Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study.

Taveras EM, Gortmaker SL, Hohman KH, et al. Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study. Arch Pediatr Adolesc Med. 2011 Aug;165(8):714-22. Epub 2011 Apr 4. (Original) PMID: 21464376
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.
INTERVENTIONS: 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.

Comments from Clinical Raters
  • General Practice(GP)/Family Practice(FP):
    Useful in demonstrating relatively robustly that this intervention in the primary care setting did NOT significantly change children's weight nor most behaviours that would promote obesity. Learning of the negative trials is as important as learning of the trials with positive results.
  •  Special Interest - Obesity -- Physician:
    This is a very nice study. A lot of effort was put in the intervention. The results (lack of influence on BMI) are surprising and just shows why you need RCTs. It is noteworthy that positive results were obtained in families who's income was below $50.000, thus, indicating, perhaps, that the intervention is still worthwhile in poorer populations.