Improving primary care to prevent childhood obesity

在过去的20年里，墨西哥的肥胖患病率在个人中增加了一倍多 包括最年轻的人群。肥胖症一旦出现就很难治疗。 肥胖症的流行，我们需要在生命的早期进行干预，以免体重过度增加。 一个重要的和未开发的资源，以制止这种肥胖流行病是初级保健提供者。 包括家庭医生和护士在内的初级保健提供者对打击肥胖症的上升感兴趣 患者和家属信任他们从医疗服务提供者那里得到的建议。本研究的总体目标是 测试创新的基于诊所的干预措施的可行性和有效性，以促进健康饮食， 肥胖风险增加的2-5岁墨西哥儿童的活动行为。我们提出的 干预将建立在我们与美国儿童五大组织的合作基础上，美国国立卫生研究院资助的肥胖预防 干预措施包括根据慢性病护理模式重建初级保健，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的10个家庭医疗诊所进行的随机对照试验（RCT） 墨西哥社会保障局是一个大型综合保健系统，为4 500多万墨西哥人提供保健服务。的 主要目的是评估干预的程度，与通常的护理控制条件相比， 在6个月的干预和6个月的随访期内降低体重指数的变化。我们还将 评估干预对特定肥胖相关行为的影响及其可行性和可接受性。 这项拟议中的研究联合了一个具有不同优势的多学科研究团队;哈佛 研究人员提供儿童超重流行病学的专业知识， 肥胖预防干预措施，而IMSS研究人员提供实验设计和 与IMSS诊所建立研究合作记录。这项研究将主要在 墨西哥城IMSS与Ricardo Pérez-Cuevas合作，作为NIH第100000号资助的延伸。 5 R 01 HD 050966 -05，2005年8月22日至2010年6月30日，计划免费延长一年至2011年6月30日。

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 P¿rez-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.