Clinic and Home Family Based Behavioral Treatment for Obese Preschoolers: LAUNCH

针对肥胖学龄前儿童的基于诊所和家庭的行为治疗：启动

• 批准号: 8225593
• 负责人: LORI J STARK
• 金额: $ 63.13万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-20 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8225593
• 关键词: 21 year old; 6 year old; Address; Adult; Affect; Aftercare; Age; Attention; Behavior; Behavior Therapy; Behavioral; Beverages; Body Weight Changes; Body mass index; Caregivers; Child; Child Behavior; Child health care; Childhood; Clinic; Community Practice; Comorbidity; Data; Development; Dietary intake; Disease; Eating; Educational process of instructing; Energy Intake; Environment; Environmental Risk Factor; Evidence based treatment; Family; Food; Goals; Growth; Habits; Health; Health Care Costs; Home environment; Home visitation; House Call; Individual; Insulin-Dependent Diabetes Mellitus; Intervention; Intervention Studies; Knowledge; Learning; Life Cycle Stages; Life Expectancy; Life Style; Longevity; Maintenance; Measures; Modeling; NIH Program Announcements; Non obese; Non-Insulin-Dependent Diabetes Mellitus; Nursery Schools; Obesity; Outcome; Overweight; Parenting behavior; Parents; Participant; Pattern; Pediatric Research; Physical activity; Population; Population Decreases; Positioning Attribute; Preschool Child; Prevalence; Prevention approach; Programmed Learning; Public Health; Quality of life; Randomized; Randomized Clinical Trials; Recommendation; Recording of previous events; Recruitment Activity; Research; Risk; School-Age Population; Spouses; Staging; Stimulus; Techniques; Testing; Time; Weight; age group; arm; base; cost; design; diet and exercise; early childhood; effective therapy; feeding; follow-up; grandparent; in vivo; innovation; meetings; motivational enhancement therapy; novel strategies; nutrition; obesity in children; obesity treatment; practice-based research network; randomized trial; sedentary; social cognitive theory; standard of care; treatment program; trend

DESCRIPTION (provided by applicant): Obesity now affects an estimated 2.8 million children between the ages of 2 and 5 years, as the prevalence of obesity among preschool school age children has almost tripled from 5 percent of the population in 1971-1980 to 13.9 percent by 2004. Being obese at age 5 confers a 47 times greater risk of being overweight or obese at age 12. In fact being obese any time between 2 and 5 year increases the risk of remaining overweight or obese as an adult by four times the risk of nonobese preschoolers. Being obese as a preschooler also increases the risk of a number of serious health conditions, including a 2.6 times greater risk of developing type 2 diabetes by age 21 years. In fact, the obesity rate among preschoolers is thought to impose such a cumulative health risk across the life span that children born today, for the first time in history, are expected to have a shorter life expectancy than their parents by to 2 to 5 years. Early effective treatments for establish obesity during the preschool years have the potential to change the trajectory of obesity and related co-morbid health condition across the life-span by reducing obesity and changing the development of lifestyle habits of diet and exercise at a time when these are being formed. Yet research on interventions to reduce obesity in preschool children is severely limited and none exist that addresses established obesity in this age group. Therefore the current study has the potential to have a significant impact on public health by providing evidence-based treatment for obesity in preschoolers, a developmental period in which eating and activity patterns are being formed, that could significantly impact the trajectory of obesity thereby decreasing the population obesity rates and associated healthcare costs at across the life span. Fortunately, we are on our way to addressing the problem of obesity reduction in already obese preschoolers. We have developed and conducted a pilot randomized clinical trial of a treatment program aimed at reducing obesity in already obese preschool children. Our program (Learning about Activity and Understanding Nutrition for Child Health: LAUNCH) is tailored to the developmental stage of preschool children and produced promising preliminary results. In the proposed trial a 3 arm, randomized, parallel group design will test LAUNCH against 1) motivational interviewing (attention control; MI) and 2) standard of care (true standard of care control; STC) with 168 children ages 2 to 5 years who meet the criteria for obesity (>95th percentile for body mass index; BMI). Participants will be randomized to receive a 6 month intervention (LAUNCH, MI) or standard of care. The primary end-point will be change in BMI z-score at the end of treatment. We will also assess maintenance of treatment gains at 6 and 12 months after treatment, and changes in factors thought to be mechanisms for change in weight (food intake and activity level), changes in the obesiogenic environment (parent weight, food intake and activity, and changes in the home food environment) and factors that could be negatively impacted (parent and child eating and feeding interactions). PUBLIC HEALTH RELEVANCE: Obesity among preschool children is a significant health problem affecting approximately 2.8 million children ages 2 to 5 years. There are no treatment studies to reduce established obesity in this age group. Because obesity during the preschool years tracks into childhood and adulthood and increases the likelihood of disorders such as type 1 diabetes, effective treatments for preschoolers are critical in order to change the trajectory of obesity and co-morbidities throughout the life course. Without intervention it is speculated that obesity trends will continue to occur at younger ages, children will carry obesity related health risks for a greater portion of their lives, and, for the first time in history, children born today will have a shorter life expectancy than their parents.

