Improving primary care to prevent childhood obesity

描述(申请人提供)：在过去的20年里，墨西哥的肥胖症患病率在一生中翻了一番以上，甚至包括最年轻的人群。一旦出现肥胖，就很难治疗。为了遏制肥胖症的流行，我们需要在超重之前进行早期干预。阻止肥胖症流行的一个重要且尚未开发的资源是初级保健提供者。初级保健提供者，包括家庭医生和护士，对抗击患者肥胖率上升感兴趣，家庭信任他们从提供者那里得到的建议。这项研究的总体目标是测试创新的基于临床的干预措施的可行性和有效性，以促进2-5岁肥胖风险增加的墨西哥儿童的健康饮食和活动行为。我们建议的干预措施将建立在我们与High Five for Kids的合作基础上，这是一项总部位于美国、由NIH资助的肥胖预防干预措施，涉及根据慢性护理模式重组初级保健，并培训临床医生为2-5岁儿童的父母提供行为改变咨询。为了实现这一目标，我们将在墨西哥社会保障研究所(IMSS)的10家家庭医疗诊所进行随机对照试验(RCT)，IMSS是一个大型综合医疗保健系统，为超过4500万墨西哥人提供医疗保健。主要目的是评估与通常的护理控制条件相比，干预措施在多大程度上减少了6个月干预和6个月随访期内体重指数的变化。我们还将评估干预措施对特定肥胖相关行为的影响及其可行性和接受性。拟议的研究联合了一个具有不同优势的多学科研究团队；哈佛大学的研究人员在开发创新的肥胖预防干预措施方面提供了儿童超重流行病学方面的专业知识，而IMSS的研究人员提供了实验设计方面的专业知识，并与IMSS诊所建立了研究合作的既定记录。这项研究将主要在墨西哥城IMSS与Ricardo Pirez-Cuevas合作进行，作为NIH编号5R01HD050966-05、2005年8月22日至2010年6月30日的延长，计划延长一年至2011年6月30日。 与公共健康相关：这项拟议的研究利用了NIH为儿童高五研究提供资金创建的广泛基础设施，并测试了墨西哥-初级保健提供者-未开发的肥胖预防资源的有效性。这项研究将通过评估一种基于临床的创新干预措施的有效性和可行性来推动肥胖预防领域的发展，该干预措施将控制学龄前儿童超重所需的强度与墨西哥初级保健诊所维持该计划所需的基本特征相结合。

DESCRIPTION (provided by applicant): Over the past 20 years, the prevalence of obesity in Mexico has more than doubled among individuals across the lifespan, including even the youngest populations. Once present, obesity is difficult to treat. To halt the obesity epidemic, we need to intervene early in life before excess weight gain takes hold. An important and untapped resource to halting this obesity epidemic is the primary care provider. Primary care providers, including family physicians and nurses, are interested in combating the rise of obesity in their patients, and families trust the advice they get from their providers. The overall goal of this research is to test the feasibility and effectiveness of an innovative clinic-based intervention to promote healthy eating and activity behaviors among Mexican children aged 2-5 years at elevated risk of obesity. Our proposed intervention will build upon our work with High Five for Kids, a U.S.-based, NIH funded obesity prevention intervention that involved restructuring primary care based on the chronic care model and training clinicians to provide behavior change counseling to parents of children age 2-5 years. To achieve this goal, we will conduct a randomized controlled trial (RCT) in 10 family medical clinics of the Mexican Institute of Social Security (IMSS), a large integrated health care system that provides health care for over 45 million Mexicans. The primary aim is to assess the extent to which the intervention, compared with the usual care control condition, reduces change in body mass index over a 6-month intervention and 6-month follow-up period. We will also assess the intervention's effect on specified obesity-related behaviors and its feasibility and acceptance. The proposed study unites a multidisciplinary research team with diverse strengths; the Harvard researchers provide expertise in the epidemiology of childhood overweight in the development of innovative obesity prevention interventions, while the IMSS researchers provide expertise in experimental design and an established record of research collaboration with IMSS clinics. This research will be conducted primarily in Mexico City at IMSS in collaboration with Ricardo Pirez-Cuevas, as an extension of NIH Grant No. 5R01HD050966-05, 8-22-2005 to 06-30-2010, with a planned one-year no-cost extension to 06-30-2011. PUBLIC HEALTH RELEVANCE: The proposed study takes advantage of the extensive infrastructure created with NIH funding for the High Five for Kids study and tests the effectiveness of an untapped resource for obesity prevention in Mexico - the primary care provider. This research will move the field of obesity prevention forward by assessing the effectiveness and feasibility of an innovative clinic-based intervention that combines the intensity needed to curb excess weight gain among preschool children with the essential features needed to sustain the program within primary care clinics in Mexico.