Improving primary care to prevent childhood obesity

描述（由申请人提供）：肥胖症的流行没有放过任何年龄组，包括我们最小的孩子。学龄前儿童的超重与心血管危险因素和哮喘有关，并预示着儿童期以后的超重。 此外，与饮食摄入、身体活动和不活动有关的行为可能在这些早期年龄被“编码”。 一个相对研究不足的行为改变的网站是初级保健医生的办公室。 这项研究的总体目标是评估一种创新的、可持续的初级保健实践改变干预措施，以预防幼儿肥胖。为了实现这一目标，我们将在哈佛先锋医疗协会的10个儿科实践中进行一项群集随机对照试验，该协会是马萨诸塞州东部的一个大型多地点团体实践，具有研究合作的记录。该试验将包括400名年龄在2-5岁之间的儿童，他们根据自己和父母的体重指数患有肥胖症的风险增加。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2年随访期间降低体重指数变化的程度。我们还将评估干预措施对特定肥胖相关行为的影响，其可行性和可接受性，以及其成本效益。干预措施的主要特点包括基于慢性护理模式的初级保健团队方法：临床医生提供的干预措施，以修改父母和儿童的行为，采用动机咨询，量身定制的准备改变：和外展到儿童保育设置作为一种强化策略。儿童的行为目标包括减少看电视/录像：减少儿童卧室的电视;减少含糖饮料和快餐的消费。 需要将临床环境中肥胖预防的潜在有效性与可行性和可持续性相结合。通过创新的方法，并通过扩展现有的儿童肥胖研究人员，行为改变和成本效益分析专家，以及大型多地点医疗集团实践的临床医生领导人之间的合作，该项目准备为儿童肥胖预防提供一个新的和可持续的范式。

DESCRIPTION (provided by applicant): The obesity epidemic has spared no age group, including our youngest children. Overweight in preschool age children is associated with cardiovascular risk factors and asthma, and predicts overweight later in childhood. In addition, behaviors related to dietary intake, physical activity, and inactivity are likely "encoded" at these early ages. One relatively understudied site for behavior change is the primary care clinician's office. The overall goal of this research is to assess an innovative, sustainable primary care practice change intervention to prevent obesity among young children. To achieve this goal, we will conduct a cluster-randomized controlled trial in 10 pediatric practices of Harvard Vanguard Medical Associates, a large multi-site group practice in eastern Massachusetts with a track record of research collaboration. The trial will include 400 children age 2-5 years at elevated risk of obesity based on their and their parents' body mass indexes. 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 2-year follow-up period. We will also assess the intervention's effect on specified obesity-related behaviors, its feasibility and acceptance, and its cost-effectiveness. Major features of the intervention include a primary care team approach based on the Chronic Care Model: a clinician-delivered intervention to modify behaviors of parents and children that employs motivational counseling, tailored to readiness to change: and outreach to child care settings as a reinforcing strategy. Behavioral goals for the children include reduction in TV/video viewing: fewer TVs in children's bedrooms: and reduction in sugar-sweetened beverage and fast food consumption. A need exists to combine the potential effectiveness of obesity prevention in the clinical setting with feasibility and sustainability. Through innovative methods and by extending existing collaborations among established childhood obesity researchers, experts in behavior change and cost-effectiveness analysis, and clinician-leaders of a large multi-site medical group practice, this project is poised to provide a new and sustainable paradigm for childhood obesity prevention in primary care.