Peer Counseling in Family-Based Pediatric Overweight Treatment

描述(申请人提供)：儿童肥胖症在美国非常普遍。针对较小超重儿童(6-12岁)的基于家庭的行为体重控制治疗已确立疗效，治疗后体重状况持续改善长达10年。美国预防服务工作组最近的建议是，需要进行中到高强度的干预(接触时间为25小时)，以帮助超重儿童实现并保持更好的体重控制。然而，大多数医疗保险覆盖范围明确禁止超重/肥胖治疗服务，或将提供者的服务限制在远低于推荐水平(例如，每年最多4次营养就诊)，这使得实施治疗计划变得困难。仅在美国就有相当多的超重儿童，约三分之一的儿童，比专业人士可能治疗的要多。需要一种新的模式，提供以家庭为基础的儿科超重治疗，降低成本，但保持短期和长期疗效。一个可能的机会，将在目前的提案中开发和初步测试，是一种同伴干预模式，在这种模式下，接受专业干预的家庭随后向其他家庭提供干预。该提案还考察了同伴干预者通过向他人提供干预来持续参与围绕饮食和身体活动的行为改变是否提高了他们自己的长期疗效。拟议项目首先采用循证方法，由专业干预者向超重儿童及其家长(S)(第一代家庭；n=28)提供以家庭为基础的行为体重控制治疗。在接受治疗后，第一代家庭中的一半将被随机分配为其他超重儿童和父母(第二代家庭；n=28)的同伴干预者。其余的第一代家庭将不会接受或提供任何额外的治疗。该项目旨在开展同伴干预培训和提供，并审查在整个干预过程中提供同伴干预的可行性和可接受性。该项目还旨在估计同伴干预(接受和提供)对儿童和父母体重结果的影响，并在接受治疗结束时和6个月后进行评估。这个R21应用程序开发并开始评估基于家庭的儿童行为超重治疗的创新交付策略，并有可能在未来进行全面试验，以检查长期体重控制效果、成本效益和传播。 公共卫生相关性：美国近三分之一的儿童超重或肥胖，需要采取干预措施，以减少儿童超重/肥胖带来的直接和长期的负面身体和心理社会后果。针对儿童超重的有效的以家庭为基础的行为干预措施已经存在，但目前成本太高，而且不容易获得。以同伴为基础的这种干预措施有可能降低成本和扩大覆盖范围，但这种新的方法需要开发，并需要评估可行性、可接受性和初步效果。

DESCRIPTION (provided by applicant): Childhood obesity is highly prevalent in the U.S. Family-based behavioral weight control treatment for younger overweight children (6-12 years old) has established efficacy, with sustained weight status improvements up to 10 years after treatment. Recent recommendations of the U.S. Preventive Services Task Force are that moderate- to high-intensity interventions (>25 contact hours) are needed to help overweight children achieve and sustain better weight control. However, the majority of health insurance coverage specifically disallows overweight/obesity treatment services or limits provider services far below recommended levels (e.g., up to 4 annual nutrition visits), making it difficult to sustai treatment programs. There are also considerably more overweight children in the U.S. alone, ~1 in 3 children, than professionals could possibly treat. A new model of delivering family-based pediatric overweight treatment that decreases costs, but sustains short- and long-term efficacy, is needed. One possible opportunity, to be developed and initially tested in the current proposal, is a peer intervention model in which families receiving professionally-delivered intervention subsequently provide intervention to other families. The proposal also examines whether peer interventionists' continued engagement in behavior change around eating and physical activity through providing intervention to others improves their own long-term efficacy. The proposed project begins with the evidence-based approach of professional interventionists delivering family-based behavioral weight control treatment to overweight children and their parent(s) (1st generation families; n=28). After receiving treatment, half of 1st generation families will be randomly assigned to serve as peer interventionists to other overweight children and parents (2nd generation families; n=28). The remaining 1st generation families will neither receive nor provide any additional treatment. This project aims to develop peer intervention training and delivery and to examine the feasibility and acceptability of the peer intervention delivery throughout the intervention. This project also aims to derive an estimate of the impact of peer intervention (receiving and providing) on child and parent weight outcomes, with assessments at the end of receiving treatment and 6 months later. This R21 application develops and begins to evaluate an innovative delivery strategy for family-based behavioral pediatric overweight treatment, with the potential for future comprehensive trials to examine longer term weight control efficacy, cost effectiveness, and dissemination. PUBLIC HEALTH RELEVANCE: Nearly 1 in 3 children in the U.S. is overweight or obese and interventions are needed to decrease the immediate and long-term negative physical and psychosocial consequences of childhood overweight/obesity. Efficacious family-based behavioral interventions for pediatric overweight exist, but are currently too costly and not readily available. Peer-based delivery of this intervention has the potential to reduce costs and increase reach, but this novel approach requires development, and evaluation of feasibility, acceptability, and initial efficacy.