The Girls health Enrichment Multi-site Studies (GEMS) was an obesity prevention initiative, with the aim of developing and testing interventions for African American girls.1 Pilot studies were conducted at 4 sites, starting more than 10 years ago. Based on promising pilot data from the Memphis and Stanford sites,2,3 the National Heart, Lung, and Blood Institute funded 2 larger randomized controlled trials. The results of these trials, presented by Klesges et al4 and Robinson et al5 in this issue of the Archives, are undeniably discouraging. Changes in body mass index (BMI; calculated as weight in kilograms divided by height in meters squared), the primary outcome, did not differ over 2 years between prevention and comparison groups in either study, despite outstanding investigative teams, extensive pilot work to develop culturally appropriate interventions that involved parents/caregivers or families, and substantial funding. To explore possible reasons for these null results and inform future research, several questions relating to the design of obesity prevention studies warrant consideration.
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