IT-Supported Early Treatment of Childhood Overweight

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DESCRIPTION (provided by applicant): The prevention and treatment of pediatric obesity is a national priority. Minority children and those living in poverty are at additional risk for obesity. There is a pressing need for low-cost, effective interventions for the large numbers of overweight children. A reliable way to do this would have wide applicability and usefulness. The goal of this exploratory/developmental (R21) study is to develop and evaluate an integrated information system, Healthy Eating and Activity Today (HEAT), for promoting self-care in overweight children. HEAT is comprised of two components: 1) Telephone Linked Care-HEAT (TLC-HEAT), a self-care intervention delivered at home through totally automated telephone conversations; and 2) Primary Care-HEAT (PC-HEAT), a primary care intervention linked with TLCHEAT and delivered through an electronic health record (EHR). The HEAT system will guide children in the early stages of overweight (i.e., children with Body Mass Index (BMI) 0-3 BMI points above the 95th percentile for age and gender) toward healthy weight management and assist the child's parent(s) and primary care provider (PCP) to support the child's efforts. For this project we will: 1) develop TLC-HEAT for use by children in the earliest stage of overweight and their parents; 2) integrate TLC-HEAT with an electronic health record to provide child- and parent reported behavior summaries combined with evidence-based decision support to PCPs at the point-of care (PC-HEAT); and 3) conduct a pilot study of the combined HEAT system to explore the appropriateness of conducting a larger, randomized clinical trial in the future. We hypothesize that TLC use will 1) reduce the child's caloric and fat intake (% calories from total fat and saturated fat); 2) reduce the number of hours per week of recreational screen-time (TV, video, computer); 3) and lead to a reduced rate of BMI increase. We will also evaluate whether HEAT will be acceptable to children, parents, and their PCPs and feasible in pediatric practices using an EHR. The ultimate purpose of the development of HEAT is to create a program that is easy to disseminate widely in pediatric practice. If the aims of this study are met, the findings from this project will provide data to modify and improve the system, generate hypotheses, and determine the possibility of proposing a randomized clinical trial of the system with sufficient power to evaluate its effectiveness.