Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. e539-e546 (doi:10.1542/peds.2007-1786)
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ARTICLE

Randomized, Controlled Trial of a Best-Practice Individualized Behavioral Program for Treatment of Childhood Overweight: Scottish Childhood Overweight Treatment Trial (SCOTT)

Adrienne R. Hughes, PhDa, Laura Stewart, BScb, Jan Chapple, BScc, John H. McColl, MScd, Malcolm D. C. Donaldson, FRCPCHa, Christopher J. H. Kelnar, MDe, Mehran Zabihollah, BEngf, Faisal Ahmed, MDa and John J. Reilly, PhDa

a Division of Developmental Medicine, University of Glasgow, Yorkhill Hospitals, Glasgow, United Kingdom
b Department of Nutrition and Dietetics, Royal Hospital for Sick Children, Edinburgh, United Kingdom
c Department of Nutrition and Dietetics, Yorkhill Hospitals, Glasgow, United Kingdom
d Department of Statistics, University of Glasgow, Glasgow, United Kingdom
e Department of Reproductive and Developmental Sciences, University of Edinburgh, Royal Hospital for Sick Children, Edinburgh, United Kingdom
f University of Liverpool Management School, Liverpool, United Kingdom

OBJECTIVE. The objective of this study was to determine whether a generalizable best-practice individualized behavioral intervention reduced BMI z score relative to standard dietetic care among overweight children.

METHODS. The design consisted of an assessor-blinded, randomized, controlled trial involving 134 overweight children (59 boys, 75 girls; BMI ≥ 98th centile relative to United Kingdom 1990 reference data for children aged 5–11 years) who were randomly assigned to a best-practice behavioral program (intervention) or standard care (control). The intervention used family-centered counseling and behavioral strategies to modify diet, physical activity, and sedentary behavior. BMI z score, weight, objectively measured physical activity and sedentary behavior, fat distribution, quality of life, and height z score were recorded at baseline and at 6 and 12 months.

RESULTS. The intervention had no significant effect relative to standard care on BMI z score from baseline to 6 months and 12 months. BMI z score decreased significantly in both groups from baseline to 6 and 12 months. For those who complied with treatment, there was a significantly smaller weight increase in those in the intervention group compared with control subjects from baseline to 6 months. There were significant between-group differences in favor of the intervention for changes in total physical activity, percentage of time spent in sedentary behavior, and light-intensity physical activity.

CONCLUSIONS. A generalizable, best-practice individualized behavioral intervention had modest benefits on objectively measured physical activity and sedentary behavior but no significant effect on BMI z score compared with standard care among overweight children. The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention, although such treatments may not be realistic for many health care systems.

Key Words: obesity • overweight • children • treatment • BMI • physical activity • sedentary behavior • randomized • controlled trial

Abbreviations: RCT—randomized, controlled trial • QoL—quality of life • IQR—interquartile range • df—degrees of freedom • CI—confidence interval

Accepted Aug 15, 2007.