Family Inclusive Childhood Obesity Treatment designed for Low Income and Hispanic Families

项目摘要：这项提案解决了一个重要的公共卫生问题--儿童肥胖和 来自低收入家庭的西班牙裔儿童面临的相关健康差距--对此采取干预措施 缺乏。这项随机对照试验(RCT)将测试包含家庭的体重的有效性 为低收入西班牙裔人口制定的管理计划。预防和治疗的干预措施 从历史上看，儿童肥胖症一直将讲西班牙语的家庭排除在外。 将被测试的干预措施是通过深入的合作研究设计的，包括 儿童肥胖临床医生/研究人员、安全网诊所、社区组织以及低收入和 他们服务的家庭大多是西班牙裔家庭。健康生活计划/La Vida Saludable(Help)一直是 旨在为低收入和西班牙裔家庭实现覆盖范围、留住和有效性，包括 会说西班牙语的人。帮助结合了基于证据的家庭行为的核心组件- 美国预防服务工作组建议的剂量的治疗是有效的。最重要的小说 帮助的设计组件包括：1)包含整个家庭。此前的干预措施主要集中在 亲子二人。在帮助下，肥胖儿童和所有2-16岁的兄弟姐妹和成年照顾者将获得 有针对性的课程组成部分。被推荐为肥胖儿童的较年轻的健康体重兄弟姐妹是目标人群 预防肥胖，2)在饮食计划、购物和烹饪方面的亲身实践培训侧重于减少 在适应传统烹饪的同时，粮食不安全，3)通过初级合作伙伴关系在家中就近递送 护理诊所和娱乐中心，以及4)训练有素、低成本、文化和语言协调的接生方式 健康教育者。 这项研究的目标是使用随机对照设计明确地评估 超重和肥胖治疗和预防的帮助干预与初级保健咨询 方案主动控制条件-推荐在初级保健中治疗肥胖症(RTOP)。的目标是 本研究的目的是：1)比较HELP和RTOP在三个年龄段的低收入人群中降低BMI的效果。 收入西班牙裔肥胖儿童：2-6岁、7-12岁和13-16岁(次级衡量标准包括： 心脏代谢实验室测试、健身、生活质量、饮食行为和食品安全)；2)比较 通过比较2-11岁非肥胖儿童的BMI轨迹，了解HELP预防肥胖的效果 BMI高于中位数的兄弟姐妹参加HELP与RTOP；3)研究HELP的实施情况 和RE-AIM框架内的RtoP，包括：REACH、采用、实施(保真度、复制 成本和单位BMI变化成本)和维护。这项建议旨在填补 了解如何在低收入和西班牙裔家庭中有效地治疗儿童肥胖症。

Project Summary: This proposal addresses a significant public health problem – childhood obesity and related health disparities faced by Hispanic children from low-income families – for which interventions are lacking. This Randomized Controlled Trial (RCT) will test the effectiveness of a family-inclusive weight management program developed for low-income Hispanic populations. Interventions to prevent and treat childhood obesity have historically excluded Spanish speaking families. The intervention to be tested has been designed through in-depth collaborative research involving childhood-obesity clinician/researchers, safety-net clinics, community organizations, and the low-income and mostly Hispanic families they serve. The Healthy Living Program / La Vida Saludable (HeLP) has been designed to achieve reach, retention, and effectiveness for low-income and Hispanic families, including Spanish Speakers. HeLP incorporates the core components of evidence-based family-based-behavioral- therapy at a dose the US Preventive Services Task Force has recommended to be effective. The key novel design components of HeLP include: 1) Inclusion of the entire family. Previous interventions have focused on parent-child dyads. In HeLP, children with obesity and all siblings 2-16 years and adult caregivers receive targeted curricular components. Younger healthy weight siblings of children referred for obesity are targeted for obesity prevention, 2) Hands-on family training in meal-planning, shopping, and cooking is focused on reducing food insecurity while adapting traditional cuisine, 3) Delivery close to home through a partnership of primary care clinics and recreation centers, and 4) Delivery by trained, low-cost, culturally and linguistically concordant health educators. The goal of this research is to definitively assess using a randomized controlled design the effectiveness of the HeLP intervention for treatment and prevention of overweight and obesity vs a primary care counseling protocol active control condition—Recommended Treatment of Obesity in Primary Care (RTOP). The aims of this study are to: 1) compare the effectiveness of HeLP vs. RTOP at BMI reduction in three age groups of low- income Hispanic children with obesity: 2-6, 7-12, and 13-16 years (secondary measures include: cardiometabolic lab tests, fitness, quality of life, eating behaviors, and food security); 2) To compare the effectiveness of HeLP at obesity prevention by comparing the BMI trajectory of non-obese 2-11yr old children with BMI above median whose siblings are enrolled in HeLP vs. RTOP; 3) To study implementation of HeLP and RTOP within the RE-AIM framework, including: Reach, Adoption, Implementation (fidelity, replication costs, and cost per unit BMI change), and Maintenance. This proposal seeks to fill a major gap in understanding of how childhood obesity might be effectively treated in low-income and Hispanic families.