Int. J. Environ. Res. Public Health 2012, 9, 1368-1378; doi:10.3390/ijerph9041368 OPEN ACCESS International Journal of Environmental Research and Public Health ISSN 1660-4601 www.mdpi.com/journal/ijerph Communication Are Changes in Consumption of “Healthy” Foods Related to Changes in Consumption of “Unhealthy” Foods During Pediatric Obesity Treatment? Shannon M. Looney * and Hollie A. Raynor Department of Nutrition, University of Tennessee, 229 Jessie Harris Building, 1215 West Cumberland Avenue, Knoxville, TN 37996, USA; E-Mail: hraynor@utk.edu * Author to whom correspondence should be addressed; E-Mail: slooney1@utk.edu; Tel.: +1-865-974-0754; Fax: +1-865-974-3491. Received: 21 November 2011; in revised form: 22 December 2011 / Accepted: 5 January 2012 / Published: 16 April 2012 Abstract: Increasing fruits and vegetables (FVs), a dietary recommendation for pediatric weight management, is theorized to reduce energy intake by reducing intake of more energy-dense foods, such as snack foods (SFs). This study examined the relationship between changes in FV, SF, and energy intake in children enrolled in a 6-month, family-based behavioral pediatric weight management trial. Secondary data analyses examined dietary intake in 80 overweight (≥85th to <95th percentile for body mass index [BMI]) and obese (≥95th percentile for BMI) children (7.2 ± 1.7 years) with complete dietary records at 0 and 6 months. Participants were randomized to one of three treatment conditions: (1) increased growth monitoring with feedback; (2) decrease SFs and sugar sweetened beverages; or (3) increase FVs and low-fat dairy. With treatment condition controlled in all analyses, FV intake significantly increased, while SF and energy intake decreased, but not significantly, from 0 to 6 months. Change in FV intake was not significantly associated with change in SF consumption. Additionally, change in FV intake was not significantly related to change in energy intake. However, reduction in SF intake was significantly related to reduction in energy intake. Changing only FVs, as compared to changing other dietary behaviors, during a pediatric obesity intervention may not assist with reducing energy intake.