Improving primary care to prevent childhood obesity

改善初级保健以预防儿童肥胖

• 批准号: 7943569
• 负责人: MATTHEW W GILLMAN
• 金额: $ 6.18万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7943569
• 关键词: 5 year old; Address; Administrator; Age; Asthma; Behavior; Behavioral; Body Weight decreased; Body mass index; Child; Child Behavior; Child Care; Childhood; Cities; Clinic; Collaborations; Consumption; Counseling; Data; Development; Dietary Fiber; Dietary intake; Eating; Effectiveness; Effectiveness of Interventions; Energy Intake; Energy Metabolism; Ensure; Environment; Epidemic; Epidemiology; Experimental Designs; Family; Family Physicians; Fatty acid glycerol esters; Food; Frequencies; Funding; Future; Goals; Grant; Group Practice; Healthcare; Height; Human Resources; Individual; Institutes; Insulin; Intake; Integrated Health Care Systems; Interdisciplinary Study; International; Intervention; Knowledge; Leptin resistance; Life; Longevity; Massachusetts; Measurement; Medical; Mexican; Mexico; Nursery Schools; Nurses; Nutrient; Obesity; Overweight; Parents; Patients; Physical activity; Population; Preschool Child; Prevalence; Preventive Intervention; Primary Health Care; Provider; Public Health; Randomized; Randomized Controlled Trials; Readiness; Relative (related person); Research; Research Infrastructure; Research Personnel; Resources; Science; Services; Site; Social Security; Specific qualifier value; Television; Testing; Time; Training; Trust; United States National Institutes of Health; Weight; Weight Gain; Work; age group; aged; base; behavior change; cardiovascular risk factor; chronic care model; combat; cost; cost effectiveness; empowered; experience; fast food; follow-up; fruits and vegetables; group intervention; improved; innovation; interest; intervention effect; medical schools; novel strategies; obesity in children; obesity prevention; obesity risk; outreach; parent grant; prevent; prevention service; primary outcome; programs; public health relevance; sex; success; sugar; sweetened beverage; time use; tool; treatment as usual

DESCRIPTION (provided by applicant): 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 Pirez-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. PUBLIC HEALTH RELEVANCE: The proposed study takes advantage of the extensive infrastructure created with NIH funding for the High Five for Kids study and tests the effectiveness of an untapped resource for obesity prevention in Mexico - the primary care provider. This research will move the field of obesity prevention forward by assessing the effectiveness and feasibility of an innovative clinic-based intervention that combines the intensity needed to curb excess weight gain among preschool children with the essential features needed to sustain the program within primary care clinics in Mexico.

描述（由申请人提供）：在过去的20年里，墨西哥的肥胖患病率在整个生命周期中增加了一倍多，甚至包括最年轻的人群。肥胖一旦出现就很难治疗。为了阻止肥胖的流行，我们需要在体重过度增加之前进行早期干预。 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。初级保健提供者，包括家庭医生和护士，有兴趣打击他们的病人肥胖的上升，和家庭信任他们从他们的提供者得到的建议。这项研究的总体目标是测试一种创新的基于诊所的干预措施的可行性和有效性，以促进2-5岁肥胖风险升高的墨西哥儿童的健康饮食和活动行为。我们提出的干预措施将建立在我们与美国儿童五人组的工作基础上，在此基础上，NIH资助了肥胖预防干预，包括基于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一项随机对照试验，这是一个为4 500多万墨西哥人提供保健的大型综合保健系统。主要目的是评估干预与常规护理控制条件相比，在6个月干预和6个月随访期间降低体重指数变化的程度。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。 拟议的研究联合了一个多学科的研究团队，具有不同的优势;哈佛的研究人员在开发创新的肥胖预防干预措施中提供了儿童超重流行病学方面的专业知识，而IMSS的研究人员提供了实验设计方面的专业知识和与IMSS诊所建立的研究合作记录。本研究将主要在墨西哥城IMSS与Ricardo Pirez-Cuevas合作进行，作为NIH资助号5 R 01 HD 050966 -05（2005年8月22日至2010年6月30日）的扩展，计划免费延长一年至2011年6月30日。 公共卫生相关性：这项拟议中的研究利用了NIH为High Five for Kids研究提供资金的广泛基础设施，并测试了墨西哥未开发的肥胖预防资源的有效性-初级保健提供者。这项研究将通过评估一种创新的基于诊所的干预措施的有效性和可行性来推动肥胖预防领域的发展，这种干预措施将抑制学龄前儿童体重过度增加所需的强度与在墨西哥初级保健诊所内维持该计划所需的基本特征相结合。