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

Abstract

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 NCT00377767.

Figures

Figure 1

Conceptual framework, based on the Chronic Care Model, of the High Five for Kids Study

Figure 2

Participant flow for the High Five for Kids Study

Figure 3

High Five for Kids poster for pediatric primary care waiting rooms

Figure 4

Change in health behaviors from baseline to 1-year according to whether the family chose to work on the behavior