OBJECTIVE: The objective of this study was to examine the efficacy of US primary care paediatric obesity treatment recommendations, within two randomized trials. METHODS: Between November 2005 to September 2007, 182 families (children aged 4 to 9 years, body mass index (BMI) >= 85th percentile) were recruited for two separate trials and randomized within trial to a 6-month intervention. Each trial had one intervention that increased child growth-monitoring frequency and feedback to families (GROWTH MONITORING). Each trial also had two interventions, combining GROWTH MONITORING with an eight-session, behavioural, parent-only intervention targeting two energy-balance behaviours (trial 1: reducing snack foods and sugar-sweetened beverages (DECREASE), and increasing fruits, vegetables and low-fat dairy (INCREASE); trial 2: decreasing sugar-sweetened beverages and increasing physical activity (TRADITIONAL) and increasing low-fat milk consumption and reducing television watching (SUBSTITUTES)). Child standardized BMI (ZBMI) and energy intake were assessed at 0, 6 and 12 months. RESULTS: In both trials, main effects of time were found for ZBMI, which decreased at 6 and 12 months (p < 0.01). In trial 1, ZBMI reduced from 0 to 6 months, which was maintained from 6 to 12 months (delta ZBMI 0 to 12 months -0.12 +/- 0.22). In trial 2, ZBMI reduced from 0 to 6 and from 6 to 12 months (delta ZBMI 0 to 12 months -0.16 +/- 0.31). For energy intake, main effects of time were found in both trials and intake reduced from 0 to 6 months (p < 0.05), with trial 1 reducing intake from 0 to 12 months (p < 0.05). CONCLUSIONS: All interventions improved weight status. Future research should examine effectiveness and translatability of these approaches into primary care settings.

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