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C-C2-02: The High Five for Kids Study: An Intervention to Improve Primary Care to Prevent Childhood Obesity

Background and Aims: The preschool age group is ripe for clinically-based obesity prevention interventions. Objective: To assess the extent to which a primary care-based obesity prevention intervention (Ix), compared with the usual care control condition (UC), resulted in a smaller age-associated increase in body mass index (BMI) and improvement in specified obesity-related behaviors over the first year of a planned 2-year intervention. Methods: High Five for Kids is a cluster-randomized controlled trial in 10 primary care pediatric offices in Massachusetts. We randomly assigned 5 practices to the Ix condition and 5 to UC. Eligible children were age 2.0 – 6.9 years at baseline with BMI > 95th percentile or 85th-<95th percentile if at least one parent was overweight. The major components of the intervention were restructuring primary care based on the Chronic Care Model, stage-based motivational counseling by nurse practitioners, and stage-matched educational modules targeting TV, fast food, and sugar sweetened beverages. We enrolled 486 participants of whom 459 (94%) had primary outcomes measured at 1 year. We used intention-to-treat analysis, adjusted for baseline socio-demographic characteristics and corrected for clustering. Results: Mean (SD) age of participants was 4.9 (1.2) years; 29% had an annual household income < $50K; 57% were white, 20% black, 16% Hispanic. Compared with UC, Ix participants had slightly smaller change in mean BMI from baseline to 1 year (−0.18 kg/m2; 95% CI: −0.44, 0.08). Ix participants decreased their TV viewing (−0.41 hrs/day; 95% CI: −0.68, −0.13) and fast food intake (−0.17 servings/week; 95% CI: −0.34, 0.00) more than UC, but there was no effect on sugar sweetened beverage intake (−0.20 servings/day; 95% CI: −0.51, 0.11). In post-hoc stratified analyses, the intervention had a greater effect on BMI change among participants living in households with incomes <$50K (−0.79 kg/m2; 95% CI: −1.45, −0.13) than in higher income households (0.01 kg/m2; 95% CI: −0.34, 0.36). Conclusions: After a 1-year intervention period, High Five for Kids was effective in reducing TV viewing and fast food intake but did not significantly reduce BMI.