OBJECTIVE: To examine whether differentially targeting physical activity within the context of pilot family-based pediatric weight control treatment results in differential change in abdominal fat, particularly visceral fat. METHOD: Twenty-nine overweight children (> 85th body mass index (BMI) percentile) and at least one participating parent were randomly assigned to one of two family-based behavioral weight management conditions that either targeted (1) primarily dietary change (STANDARD; n = 15) or (2) dietary plus physical activity change (ADDED; n = 14). Differences at post-treatment in overall child weight status (eg, BMI), whole-body composition (measured by dual x-ray absorptiometry), and abdominal fat (measured by waist circumference and magnetic resonance imaging) were assessed using intent-to-treat analyses, as were post-treatment parent BMI and waist circumference. Child and parent physical activity and dietary behavior changes were also evaluated. RESULTS: At post-treatment, overall child weight status, whole-body composition, and child dietary measures did not differ by condition. Children in the ADDED condition tended to have higher physical activity and lower visceral abdominal fat at post-treatment relative to children in the STANDARD condition. CONCLUSIONS: Increasing physical activity may be important to optimize reductions in abdominal fat, especially visceral fat, among overweight children provided with family-based behavioral weight management treatment. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT00359957.

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