Treatment of children with obesity in primary care

儿童和青少年的肥胖正日益给他们的身体健康和情感造成负担

Obesity in children and adolescents increasingly is imposing a burden on their physical health and emotional well being. Because effective management of obesity requires ongoing monitoring of and attention to the onset of known co-morbidities, it is most appropriately conceptualized as a chronic medical condition and is best managed in the' pediatric primary care setting. Although it has been recommended that treatment targeting pediatric obesity be offered within primary care practice, and although there is an efficacious treatment that targets this problem, there are no published studies of efforts to determine the effectivenessof this intervention when offered in a pediatric practice. This project (which will begin this translation) will apply concepts from the Chronic Care Model to the problem of pediatric obesity and proposes to: (1) assess the effectiveness of teaching primary care providers (within diverse pediatric practices) to use specific communication strategies with parents of overweight children to help them take steps with their child toward healthy behavior change; and (2) offer core components of an efficacious family-based behavioral weight management program within the pediatric primary care setting to determine if participating children will change behaviors regarding dietary intake and physical activity to achieve clinically meaningful weight loss. The proposed study is a prospective, randomized, controlled clinical trial in which the outcome of children participating in an immediate intervention will be comparedto a control group. The primary project outcomes will include the (1) change in frequency with which providers counsel parents of overweight children and (2) change in children's diet, physical activity, weight and absolute BMIat the end of treatment compared to a control group. The proposed study will take place within 5 of the 22 practices comprising Pediatric PitNet, a practice-based research network servicing 130,000 children and including 142 providers. If this proves to be effective we will disseminate the components of the comprehensive intervention, which includes not only targeting the patients, but also the providers, the practice, the health insurers, and the community.