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Summary: Background: Obesity disproportionately affects Latino youth. Community clinics are an important resource, yet there is little evidence for the efficacy of clinic‐based approaches in this population. Objective: The purpose of this study was to test the efficacy of a clinic‐based intervention to lower body mass index (BMI) and improve body composition among overweight Latino children. Methods: A randomized trial (2 group × 3 repeated measures) was conducted among 297 randomly sampled, overweight paediatric patients (5–10 years old) and their parents. The 12‐month family‐based culturally tailored behavioural intervention (Luces de Cambio) was based on the 'traffic light' concepts to address behaviour change and was delivered by clinic health educators and mid‐level providers. The primary study outcome was child BMI (kg m−2) assessed at baseline, 6‐month (n = 191) and 12‐month (n = 201) post‐baseline. A subsample of the children was examined for overall and site‐specific adiposity using dual‐energy X‐ray absorptiometry (n = 79). Results: There were no significant intervention effects on child BMI (p > 0.05); however, intervention children showed significantly (p < 0.05) lower total and trunk per cent fat compared with the usual care condition. Conclusions: The Luces intervention did not reduce child BMI, yet small but significant reductions were observed for child per cent body fat. Further research is needed to identify and reduce barriers to recruitment and participation among Latino families. [ABSTRACT FROM AUTHOR]