An Individually Tailored, Family-Centered Intervention for Childhood Obesity: Connecting Services in Pediatric Primary Healthcare, the Home, and the Community

项目总结 儿童肥胖是一个多方面的公共卫生问题。近三分之一的肥胖儿童，被定义为 体重指数(BMI)≥95百分位数的年龄和性别，显示心脏代谢危险因素(CRF)，这 与加速的心血管疾病、许多癌症和发病率有关。饮食上的微小变化， 减肥或体力活动可以显著降低慢性肾功能衰竭的风险。尽管基于证据的干预措施 由医疗保健提供者(医生、护士、营养师)提供，用于预防儿童肥胖 高危青年、低参与率和方案可获得性，以及不遵守建议， 是取得积极成果的重大障碍。尽管它们没有被广泛使用，但以家庭为中心的行为 干预是一种基于证据的方法，已被发现可显著预防儿童肥胖 和青少年。建议的研究使用家庭体检(FCU)的改编以健康为目标 行为(Hb)改变，被称为FCU-Hb计划，在BMI升高的年轻人中。广泛的数据支持 最初的FCU在改善健康和功能领域的儿童结果方面的有效性，包括 通过家庭一级的行动机制预防肥胖。FCU-HB是以评估为导向的 为满足超重人群的行为健康需求而量身定做服务和增加动力的方法 肥胖儿童和他们的家人。我们将进行务实的随机试验，以测试 FCU-HB儿科初级保健计划，对有6至12岁孩子的350个家庭进行多民族抽样 被确定为肥胖(体重指数≥第95百分位数)或超重(体重指数≥第85百分位数)并发现风险的年份 通过电子健康记录(EHR)。FCU-HB将与三个初级保健中心的护理相协调 诊所：凤凰城儿童医院的儿科综合诊所和两个联邦合格的健康中心。全 三家诊所主要为医疗补助患者和墨西哥的大量少数民族人口提供服务 美国人和美国印第安人，他们在儿童肥胖症、慢性肾功能衰竭和在以下情况下获得护理方面存在差异 与非拉丁裔白人相比。与文献一致，提供者报告了儿科治疗的障碍 肥胖治疗与家庭功能、动机和对建议的遵守有关。FCU- HB旨在通过改善家庭参与度和行为健康实践来减少BMI。这场审判 旨在促进可持续性和扩大规模。社区和科学委员会将为研究提供指导 和程序设计，以确保该计划实现这一目标，并被发现改善儿童的体重。我们会 采用多方法、多信息的评估策略，包括电子健康记录数据、行为观察、 问卷和访谈，以评估FCU-HB对BMI的影响，作为主要结果，儿童健康 行为、育儿方式和服务利用率。我们还将评估执行成果，包括 可接受性、采用率、可行性、适当性、保真度和成本，这将提供可操作的信息 在其他医疗系统中提供可持续的服务。

PROJECT SUMMARY Pediatric obesity is a multifaceted public health concern. Nearly one-third of children with obesity, defined as a body mass index (BMI) ≥ 95th percentile for age and gender, exhibit cardiometabolic risk factors (CRF), which are associated with accelerated cardiovascular disease, many cancers, and morbidity. Small changes in diet, weight loss, or physical activity can significantly reduce risk for CRF. Although evidence-based interventions delivered by healthcare providers (physicians, nurses, dieticians) exist for the prevention of pediatric obesity for high-risk youth, low participation rates and program availability, as well as nonadherence to recommendations, are significant barriers to positive outcomes. Although they are not widely used, family-centered behavioral interventions are an evidence-based approach that has been found to significantly prevent obesity in children and adolescents. The proposed study uses an adaptation of the Family Check-Up (FCU) to target health behavior (HB) change, termed the FCU-HB program, in youth with elevated BMI. Extensive data support the original FCU's efficacy in improving child outcomes across domains of health and functioning, including the prevention of obesity, through family-level mechanisms of action. The FCU-HB is an assessment-driven approach to tailoring services and increasing motivation to address the behavioral health needs of overweight and obese children and their families. We will conduct a pragmatic randomized trial to test the effects of the FCU-HB program in pediatric primary care with a multiethnic sample of 350 families with children ages 6 to 12 years who are identified as obese (BMI≥95th percentile) or overweight (BMI≥85th percentile) with risk identified through the electronic health records (EHR). The FCU-HB will be coordinated with care in three primary care clinics: the general pediatrics clinic at Phoenix Children's Hospital and two federally qualified health centers. All three clinics serve predominantly Medicaid patients and a large ethnic minority population of Mexican Americans and American Indians, who face disparities in pediatric obesity, CRF, and access to care when compared with Non-Latino Whites. Consistent with the literature, providers have reported barriers to pediatric obesity treatment with respect to family functioning, motivation, and adherence to recommendations. The FCU- HB was designed to reduce BMI by improving family engagement and behavioral health practices. This trial aims to facilitate sustainability and scale up. Community and scientific boards will provide guidance on study and program design to ensure the program achieves this aim and is found to improve children's weight. We will use a multi-method and multi-informant assessment strategy including EHR data, behavioral observation, questionnaires, and interviews to assess the impact of the FCU-HB on BMI as a primary outcome, child health behaviors, parenting, and service utilization. We will also assess implementation outcomes, including acceptability, adoption, feasibility, appropriateness, fidelity, and cost, which will provide actionable information for sustainable delivery in other healthcare systems.