Childhood obesity treatment targeting specific behaviors

描述（由申请人提供）：美国正处于肥胖流行病之中，影响幼儿。儿科初级保健环境是解决这个问题的理想场所，因为大多数家庭经常与儿科医生接触，并且在这种环境中定期评估儿童的健康状况。一个儿童问题专家委员会提出了在初级保健环境中治疗体重指数超过第85百分位数的儿童的建议。需要符合委员会建议的方案，包括：1）尽可能早地开始治疗; 2）关注家庭，父母是治疗的主要改变者; 3）使用行为矫正技术来改变饮食和活动行为; 4）一次在饮食和活动中进行2或3次非常具体的改变。因此，这项R21申请的目的是开发、实施和评估一项6个月的儿童肥胖行为干预措施，该措施符合委员会的建议，并可在初级保健环境中实施。该项目的第二个目的是确定哪些饮食和活动行为应在干预中作为目标。135名年龄在4到8岁之间，BMI > 85百分位数的儿童，由他们的儿科医生评估和推荐，将被随机分为三种情况之一：1）时事通讯条件; 2）增加身体活动的行为育儿计划（60分钟/天），并减少含糖饮料的摄入量（< 3份/周）（传统）;或3）行为育儿计划，减少看电视（< 2小时/天），增加低脂牛奶消费（2份/天）（替代品）。将在3、6、9和12个月时对体重、身高和标准化BMI（z-BMI）（主要因变量）进行随访评估。儿科医生将在评估后向家庭提供有关体重和身高状况的后续信件。这项试点研究使我们能够确定儿童肥胖干预的可行性和有效性，优化儿科医生的作用，并满足委员会在初级保健环境中治疗的建议。此外，通过比较针对传统或替代行为的效果，将获得数据，用于全面试验这两种方法对长期减肥效果的功效分析。

DESCRIPTION (provided by applicant): The US is in the midst of an obesity epidemic, affecting young children. The pediatric primary care setting is an ideal place to address this problem since most families have frequent contact with their pediatrician and a child's health status is regularly assessed in this setting. Recommendations for treating children with a body mass index (BMI) over the 85th percentile in the primary care setting have been developed by an Expert Committee on childhood. Programs are needed that meet the recommendations from the Committee, which include: 1) beginning treatment as young as possible; 2) focusing on the family, with the parent being the primary change agent for treatment; 3) using behavior modification techniques to change eating and activity behaviors; and 4) making 2 or 3 very specific changes in diet and activity at one time. Thus, the aim of this R21 application is to develop, implement, and evaluate a 6-month behavioral childhood obesity intervention that meets the Committee's recommendations and can be implemented in a primary care setting. A second aim of this project is to determine which eating and activity behaviors should be targeted in the intervention. One hundred thirty-five children, aged 4 to 8 years with a BMI > 85th percentile, assessed and referred by their pediatricians, will be randomized to one of three conditions: 1) a newsletter condition; 2) a Behavioral Parenting Program that increases physical activity (60 min/day) and decreases sweetened drink consumption (< 3 servings/week) (Traditional); or 3) a Behavioral Parenting Program that reduces TV watching (< 2 hours/day) and increases low-fat milk consumption (2 servings/day) (Substitutes). Follow-up assessments on weight, height, and standardized BMI (z-BMI), the primary dependent variable, will be conducted at 3, 6, 9, and 12 months. Pediatricians will provide follow-up letters to families, regarding weight and height status, following the assessments. This pilot study allows us to determine the feasibility and efficacy of a pediatric obesity intervention that optimizes the role of the pediatrician and meets the Committee's recommendations for treatment in a primary care setting. Moreover, by comparing the effects of targeting the traditional or substitute behaviors, data will be obtained for a power analysis for a full-scale trial of the effects of these two approaches on long-term weight loss.