Healthy Homes/Healthy Kids: Pediatric Primary Care-based Obesity Prevention

描述（由申请人提供）：基于儿科初级保健的肥胖预防 肥胖是美国第一大营养问题。由于儿童一生中因超重和肥胖而面临的健康风险最大，因此针对他们的干预措施具有高度优先性。医疗保健系统是有关健康风险和风险预防行为的重要且可靠的信息来源，绝大多数儿童在小学早期就接触过初级保健医学。因此，基于初级保健的肥胖干预措施在人口推广方面特别有吸引力。本申请旨在测试简短的儿科医生咨询和电话辅导跟进对儿童体重增加率的效果。该研究扩展了该团队之前在儿科初级保健机构中治疗肥胖的依从性、亲子互动以及基于提供者和电话的系统方面的工作。根据参考标准，有资格接受 5 至 9 岁儿童健康检查且 BMI 高于 75% 的儿童将被随机分配到以下任一组： (1) 健康饮食和身体活动医生信息加电话辅导； (2) 安全和伤害预防医生信息加电话指导。参与者将被跟踪两年。主要研究结果将是 BMI 百分位数的变化。次要结果包括鼓励健康饮食和活动的父母行为、儿童体力活动水平、饮食摄入量以及儿童心理社会调整和父母体重指数的变化。我们还将衡量计划实施成本和完整性。据推测，健康饮食/PA 组的儿童相对于安全组的儿童，BMI 百分位的增幅较小。进一步假设，随着时间的推移，父母对治疗建议的依从性将与 BMI 百分位数的降低相关。总体目标是证明针对初级保健机构中儿童肥胖预防的低成本干预措施的有效性，并具有广泛传播的潜力。公共健康相关性：这项随机临床试验将评估基于初级保健的肥胖预防干预措施的有效性，该干预措施结合了儿科初级保健提供者的咨询和针对有肥胖风险的 5-9 岁儿童家长的基于电话的计划。基于电话的计划将强化医生的信息，并帮助父母创造一个健康的家庭环境，以鼓励孩子健康的饮食和活动模式以及健康的体重增加。

DESCRIPTION (provided by applicant): Pediatric Primary Care Based Obesity Prevention Obesity is the number one nutritional problem in the US. Because children bear the greatest lifetime health risk from overweight and obesity, interventions targeting them are of high priority. The medical care system is an important and credible source of information about health risks and risk prevention behavior, and a large majority of children have contact with primary care medicine in the early elementary school years. Therefore, primary care based obesity interventions are particularly attractive in terms of population outreach. The present application aims to test the efficacy of brief pediatrician counseling with phone coaching follow up on rate of weight gain in children. The research extends prior work by this team on adherence, parent-child interaction, and provider and telephone based systems for treating obesity in the pediatric primary care setting. Children eligible for five through nine year well-child visits who are above the 75th percentile on BMI according to reference standards will be randomized to either: (1) Healthy Eating and Physical Activity physician message plus phone coaching; or (2) Safety and Injury Prevention physician message plus phone coaching. Participants will be followed for 2 years. The primary study outcome will be change in BMI percentile. Secondary outcomes include parental behaviors encouraging healthy eating and activity, child physical activity level, dietary intake, and child psychosocial adjustment and change in parent BMI. We will also measure program implementation cost and integrity. It is hypothesized that children in the Healthy Eating/PA group will show a smaller increase in BMI percentile relative to the children in the Safety group. It is further hypothesized that parent compliance with treatment recommendations will be associated with reductions in BMI percentile over time. The overall objective is to demonstrate the efficacy of a low-cost intervention targeting obesity prevention in children in a primary care setting with potential for widespread dissemination. PUBLIC HEALTH RELEVANCE: This randomized clinical trial will evaluate the efficacy of a primary care-based obesity prevention intervention that integrates counseling by pediatric primary care providers and a phone-based program for parents of 5-9 year old children at risk for obesity. The phone-based program will reinforce the physician message and help parents create a healthy home environment to encourage healthy eating and activity patterns and healthy weight gain in their children.