title: Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City.
abstract: BACKGROUND
  Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children <5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics.
  
  
  METHODS
  We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care. Children were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children's height and weight and parents reported children's diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values.
  
  
  RESULTS
  93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3 months, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified analyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and increased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation time and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were satisfied with the program.
  
  
  CONCLUSIONS
  Although satisfaction was high among participants, barriers to participation and retention included transportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not other behaviors or BMI.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS: 2009-785-120.
authors.forename: Gloria Oliva
authors.initials: GO
authors.lastname: Martínez-Andrade
authors.affiliation: Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, 133 Brookline Avenue, 3rd Floor, Boston, MA 02215, USA. emc611@mail.harvard.edu.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Cespedes
authors.forename: Sheryl L
authors.initials: SL
authors.lastname: Rifas-Shiman
authors.forename: Guillermina
authors.initials: G
authors.lastname: Romero-Quechol
authors.forename: Marco Aurelio
authors.initials: MA
authors.lastname: González-Unzaga
authors.forename: María Amalia
authors.initials: MA
authors.lastname: Benítez-Trejo
authors.forename: Samuel
authors.initials: S
authors.lastname: Flores-Huerta
authors.forename: Chrissy
authors.initials: C
authors.lastname: Horan
authors.forename: Jess
authors.initials: J
authors.lastname: Haines
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
authors.forename: Ricardo
authors.initials: R
authors.lastname: Pérez-Cuevas
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Gillman
mesh_terms: D015992:Body Mass Index; D002675:Child, Preschool; D004311:Double-Blind Method; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008800:Mexico; D009765:Obesity / Q000517:prevention & control*; D010865:Pilot Projects; D013997:Time Factors; D014504:Urban Health