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

摘要

OBJECTIVE. To determine whether a generalisable 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 UK centile, age 5-11 years) randomized 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, 6 and 12 months. RESULTS. The intervention had no significant effect relative to standard care on BMI Z-score from baseline to 6 months (-0.10 vs -0.06; 95%CI -0.05 to 0.11) and 12 months (-0.07 vs -0.19; 95%CI -0.17 to 0.07). BMI Z score decreased significantly in both groups from baseline to six and 12 months. For those who complied with treatment, there was a significantly smaller weight (kg) increase in the intervention group compared to controls from baseline to six months (95%CI 0.05, 2.25). There were significant between group differences in favor of the intervention for changes in total physical activity (95% CI -199 to –31 accelerometer counts/minute), % of time spent in sedentary behavior (95%CI 0.8 to 6.3) and light intensity physical activity (95%CI -4.8 to -0.5). 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 to standard care among overweight children. The modest magnitude of the benefits observed perhaps argues for a longer-term and more intense intervention, though such treatments may not be realistic for many healthcare systems.