When Leonard Epstein began tracking families in Buffalo in the 1980s, no one knew where the research would lead. Four decades later, the answer is remarkable: 70 percent of children who participated in the family-based behavioral treatment he pioneered met the clinical criteria to prevent metabolic disease well into adulthood.
The finding comes from a mega-analysis published in Health Psychology, pooling individual data from 16 randomized controlled trials conducted by Epstein and his colleagues at the University at Buffalo. The studies followed more than 1,000 families across different regions of the United States over follow-up periods ranging from one to ten years — among the longest in pediatric obesity research.
"This is brand new data that proves the clinical effectiveness of our program," said Epstein, corresponding author and SUNY Distinguished Professor in the Department of Pediatrics at the Jacobs School of Medicine and Biomedical Sciences at UB. "These results strongly suggest that our family-based behavioral treatment is associated with clinically meaningful effects using new criteria based on long-term health outcomes."
The criteria, developed by researchers at Sweden's Karolinska Institute, establish that a change of just -0.25 zBMI in childhood — a measurement of body mass index adjusted for age and growth — can prevent adults from developing conditions like diabetes, dyslipidemia, hypertension, or the need for bariatric surgery. Nearly half of the children in the UB studies reversed their obesity status entirely and maintained that improvement over time.
Epstein's approach targets both parents and children together. The treatment combines the Traffic Light Diet and Activity program — also developed at UB — with positive parenting techniques, behavioral skills training, and stimulus control, which reshapes the shared family environment to support healthier eating and physical activity.
The implications extend beyond the treated child. Epstein's research has consistently shown that siblings who aren't directly enrolled in the program also experience improvements in weight and health, suggesting that family-wide behavioral shifts create ripple effects throughout the household.
Age matters too. The younger a child is when treatment begins, the more significant the improvement in weight status, underscoring the value of early intervention.
With roughly a third of children in the United States either overweight or obese, the study offers a rare piece of long-term good news: metabolic disease is not inevitable. For families willing to change habits together, Epstein's decades of evidence suggest the path toward healthier futures may begin at home, in the choices parents and children make side by side.