Choices: Family Physicians Treat Overweight Children

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DESCRIPTION (provided by applicant): The problem of childhood obesity has become a national epidemic, with even higher rates found among minority children. Physicians and clinics have not provided adequate care for obese children; this problem is even more acute for clinics serving lower income and minority populations. The group office visit model is an approach to managing chronic conditions which fits within the clinic fee-for-service model and is being used increasingly to deliver care to groups of patients with needs in common. We propose the use of the group office visit model to provide an obesity treatment intervention for children 9-11 years of age in gender specific groups and their parents in a clinic setting that serves a high proportion of Mexican American lower income patients. The targets of the intervention for the children are less TV viewing, less sweetened beverages, and net lower portion sizes, improved fast food choices (or less fast food), and more general physical activity. Each session will include self-monitoring, physical activity, and a cognitive/learning component. Parents will learn along with their children, and will gain information about why these family lifestyle changes will benefit all family members. The cognitive basis for the intervention is enhancing resiliency, shown to be effective for both adults and children in this age group across a variety of settings. This pilot study will develop and implement the group office visit intervention for 40 children and their parents in a lagged intervention design. Families will be randomly assigned to begin immediately or wait six months for the class. The intervention will have 12 approximately weekly sessions. All children will be measured at baseline, 3, 6, 9, 12, and 15 months; measurements will include weight and height, diet and physical activity by telephone recalls, and measures of cognitive change. Children will be eligible for participation who are above the 90th percentile of BMI for age, and who can have the regular participation of at least one parent or guardian.