Background: Mexico has the highest adult overweight and obesity prevalence in the Americas; 23.8% of children\n<5 years old are at risk for overweight and 9.7% are already overweight or obese. Creciendo Sanos was a pilot\nintervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social (IMSS) clinics.\nMethods: We randomized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful\nnutrition and physical activity or usual care. We recruited 306 parent-child pairs: 168 intervention, 138 usual care.\nChildren were 2-5 years old with WHO body mass index (BMI) z-score 0-3. We measured children�s height and weight\nand parents reported children�s diet and physical activity at baseline and 3 and 6-month follow-up. We analyzed\nbehavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values.\nResults: 93 (55%) intervention and 96 (70%) usual care families completed 3 and 6-month follow-up. At 3\nmonths, intervention v. usual care children increased vegetables by 6.3 servings/week (95% CI, 1.8, 10.8). In stratified\nanalyses, intervention participants with high program adherence (5-6 sessions) decreased snacks and screen time and\nincreased vegetables v. usual care. No further effects on behavioral outcomes or BMI were observed. Transportation\ntime and expenses were barriers to adherence. 90% of parents who completed the post-intervention survey were\nsatisfied with the program.\nConclusions: Although satisfaction was high among participants, barriers to participation and retention included\ntransportation cost and time. In intention to treat analyses, we found intervention effects on vegetable intake, but not\nother behaviors or BMI
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