title: Efficacy of U.S. paediatric obesity primary care guidelines: two randomized trials.
abstract: OBJECTIVE
  The objective of this study was to examine the efficacy of U.S. primary care paediatric obesity treatment recommendations, within two randomized trials.
  
  
  METHODS
  Between November 2005 to September 2007, 182 families (children aged 4-9 years, body mass index [BMI] ≥85th percentile) were recruited for two separate trials and randomized within trial to a 6-month intervention. Each trial had one intervention that increased child growth-monitoring frequency and feedback to families (GROWTH MONITORING). Each trial also had two interventions, combining GROWTH MONITORING with an eight-session, behavioural, parent-only intervention targeting two energy-balance behaviours (Trial 1: reducing snack foods and sugar-sweetened beverages [DECREASE], and increasing fruits, vegetables and low-fat dairy [INCREASE]; Trial 2: decreasing sugar-sweetened beverages and increasing physical activity [TRADITIONAL] and increasing low-fat milk consumption and reducing television watching [SUBSTITUTES]). Child standardized BMI (ZBMI) and energy intake were assessed at 0, 6 and 12 months.
  
  
  RESULTS
  In both trials, main effects of time were found for ZBMI, which decreased at 6 and 12 months (P < 0.01). In Trial 1, ZBMI reduced from 0 to 6 months, which was maintained from 6 to 12 months (ΔZBMI 0 to 12 months = -0.12 ± 0.22). In Trial 2, ZBMI reduced from 0 to 6 and from 6 to 12 months (ΔZBMI 0-12 months = -0.16 ± 0.31). For energy intake, main effects of time were found in both trials and intake reduced from 0 to 6 months (P < 0.05), with Trial 1 reducing intake from 0 to 12 months (P < 0.05).
  
  
  CONCLUSIONS
  All interventions improved weight status. Future research should examine effectiveness and translatability of these approaches into primary care settings.
authors.affiliation: Department of Nutrition, University of Tennessee, Knoxville, TN 37996-1920, USA. hraynor@utk.edu
authors.forename: H A
authors.initials: HA
authors.lastname: Raynor
authors.forename: K M
authors.initials: KM
authors.lastname: Osterholt
authors.forename: C N
authors.initials: CN
authors.lastname: Hart
authors.forename: E
authors.initials: E
authors.lastname: Jelalian
authors.forename: P
authors.initials: P
authors.lastname: Vivier
authors.forename: R R
authors.initials: RR
authors.lastname: Wing
mesh_terms: D015992:Body Mass Index; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003362:Cost-Benefit Analysis; D004038:Diet, Reducing; D002149:Energy Intake; D015444:Exercise / Q000502:physiology; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000517:prevention & control / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D016896:Treatment Outcome; D014481:United States; D015431:Weight Loss