The Effectiveness of Family-based Weight Loss Treatment Implemented in Primary Care - CCC - Lead Application

在初级保健中实施以家庭为基础的减肥治疗的有效性 - CCC - 主要应用

• 批准号: 9922789
• 负责人: Leonard H Epstein
• 金额: $ 126.64万
• 依托单位: STATE UNIVERSITY OF NEW YORK AT BUFFALO
• 依托单位国家: 美国
• 财政年份: 2016
• 资助国家: 美国
• 起止时间: 2016-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9922789
• 关键词: 12 year old; 18 year old; Adult; Advisory Committees; Attitude; Basic Science; Behavior; Behavioral; Behavioral Weight Control; Body Weight; Body Weight Changes; Body Weight decreased; Brain; Caring; Child; Child Rearing; Clinic; Data; Diet; Disease; Dose; Eating; Effectiveness; Ensure; Evidence based practice; Evidence based treatment; Family; Family member; Food; Future; Generations; Guidelines; Health Benefit; Health Food; Health Personnel; Healthcare; Home environment; Impulsivity; Individual; Individual Differences; Instruction; Intention; Intervention; Lead; Learning; Long-Term Care; Maintenance; Measures; Medical center; Modeling; Modification; Multi-Institutional Clinical Trial; Neurosciences; Obesity; Outcome; Overweight; Parents; Participant; Perception; Physical activity; Prevention; Preventive service; Primary Care Physician; Primary Health Care; Process; Provider; Randomized; Randomized Clinical Trials; Recommendation; Regulation; Research; Resources; Rewards; Risk; Sampling; Self-control as a personality trait; Siblings; Site; Social Environment; System; Testing; Thinking; Time; Training; Translating; Weight; Weight Gain; Weight maintenance regimen; adult obesity; base; behavior change; behavioral economics; care fragmentation; care providers; compare effectiveness; contingency management; cost; cost effective; design; discount; discounting; environmental enrichment for laboratory animals; evidence base; follow-up; improved; medical specialties; obesity in children; obesity treatment; patient oriented; pediatrician; practice setting; primary care setting; public health relevance; reinforcer; response; success; treatment as usual; usual care arm; weight loss program

DESCRIPTION (provided by applicant): Family-based treatment (FBT) is a behavioral weight control intervention that targets children who are overweight/obese and their parents, and has the capacity to improve the weight status of non-targeted family members such as siblings. FBT has significant positive effects on body weight in children for up to 10-years of follow-up, and a robust relationship is observed between child and parent outcomes. FBT's concurrent care of two generations of obesity in the family is more efficacious and cost-effective than if family members are treated by their separate health care providers. Despite its recognized efficacy, FBT is mainly available in specialty clinics and many children fail to receive this guideline-based level of treatment, as recommended by the U.S. Preventive Services Task Force. Primary care offers an optimal setting for delivery of FBT by capitalizing on the established relationship between primary care providers and families. Using interventionists co-located within the primary care setting overcomes barriers posed by fragmentation of care, and lack of provider time and training. One of the challenges to integrating childhood obesity treatment into primary care is optimizing limited health care resources. In behavioral weight loss programs, some individuals learn diet, physical activity, and behavior change information quickly, while others learn more slowly. Individuals also differ in their ability to implement treatment recommendations due to individual differences, such as problems with delaying gratification. FBT accommodates these individual differences by using a personalized system of instruction, or a mastery model, in which the content and dose of treatment is calibrated to the needs of the family, ensuring that treatment effort is consistent with need. This multi-site, clinical trial aims to evaluate over a to year period the effectiveness of FBT delivered by a trained interventionist co-located within primary care plus enhanced usual care delivered by the primary care provider (FBT+EUC) compared to enhanced usual care alone (EUC). Participants will be a representative sample of 528 families with a 6-12 year-old child and a parent who are both overweight/obese. Weight changes in approximately 228 siblings who are overweight/obese and between 2-18 years of age will also be studied. This study will test between group differences in child (Primary Specific Aim 1A) and parent (Primary Specific Aim 1B) weight change, as well as weight change in siblings who are overweight/obese (Secondary Aim 1), changes in parent and child delay of gratification, and how changes in delay of gratification are related to parent and child weight changes (Secondary Aim 2), participant level predictors of treatment success (Secondary Aim 3), and how provider attitudes toward evidence-based treatment and perceptions of FBT may relate to their intention to use co- located FBT in their practices in the future (Exploratory Aim 1). Establishing that FBT can be effectively implemented within real world settings is crucial to creating a system by which children and their families who suffer from obesity can be treated in a centralized primary care setting.

描述（由申请人提供）：以家庭为基础的治疗（FBT）是一种针对超重/肥胖儿童及其父母的体重控制行为干预，并有能力改善非目标家庭成员（如兄弟姐妹）的体重状况。在长达10年的随访中，FBT对儿童的体重有显著的积极影响，并且观察到儿童和父母之间的结果有很强的关系。FBT同时治疗家族中两代肥胖患者，比家庭成员分别由各自的医疗保健提供者治疗更有效，成本效益更高。尽管FBT具有公认的疗效，但它主要在专科诊所提供，许多儿童未能接受基于指南的治疗

项目成果

Delay Discounting and the Income-Food Insecurity-Obesity Paradox in Mothers.

• DOI: 10.1155/2023/8898498
• 发表时间: 2023
• 期刊: JOURNAL OF OBESITY
• 影响因子: 3.3
• 作者: Epstein, Leonard H.;Rizwan, Ashfique;Paluch, Rocco A.;Temple, Jennifer L.
• 通讯作者: Temple, Jennifer L.

Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study.

• DOI: 10.1016/j.cct.2021.106497
• 发表时间: 2021-10
• 期刊: CONTEMPORARY CLINICAL TRIALS
• 影响因子: 2.2
• 作者: Epstein, Leonard H.;Schechtman, Kenneth B.;Kilanowski, Colleen;Ramel, Melissa;Moursi, Nasreen A.;Quattrin, Teresa;Cook, Steven R.;Eneli, Ihouma U.;Pratt, Charlotte;Geller, Nancy;Campo, Rebecca;Lew, Daphne;Wilfley, Denise E.
• 通讯作者: Wilfley, Denise E.

Parents, but not their children, demonstrate greater delay discounting with resource scarcity.

• DOI: 10.1186/s12889-023-16832-z
• 发表时间: 2023-10-12
• 期刊: BMC public health
• 影响因子: 4.5