描述(申请人提供)：据估计，肥胖症目前影响着280万2至5岁的儿童，因为学龄前儿童的肥胖率几乎增加了两倍，从1971-1980年的5%增加到2004年的13.9%。5岁时肥胖的风险是12岁时超重或肥胖风险的47倍。事实上，在2至5岁之间的任何时候肥胖都会使成年后超重或肥胖的风险增加4倍。学龄前肥胖还会增加一些严重健康状况的风险，包括21岁时患2型糖尿病的风险增加2.6倍。事实上，学龄前儿童的肥胖率被认为在整个生命周期内施加了如此累积的健康风险，以至于今天出生的儿童历史上第一次预计比他们的父母的预期寿命短2到5年。在学龄前阶段对肥胖进行早期有效的治疗，有可能通过减少肥胖和改变正在形成的饮食和锻炼的生活方式习惯，改变肥胖的发展轨迹和相关的终生健康状况。然而，关于减少学龄前儿童肥胖的干预研究严重有限，而且还没有解决这一年龄段已确定的肥胖问题的研究。因此，目前的研究有可能通过为学龄前儿童的肥胖提供循证治疗来对公共健康产生重大影响，学龄前儿童是一个正在形成饮食和活动模式的发育期，这可能会显著影响肥胖的发展轨迹，从而降低整个生命周期的人口肥胖率和相关的医疗成本。幸运的是，我们正在解决已经肥胖的学龄前儿童减少肥胖的问题。我们已经开发并进行了一项试验性随机临床试验，旨在减少已经肥胖的学龄前儿童的肥胖。我们的计划(了解活动和了解儿童健康的营养：启动)是为学龄前儿童的发展阶段量身定做的，并产生了令人振奋的初步结果。在拟议的试验中，一项三组随机平行小组设计将针对1)动机访谈(注意力控制；MI)和2)护理标准(真实护理标准控制；STC)对168名2至5岁符合肥胖标准(&gt；体重指数第95个百分位数；BMI)的儿童进行测试。参与者将随机接受6个月的干预(启动，MI)或标准护理。主要终点是治疗结束时体重指数z评分的变化。我们还将评估治疗后6个月和12个月的治疗成果的维持情况，以及被认为是体重变化机制(食物摄入量和活动水平)、顺应环境变化(父母体重、食物摄入量和活动以及家庭食物环境变化)以及可能受到负面影响的因素(父母和孩子的饮食和喂养互动)的因素的变化。 公共卫生相关性：学龄前儿童肥胖是一个严重的健康问题，影响到大约280万2至5岁儿童。在这个年龄段，没有治疗研究来减少既定的肥胖症。由于学龄前肥胖会追溯到童年和成年，并增加患1型糖尿病等疾病的可能性，因此对学龄前儿童进行有效的治疗对于改变肥胖和共病在整个生命过程中的轨迹至关重要。如果不进行干预，据推测，肥胖趋势将继续在更年轻的年龄发生，儿童一生中将有更多时间携带与肥胖相关的健康风险，而且，历史上第一次，今天出生的儿童的预期寿命将比他们的父母短。