Randomized controlled trial to improve primary care to prevent and manage childhood obesity the high five for kids study

Objective To examine the effectiveness of a primary care–based obesity intervention over the first year (6 intervention contacts) of a planned 2-year study. Design Cluster randomized controlled trial. Setting Ten pediatric practices, 5 intervention and 5 usual care. Participants Four hundred seventy-five children aged 2 to 6 years with body mass index (BMI) in the 95th percentile or higher or 85th to less than 95th percentile if at least 1 parent was overweight; 445 (93%) had 1-year outcomes. Intervention Intervention practices received primary care restructuring, and families received motivational interviewing by clinicians and educational modules targeting television viewing and fast food and sugar-sweetened beverage intake. Outcome Measures Change in BMI and obesity-related behaviors from baseline to 1 year. Results Compared with usual care, intervention participants had a smaller, nonsignificant change in BMI (−0.21; 95% confidence interval [CI], −0.50 to 0.07; P = .15), greater decreases in television viewing (−0.36 h/d; 95% CI, −0.64 to −0.09; P = .01), and slightly greater decreases in fast food (−0.16 serving/wk; 95% CI, −0.33 to 0.01; P = .07) and sugar-sweetened beverage (−0.22 serving/d; 95% CI, −0.52 to 0.08; P = .15) intake. In post hoc analyses, we observed significant effects on BMI among girls (−0.38; 95% CI, −0.73 to −0.03; P = .03) but not boys (0.04; 95% CI, −0.55 to 0.63; P = .89) and among participants in households with annual incomes of $50 000 or less (−0.93; 95% CI, −1.60 to −0.25; P = .01) but not in higher-income households (0.02; 95% CI, −0.30 to 0.33; P = .92). Conclusion After 1 year, the High Five for Kids intervention was effective in reducing television viewing but did not significantly reduce BMI. Trial Registration clinicaltrials.gov Identifier: NCT00377767