Clinical/Behavioral Approach to Overweight in Latino Youth

Overweight and obesity is a serious problem for Mexican-American children, due in part to
poverty, acculturation, genetic predisposition or other factors. Clinic-based weight control
studies have shown promise, but often include convenience samples with few or no Latino
children. This randomized controlled trial tests the efficacy of a culturally and
linguistically appropriate, evidence-based intervention to lower Body Mass Index (BMI) or
slow weight gain among overweight 6-9 year old Mexican-American children randomly sampled
from a large (36,192 pediatric patients) community clinic providing services to low and
medium income families in a US-Mexico border community (San Ysidro, CA). Intervention and
measurement design and selection are based on a "Socioecological Model for Latino Health
Promotion". Children and their parents will be randomly assigned to either a Special
Intervention (SI) or Usual Care (UC) group. The SI group will participate in the following
behavior change activities based on Prevention Plus and Structured Weight Management
approaches:

1. classes providing culturally-sensitive health education regarding healthy eating,
increasing physical activity, decreasing sedentary behaviors, and effective parenting
behaviors to model and reinforce children's health behaviors, instruction on how to
modify both social and structural aspects of the home environment, and skills-building
to navigate community resources;

2. clinical visits with a Health Educator and Mid-Level Provider (MLP);

3. family visits with primary care providers (PCP); and

4. phone calls to reinforce goal setting.

The UC group will receive standard health education for childhood obesity already provided
by the community clinic. The primary outcome for the study is child BMI, which along with
other changes in physical outcomes, child health behaviors and parenting behaviors will be
evaluated at four time-points (baseline, 6-, 12-, and 18-months). The primary hypothesis is
that the SI group will demonstrate lower mean BMI than the UC group at the end of a 6 month
intervention with a maximum difference occurring at 12 months, and will sustain this
difference for an additional six months (18 months after baseline). Secondary aims include
examining intervention effects on children's energy balance, physical activity levels,
sedentary behavior and parenting strategies related to their children's health behaviors.

Inclusion Criteria:

- Self-identify as Latino

- Have made a clinic visit within past 24 months prior to enrollment in study

- Have a BMI % for age/gender between 75 - 99.9th

- Plan on living in target area for following 18 months

- Have transportation to participating clinic