Efficacy of U.S. paediatric obesity primary care guidelines: two randomized trials.

Treatment for childhood obesity in a research setting has progressed in the past 25 years (1), with family-based behavioral treatment being the most consistently investigated intervention (1). A recent review of eight, family-based, pediatric obesity intervention trials conducted over the past 25 years in research settings describes an intervention that has predominantly targeted children aged 8 to 12 years, and has provided 6 months (16 to 20 sessions) of intensive behavioral treatment to parents and children, using a combined group and individual format for each session (1). Children were asked to reduce energy intake to 800 to 1200 kcals/day, and increase physical activity and/or decrease sedentary behaviors. This type of intervention has significantly improved weight status in participating children (1). Unfortunately, these highly effective, intensive, research interventions are likely not feasible for primary care settings (2). In 1997, a U.S. Expert Committee developed recommendations for pediatric obesity treatment in primary care settings (3). The Committee acknowledged there was no intervention designed for a non-research setting that was known to be efficacious. General guidelines were provided, which included: 1) starting with children as young as 3 years of age; 2) monitoring growth outcomes regularly (i.e., monthly); 3) applying a family-based model; and 4) using behavior modification techniques to change the child’s eating and activity behaviors (3). The Committee also emphasized that two or three energy-balance behaviors should be targeted during treatment (3). Although these recommendations suggest using components from empirically supported treatment, it is unclear whether a less intensive treatment approach will be effective in enhancing weight control. These recommendations were updated in 2007 and were very similar to the previous general guidelines, particularly in regards to the use of a family-based model and behavior modification techniques (4). Determining the efficacy of such an approach, including which energy balance behaviors to target, is imperative. Thus, this investigation examined the efficacy of the 1997 U.S. pediatric obesity treatment recommendations for primary care with two separate randomized trials (RTs) in children aged 4 to 9 years. Since the focus was on efficacy, not effectiveness, these interventions were delivered primarily in research settings to maximize treatment integrity. Both RTs had three interventions: one intervention focused on increasing child growth monitoring and providing feedback to families (GROWTH MONITORING); and two interventions that combined GROWTH MONITORING with a 6-month, behavioral, parent-only intervention that focused on two energy-balance behaviors ( decreasing sugar sweetened beverage and sweet and salty snack food intake [DECREASE] vs. increasing fruit, vegetable, and low-fat dairy intake [INCREASE]) (Trial 1) and decreasing sugar sweetened beverage intake and increasing physical activity [TRADITIONAL] vs. increasing low-fat milk intake and decreasing TV watching [SUBSTITUTE]) (Trial 2). It was hypothesized that the combined interventions would show greater improvements in child weight status.