Healthy Homes/Healthy Kids: Pediatric Primary Care-based Obesity Prevention

描述（由申请人提供）：基于儿科初级保健的肥胖预防肥胖是美国的头号营养问题。由于儿童承受着超重和肥胖带来的最大的终身健康风险，因此针对他们的干预措施具有高度优先地位。医疗保健系统是关于健康风险和风险预防行为的重要和可靠的信息来源，绝大多数儿童在小学早期就接触过初级保健药物。因此，基于初级保健的肥胖干预措施在人口外展方面特别有吸引力。本申请旨在测试简短的儿科医生咨询与电话辅导随访对儿童体重增加率的功效。该研究扩展了该团队先前在坚持，亲子互动，以及在儿科初级保健环境中治疗肥胖的提供者和基于电话的系统方面的工作。根据参考标准，BMI高于第75百分位数的符合5 - 9岁健康儿童访视条件的儿童将随机接受：（1）健康饮食和体力活动医生信息加电话指导;或（2）安全和伤害预防医生信息加电话指导。参与者将被跟踪两年。主要研究结局为BMI百分位数的变化。次要结果包括父母鼓励健康饮食和活动的行为，儿童身体活动水平，饮食摄入量，儿童心理社会调整和父母BMI的变化。我们还将衡量项目实施成本和完整性。假设健康饮食/PA组儿童的BMI百分位数增幅小于安全组儿童。进一步假设父母对治疗建议的依从性将与BMI百分位数随时间的降低相关。总体目标是证明在初级保健环境中针对儿童肥胖预防的低成本干预措施的有效性，并具有广泛传播的潜力。公共卫生相关性：这项随机临床试验将评估基于初级保健的肥胖预防干预措施的有效性，该干预措施将儿科初级保健提供者的咨询和针对5-9岁肥胖风险儿童父母的电话计划相结合。这项基于电话的计划将加强医生的信息，并帮助父母创造一个健康的家庭环境，以鼓励健康的饮食和活动模式，并在他们的孩子健康的体重增加。

DESCRIPTION (provided by applicant): Pediatric Primary Care Based Obesity Prevention Obesity is the number one nutritional problem in the US. Because children bear the greatest lifetime health risk from overweight and obesity, interventions targeting them are of high priority. The medical care system is an important and credible source of information about health risks and risk prevention behavior, and a large majority of children have contact with primary care medicine in the early elementary school years. Therefore, primary care based obesity interventions are particularly attractive in terms of population outreach. The present application aims to test the efficacy of brief pediatrician counseling with phone coaching follow up on rate of weight gain in children. The research extends prior work by this team on adherence, parent-child interaction, and provider and telephone based systems for treating obesity in the pediatric primary care setting. Children eligible for five through nine year well-child visits who are above the 75th percentile on BMI according to reference standards will be randomized to either: (1) Healthy Eating and Physical Activity physician message plus phone coaching; or (2) Safety and Injury Prevention physician message plus phone coaching. Participants will be followed for 2 years. The primary study outcome will be change in BMI percentile. Secondary outcomes include parental behaviors encouraging healthy eating and activity, child physical activity level, dietary intake, and child psychosocial adjustment and change in parent BMI. We will also measure program implementation cost and integrity. It is hypothesized that children in the Healthy Eating/PA group will show a smaller increase in BMI percentile relative to the children in the Safety group. It is further hypothesized that parent compliance with treatment recommendations will be associated with reductions in BMI percentile over time. The overall objective is to demonstrate the efficacy of a low-cost intervention targeting obesity prevention in children in a primary care setting with potential for widespread dissemination. PUBLIC HEALTH RELEVANCE: This randomized clinical trial will evaluate the efficacy of a primary care-based obesity prevention intervention that integrates counseling by pediatric primary care providers and a phone-based program for parents of 5-9 year old children at risk for obesity. The phone-based program will reinforce the physician message and help parents create a healthy home environment to encourage healthy eating and activity patterns and healthy weight gain in their children.