Randomized, controlled trial of a best-practice individualized behavioral program for treatment of childhood overweight: Scottish Childhood Overweight Treatment Trial (SCOTT).
OBJECTIVE
The objective of this study was to determine whether a generalizable best-practice individualized behavioral intervention reduced BMI z score relative to standard dietetic care among overweight children.


METHODS
The design consisted of an assessor-blinded, randomized, controlled trial involving 134 overweight children (59 boys, 75 girls; BMI > or = 98th centile relative to United Kingdom 1990 reference data for children aged 5-11 years) who were randomly assigned to a best-practice behavioral program (intervention) or standard care (control). The intervention used family-centered counseling and behavioral strategies to modify diet, physical activity, and sedentary behavior. BMI z score, weight, objectively measured physical activity and sedentary behavior, fat distribution, quality of life, and height z score were recorded at baseline and at 6 and 12 months.


RESULTS
The intervention had no significant effect relative to standard care on BMI z score from baseline to 6 months and 12 months. BMI z score decreased significantly in both groups from baseline to 6 and 12 months. For those who complied with treatment, there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months. There were significant between-group differences in favor of the intervention for changes in total physical activity, percentage of time spent in sedentary behavior, and light-intensity physical activity.


CONCLUSIONS
A generalizable, best-practice individualized behavioral intervention had modest benefits on objectively measured physical activity and sedentary behavior but no significant effect on BMI z score compared with standard care among overweight children. The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention, although such treatments may not be realistic for many health care systems.
Hughes
Adrienne R
AR
Division of Developmental Medicine, University of Glasgow, Yorkhill Hospitals, Glasgow, United Kingdom. ah53@stir.ac.uk
Stewart
Laura
L
Chapple
Jan
J
McColl
John H
JH
Donaldson
Malcolm D C
MD
Kelnar
Christopher J H
CJ
Zabihollah
Mehran
M
Ahmed
Faisal
F
Reilly
John J
JJ
D000367:Age Factors; D001521:Behavior Therapy / Q000379:methods*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004038:Diet, Reducing; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D050177:Overweight / Q000523:psychology* / Q000628:therapy*; D010349:Patient Compliance; D010372:Pediatrics / Q000379:methods; D012016:Reference Values; D018570:Risk Assessment; D040242:Risk Reduction Behavior; D012737:Sex Factors; D018709:Statistics, Nonparametric; D006113:United Kingdom; D015431:Weight Loss