Clinic, Family & Community Collaboration to Treat Overweight and Obese Children

诊所、家庭

• 批准号: 8289469
• 负责人: THOMAS N. ROBINSON
• 金额: $ 232.23万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2017-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8289469
• 关键词: Academic achievement; Advocacy; Agreement; Anthropology; Behavior; Behavioral; Biological; Blood Pressure; Body mass index; C-reactive protein; California; Caring; Centers for Disease Control and Prevention (U.S.); Child; Child Behavior; Child health care; Childhood; Cholesterol; Cities; Clinic; Clinical; Clinical Management; Clinical Psychology; Clinical Research; Collaborations; Communities; Control Groups; Counseling; DNA; Data; Decision Making; Diabetes Mellitus; Diastolic blood pressure; Diet; Dietary intake; Eating; Economic Models; Economics; Endocrinology; Energy Intake; Enrollment; Environment; Epidemiology; Exercise; Exercise Physiology; Failure; Family; Family Study; Fasting; Fatty acid glycerol esters; Food; Future; Genetic; Glucose; Growth; Health Priorities; Health Professional; Heart Rate; High Density Lipoprotein Cholesterol; High Density Lipoproteins; Home environment; Individual; Insulin; Intervention; Knowledge; LDL Cholesterol Lipoproteins; Link; Lipoproteins; Low income; Low-Density Lipoproteins; Mediating; Medical; Modeling; Morbidity - disease rate; National Institute of Diabetes and Digestive and Kidney Diseases; Neurosciences; Obesity; Outcome Measure; Overweight; Parents; Participant; Pediatric Hospitals; Pediatric Research; Pediatrics; Phase; Physical activity; Physiological; Physiology; Pilot Projects; Population; Primary Health Care; Process; Provider; Public Health; Public Policy; Qualifying; Randomized; Randomized Controlled Trials; Recruitment Activity; Redwood; Research; Research Design; Research Infrastructure; Resources; Rest; Schools; Site; Skinfold Thickness; Social Development; Social Psychology; Sports; Subgroup; Translating; Triceps Brachii Muscle; Triglycerides; Universities; Weight; Weight maintenance regimen; Youth; after-school program; base; boys; clinical care; clinical practice; community based participatory research; cost effectiveness; depressive symptoms; design; economic cost; eligible participant; energy balance; experience; girls; glucose metabolism; improved; innovation; mortality; novel; nutrition; obesity in children; obesity prevention; obesity risk; obesity treatment; patient population; policy implication; primary outcome; programs; psychologic; research study; secondary outcome; sedentary; social; socioeconomics; standard care; success; theories; therapy design; tv watching; waist circumference

DESCRIPTION (provided by applicant): We propose an innovative, integrated, multi-component, multi-level, multi-setting (MMM) approach to treating overweight and obese children (BMI > 85th percentile). The experimental MMM intervention is based on successful past research and ongoing community based participatory research (CBPR), and is designed to overcome barriers to existing treatment models. It includes: a theory-based community center team sports program designed specifically for overweight & obese children; a home-based family intervention to reduce screen time and to alter the home food/eating environment; and a primary care provider behavioral counseling intervention linked to the community and home interventions. After two years of formative research and pilot studies, we will evaluate our intervention in a randomized controlled trial. 240 families with overweight and obese children will be recruited through primary care pediatric clinics serving low-income, ethnically-diverse patient populations in East Palo Alto and Redwood City, California. Eligible participants will be referred by their primary medical care providers to after school programs conducted by their local YMCAs and Boys and Girls Clubs. After completing baseline assessments and enrolling in the study, families will be randomized to standard clinical care and the standard community center programs, or to the experimental MMM intervention for 36 months. All participants will complete assessments at baseline, 12 months, 24 months and 36 months. The primary outcome measure is change in BMI over the entire course of the study. Secondary outcomes include changes to 12 and 24 months, and changes in waist circumference, triceps skinfold thickness, blood pressures, heart rate, fasting lipoprotein levels, glucose and Insulin, hsCRP, physical activity (accelerometery), screen time and other sedentary behaviors, dietary intake, weight concerns, and depressive symptoms. DNA will be collected to identify genetic moderators of intervention responsiveness. We will compare the MMM intervention and standard care control groups using random regression models to take full advantage of all longitudinal data. Primary Hypothesis: Compared to standard care controls, children randomized to our multi-component, multi-level, multi-setting (MMM) intervention will significantly reduce their body mass index. We will also examine potential baseline biological, psychological, social and environmental moderating and mediating variables, cost-effectiveness and public policy implications. RELEVANCE: Existing pediatric weight control programs are often insufficient. We propose a novel, integrated, multi-component, multi-level, multi-setting treatment model based on successful past research and designed to be more generalizable to real world communities and populations.

描述（由申请人提供）： 我们提出了一种创新、综合、多成分、多层次、多环境 (MMM) 的方法来治疗超重和肥胖儿童（BMI > 85%）。实验性 MMM 干预基于过去成功的研究和正在进行的社区参与性研究 (CBPR)，旨在克服现有治疗模式的障碍。它包括：专为超重和肥胖儿童设计的基于理论的社区中心团队运动项目；以家庭为基础的家庭干预，以减少屏幕时间并改变家庭食物/饮食环境；以及与社区和家庭干预措施相关的初级保健提供者行为咨询干预措施。经过两年的形成性研究和试点研究，我们将在随机对照试验中评估我们的干预措施。将通过初级保健儿科诊所招募 240 个有超重和肥胖儿童的家庭，为加利福尼亚州东帕洛阿尔托和雷德伍德城的低收入、多种族患者群体提供服务。符合条件的参与者将由其初级医疗保健提供者转介至当地基督教青年会和男孩女孩俱乐部举办的课后项目。完成基线评估并参加研究后，家庭将被随机分配到标准临床护理和标准社区中心计划，或接受为期 36 个月的实验性 MMM 干预。所有参与者将在基线、12 个月、24 个月和 36 个月时完成评估。主要结果指标是整个研究过程中体重指数的变化。次要结局包括 12 个月和 24 个月时的变化，以及腰围、三头肌皮褶厚度、血压、心率、空腹脂蛋白水平、血糖和胰岛素、hsCRP、体力活动（加速度计）、屏幕时间和其他久坐行为、饮食摄入、体重问题和抑郁症状的变化。将收集 DNA 以确定干预反应的遗传调节因素。我们将使用随机回归模型比较 MMM 干预组和标准护理对照组，以充分利用所有纵向数据。主要假设：与标准护理对照相比，随机接受我们的多成分、多层次、多环境 (MMM) 干预的儿童将显着降低其体重指数。我们还将研究潜在的基线生物、心理、社会和环境调节和中介变量、成本效益和公共政策影响。相关性：现有的儿科体重控制计划往往不足。我们基于过去成功的研究提出了一种新颖的、综合的、多组成部分、多层次、多环境的治疗模型，旨在更广泛地推广到现实世界的社区和人群。