title: Prevention of excess weight gain in paediatric primary care: beverages only or multiple lifestyle factors. The Smart Step Study, a cluster-randomized clinical trial.
abstract: BACKGROUND
  Insufficient evidence exists to support obesity prevention in paediatric primary care.
  
  
  OBJECTIVE
  To test a theory-based behaviour modification intervention delivered by trained paediatric primary care providers for obesity prevention.
  
  
  METHODS
  Efficacy trial with cluster randomization (practice level) and a 12-session 12-month sweetened beverages decrease intervention or a comprehensive dietary and physical activity intervention, compared with a control intervention among children ages 8-12 years.
  
  
  RESULTS
  A low recruitment rate was observed. The increase in body mass index z-score (BMIz) for the 139 subjects (11 practices) randomized to any of the two obesity interventions (combined group) was less than that of the 33 subjects (five practices) randomized to the control intervention (-0.089, 95% confidence interval [CI]: -0.170 to -0.008, P = 0.03) with a -1.44 kg weight difference (95% CI: -2.98 to +0.10 kg, P = 0.095). The incidences of obesity and excess weight gain were lower in the obesity interventions, but the number of subjects was small. Post hoc analyses comparing the beverage only to the control intervention also showed an intervention benefit on BMIz (-0.083, 95% CI: -0.165 to -0.001, P = 0.048).
  
  
  CONCLUSIONS
  For participating families, an obesity prevention intervention delivered by paediatric primary care clinicians, who are compensated, trained and continuously supported by behavioural specialists, can impact children's BMIz.
authors.affiliation: Federal Health & Human Services Practice, The Lewin Group, Falls Church, VA, USA.
authors.forename: N
authors.initials: N
authors.lastname: Stettler
authors.affiliation: Department of Physical Therapy, D'Youville College, Buffalo, NY, USA.|Departments of Pediatrics, Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: B H
authors.initials: BH
authors.lastname: Wrotniak
authors.affiliation: Departments of Pediatrics, Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: D L
authors.initials: DL
authors.lastname: Hill
authors.affiliation: Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: S K
authors.initials: SK
authors.lastname: Kumanyika
authors.affiliation: Departments of Pediatrics, Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Xanthopoulos
authors.affiliation: Departments of Pediatrics, Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.
authors.forename: S
authors.initials: S
authors.lastname: Nihtianova
authors.affiliation: Departments of Pediatrics, Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: J
authors.initials: J
authors.lastname: Shults
authors.affiliation: Departments of Pediatrics, Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: S S
authors.initials: SS
authors.lastname: Leff
authors.affiliation: School of Dental Medicine, Case Western Reserve University, Cleveland, OH, USA.
authors.forename: A
authors.initials: A
authors.lastname: Pinto
authors.affiliation: Departments of Pediatrics, Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA, USA.|Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: R I
authors.initials: RI
authors.lastname: Berkowitz
authors.affiliation: Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA.
authors.forename: M S
authors.initials: MS
authors.lastname: Faith
mesh_terms: D001521:Behavior Therapy / Q000379:methods*; D001628:Beverages / Q000009:adverse effects*; D015992:Body Mass Index; D002648:Child; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D009819:Office Visits; D063766:Pediatric Obesity / Q000517:prevention & control*; D011320:Primary Health Care / Q000379:methods*; D015430:Weight Gain
keywords: Behavioural economics; beverages; office visits; primary health care