Office of Research, Wake Forest School of Medicine) for providing helpful edits of this manuscript.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to J A Skelton.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Skelton, J., Buehler, C., Irby, M. et al. Where are family theories in family-based obesity treatment?: conceptualizing the study of families in pediatric weight management. Int J Obes 36, 891–900 (2012). https://doi.org/10.1038/ijo.2012.56

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ijo.2012.56

Keywords

This article is cited by

Search

Quick links