Bright Start: Obesity Prevention in American Indian Children

描述（由申请人提供）：肥胖是当今美国印第安儿童面临的最严峻的健康挑战之一，对严重慢性疾病（包括2型糖尿病）的发展具有严重影响。早期预防儿童时期不适当的体重增加至关重要。这项针对Pine Ridge和Rosebud保留地的幼儿园和一年级美国印第安儿童的拟议研究将开发和测试学校环境干预的有效性，并通过增加体育活动和健康的饮食习惯来减少体重过度增加。干预的重点，Ohiyu lyojanjan -光明的开始方案，是在学校和家庭创造饮食和体育活动的环境变化。干预措施有三个主要目标：将学校的体育活动增加到60分钟/天;修改学校的膳食和零食以及教室的饮食习惯;让家庭参与改变家庭的行为和环境。干预的有效性将在一项分组随机对照试验中进行测试，14所学校随机分为两个条件（干预或对照）。两组幼儿园儿童将被跟踪到一年级结束。主要假设是，在16个月的干预结束时，干预学校的儿童，相对于对照学校的儿童，在调整基线值后，体重指数（BMI）和体脂百分比显着降低。儿童的主要结局指标是BMI和体脂百分比。次要措施包括儿童的每日总体力活动，营养和学校膳食和零食的食物组分析，并评估课堂食品和体力活动的做法。儿童测量将在幼儿园开始时（基线），幼儿园结束时（仅BMI）和一年级结束时进行。父母将在基线时接受调查，当他们的孩子在一年级结束时。家长评估将包括家庭食物供应的措施，家长报告自己和孩子的饮食和体育活动行为。这项研究将促进我们对如何最好地预防美国印第安人肥胖的认识，这是一个极端危险的人群，这样做将有助于解决健康差距。拟议的干预措施有可能改变学校政策，在全国学校推广和可持续。

DESCRIPTION (provided by applicant): Obesity is one of the most daunting health challenges facing American Indian children today and has serious implications for the development of serious chronic diseases, including type-2 diabetes. Early prevention of inappropriate weight gain in childhood is critical. The proposed study, targeting kindergarten and 1st grade American Indian children on the Pine Ridge and Rosebud reservations, will develop and test the efficacy of a school environmental intervention, augmented with a family household environmental intervention, to reduce excessive weight gain by increasing physical activity and healthy dietary practices. The focus of the intervention, Ohiyu lyojanjan - Bright Start Program, is to create dietary and physical activity environmental change at school and home. The intervention has three primary goals: increase physical activity at school to 60 min/day; modify school meals and snacks, and classroom food practices; and involve families in making behavioral and environmental changes at home. The efficacy of the intervention will be tested in a group-randomized controlled trial with 14 schools randomized to two conditions (intervention or control). Two cohorts of kindergarten children will be followed through the end of 1st grade. The major hypothesis is that by the end of the 16-month intervention, children in the intervention schools, relative to children in the control schools, will have significantly lower body mass index (BMI) and percent body fat after adjustment for baseline values. The primary outcome measures in children are BMI and percent body fat. Secondary measures include child's total daily physical activity, nutrient and food-group analysis of school meals and snacks, and assessment of classroom food and physical activity practices. Child measures will occur at the beginning of kindergarten (baseline), at the end of kindergarten (BMI only), and at the end of the 1st grade. Parents will be surveyed at baseline, and when their child is at the end of the 1st grade. Parent assessments will include measures of household food availability, parent reports of their own and child eating and physical activity behaviors. The study will advance our knowledge of how best to prevent obesity in American Indians, a population at extreme risk, and in doing so will help address health disparities. The proposed intervention has potential for school policy change that would be generalizable and sustainable in schools nationwide.