Parents as agents of change in childhood obesity--from research to practice.

The home environment is undoubtedly the most important setting in relation to shaping children's eating and physical activity behaviors. Family-based behavioral treatment is the most well-established intervention for the treatment of childhood obesity. Historically, family based interventions target the obese child and at least one or both parents. Presented here is a review of the literature on parents as exclusive agents of change, with the addition of some recent results indicating the effectiveness of this approach when implemented in public health programs. Targeting parents as the exclusive mediator has resulted in a better reduction in children's percentage overweight, and improvement in the obesogenic environment and behaviors, in comparison to a setting in which parents attended sessions with the obese child, or only children attended sessions. The findings from these studies were subsequently implemented in a national community-based survey. Both children's and parents' weight status were significantly improved, although only parents attended the group sessions. A significant reduction in the obesogenic load at home was also found. Permissive parenting style was associated with less reduction in obesogenic load at home (p < 0.01) and with less weight loss (p < 0.05). Omitting the obese child from direct intervention and targeting parents only is a cost-effective approach with integrated messages for the management of weight-related problems.