title: 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.
  
  
  METHODS
  Cluster randomized controlled trial.
  
  
  METHODS
  Ten pediatric practices, 5 intervention and 5 usual care.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  After 1 year, the High Five for Kids intervention was effective in reducing television viewing but did not significantly reduce BMI.
authors.affiliation: Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, Boston, MA 02215, USA. elsie_taveras@harvardpilgrim.org
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
authors.forename: Steven L
authors.initials: SL
authors.lastname: Gortmaker
authors.forename: Katherine H
authors.initials: KH
authors.lastname: Hohman
authors.forename: Christine M
authors.initials: CM
authors.lastname: Horan
authors.forename: Ken P
authors.initials: KP
authors.lastname: Kleinman
authors.forename: Kathleen
authors.initials: K
authors.lastname: Mitchell
authors.forename: Sarah
authors.initials: S
authors.lastname: Price
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Prosser
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
mesh_terms: D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D004032:Diet; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D009042:Motivation; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D012044:Regression Analysis; D013690:Television