An interactive web-based intervention to achieve healthy weight in young children

描述（由申请人提供）：肥胖是向照顾儿童的初级保健医生提出的最常见的慢性疾病。儿童和青少年的肥胖对他们的身体健康和情感健康造成了巨大的负担；与正常体重的儿童相比，肥胖的成年人患高血压、骨关节炎、2型糖尿病和高胆固醇的风险增加。大多数旨在治疗儿童肥胖的干预措施都集中在学龄儿童身上。除了极少数例外，这些项目只取得了适度的成功，这使我们把干预的重点放在年龄较小的儿童（3至6岁）身上，他们的饮食和体育活动习惯可能更容易改变。为了在持续时间和范围上扩大我们干预的范围，我们将与威斯康星大学麦迪逊分校的健康促进系统研究中心合作。35年来，该中心一直处于开发创新信息和通信技术的前沿，以支持面临慢性和致命疾病的患者及其非正式护理人员。他们的信息和交流平台CHESS（综合健康促进支持系统）是一套得到最广泛研究的交流工具之一，已成为众多需求评估、随机临床试验和实地测试的主题。我们将修改CHESS平台，以满足有超重或肥胖儿童的年轻家庭的需求。我们以前的经验使我们开发了一个新项目的要素：(1)我们将目标是3到6岁超重或肥胖儿童的父母，他们在初级保健环境中是唯一的变革推动者；(2)我们将提出一种非限制性的营养“饮食”，以增加水果和蔬菜为重点，最注意适当的份量；（三）提倡积极向上的生活方式，增加体育锻炼和户外活动。我们的干预措施将从在初级保健环境中进行的6次“面对面”小组咨询会议开始，同时在12个月内通过网络进行持续的输入，其中一个重要组成部分侧重于“养育技能”和增加社会支持（通过国际象棋网络），以促进健康的生活方式。该网站将包括信息资源、常见问题解答、个人故事和互动讨论组。基于web的组件可以在方便的时间访问，从而将以低成本促进长期坚持。具体目标1是评估一项干预的可行性，该干预结合了在初级保健环境中由护士进行的6次“面对面”小组咨询会议，以及为期一年的基于网络的家庭组成部分，以积极吸引超重或肥胖儿童的父母参与咨询会议和对初级保健办公室的随访。具体目标2是评估这一干预方案的有效性，以帮助3-6岁超重或肥胖儿童的父母促进(a)降低儿童BMI-z分数，(b)为他们的孩子改变健康的行为（与营养和体育活动有关），以及(c)提高养育技能。

DESCRIPTION (provided by applicant): Obesity is the most common chronic disease presenting to the primary care practitioner who cares for children. Obesity in children and adolescents imposes a huge burden on their physical health and emotional well-being; it leads to an increased probability of becoming overweight adults with an increased risk for hypertension, osteoarthritis, type 2 diabetes, and high cholesterol compared to normal weight children. Most interventions designed to treat obesity in children have focused on the school-age child. With rare exceptions, these programs have been only modestly successful, leading us to focus our intervention on younger children (3 to 6 years of age) whose dietary and physical activity habits may be easier to change. To extend the reach of our intervention, in both duration and scope, we will partner with the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison. The Center has been in the forefront in developing innovative information and communication technologies to support patients and their informal caregivers facing chronic and fatal disease for 35 years. Their platform for information and communication, CHESS (the Comprehensive Health Enhancement Support System) is among the most extensively studied set of communication tools, having been the subject of numerous needs assessments, randomized clinical trials and field tests. We will modify the CHESS platform to meet the needs of young families with overweight or obese children. Our previous experiences have led us to develop elements of a new program: (1) we will target the parents of overweight or obese 3 to 6 year old children in the primary care setting to be the sole agents of change; (2) we will propose a non-restrictive nutritious "diet" focused on increasing fruits and vegetables with most attention to proper portion size; (3) we will promote an active life style with increased physical activity and outdoor play. Our intervention will start with 6 "in-person" group counseling sessions in the primary care setting accompanied by continuous input via the web over 12 months with a strong component focusing on "parenting skills" and increasing social supports (through the CHESS network) for fostering healthy lifestyles. The website will include information resources, answers to frequently asked questions, personal stories and an interactive discussion group. The web-based component can be accessed at convenient times and thereby will promote long-term adherence at low cost. Specific Aim 1 is to assess the feasibility of an intervention combining 6 "in- person" group counseling sessions conducted in the primary care setting by a nurse plus a one year, web- based home component to actively engage parents of overweight or obese children as measured by their attendance at counseling sessions and follow-up visits to the primary care office. Specific Aim 2 is to assess the effectiveness of this intervention program to assist parents of overweight or obese 3-6 year old children in promoting (a) reduction of child BMI-z scores, (b) healthy behavior changes (related to nutrition and physical activity) for their children, and (c) improved parenting skills. PUBLIC HEALTH RELEVANCE: Obesity in children and adults is one of the most common and serious chronic diseases requiring care by the primary care practitioner. Family-based behavioral interventions have been the most successful but require ongoing contact. This proposal will test the feasibility and effectiveness of brief 'in-person' counseling and a long-term web-based intervention model. If successful, this intervention will be inexpensive, easy to replicate and export, and deliverable at the convenience of young families.