Web-Based Family Intervention for Pediatric Obesity

描述（申请人提供）：儿童超重和肥胖的患病率非常高，发病率呈上升趋势，特别是少数民族儿童。儿童期肥胖与青春期和成年期持续肥胖的高风险相关。这对公共健康具有重大意义，因为肥胖会增加患2型糖尿病和心血管疾病的风险。经验验证的干预措施可用于治疗儿童肥胖。然而，治疗的主要障碍之一是获得有效的治疗方案；因此，大多数超重儿童没有接受正式的以家庭为基础的行为体重控制干预。应对儿童肥胖流行的一个关键问题是如何为超重儿童提供有效的治疗。儿科医生对这一重要问题的日益关注为提供更有效的干预提供了机会。健康保险公司是儿童肥胖流行的另一个关键利益相关者，因为有效的治疗将最终减少与肥胖相关的医疗支出。我们设想一个系统，在这个系统中，儿科医生将超重儿童识别为常规初级保健的一部分，然后将家庭转介到一个网站，旨在提高他们对肥胖问题的认识，并增加他们通过养成健康的饮食和体育活动习惯来改变生活方式以减少肥胖的动力。随着时间的推移，儿童和家长将访问该网站，系统将生成使用情况报告，以及自我报告的健康行为和体重变化，并以电子方式发送给转诊的儿科医生。在我们的第一阶段研究中，我们开发了一个创新的网络项目来支持儿科减肥，基于那些在肥胖儿童的临床研究中显示有效的原则，以及来自超重儿童、他们的父母和儿科医生的焦点小组的输入。在一个月的试验中，我们发现经常使用该网站的儿童的身体质量指数显著下降，健康行为和体重控制的自我效能得到改善。在第二阶段，我们将与科罗拉多州丹佛市的Klein Buendel合作，修改和调整原型版本，以开发用于初级保健儿科环境和家庭环境的完整干预计划。Klein Buendel是使用技术促进健康的领导者。基于证据的项目将建立在与第一阶段的原型相同的格式上，包括家庭体重控制干预中的所有概念、技能和模块，但增加了视频组件和互动游戏。我们将进行为期六个月的随机对照试验，以确定使用该程序对BMI、健康行为、动机和生活质量的影响。然后，我们将开发交互式网络项目的最终版本，以便向健康保险公司和儿科医生推销。

DESCRIPTION (provided by applicant): The prevalence of overweight and obesity in children is very high and the incidence is increasing, especially among ethnic minority children. Obesity in childhood is associated with a high risk of continued obesity into adolescence and adulthood. This is of great public health significance because obesity increases risk for the development of type 2 diabetes and cardiovascular disease. Empirically validated interventions are available for the treatment of pediatric obesity. However, one of the major barriers to treatment is access to effective treatment programs; therefore, most overweight children do not receive formal family-based behavioral weight control intervention. A key issue in dealing with the epidemic of pediatric obesity is how to provide effective treatment to the population of overweight children. Pediatricians' increased attention to this significant issue affords an opportunity for providing greater access to effective intervention. Health insurance companies are another key stakeholder in the pediatric obesity epidemic, as effective treatment will ultimately reduce health care expenditures related to obesity over time. We envision a system in which pediatricians identify overweight children as part of routine primary care, and then refer families to a web site designed to increase their awareness of the problem of obesity, as well as increase their motivation to engage in lifestyle change to reduce obesity through the development of healthful dietary and physical activity habits. The web site will be accessed by children and parents over time and the system will generate reports on usage, as well as self- reported health behaviors and weight changes to be sent electronically to the referring pediatricians. In our Phase I research, we developed an innovative web program to support pediatric weight loss, based on those principles shown to be effective in clinical research studies of obese children, as well as input from focus groups of overweight children, their parents, and pediatricians. In a one month trial, we found that children who utilized the web site frequently had significant reductions in BMI and improvements in health behaviors and self-efficacy for weight control. During Phase II we will work with Klein Buendel of Denver, CO, to modify and adapt the prototype version to develop the complete intervention program for use in the primary care pediatric setting and home environment. Klein Buendel is a leader in the use of technology for health promotion. The evidence-based program will build upon the same format as the prototype from Phase I with all of the concepts, skills, and modules included in the family weight control intervention, but with additional video components and interactive games. We will conduct a six-month randomized controlled trial to determine the effects of using the program on BMI, health behaviors, motivation, and quality of life. We will then develop final versions of the interactive web-based program for marketability to health insurance companies and pediatricians. PUBLIC HEALTH RELEVANCE: Childhood obesity is very prevalent and of great public health significance. Evidence-based interventions are available to treat obesity in children, yet most children do not receive such interventions. The proposed research will finalize development of an innovative web-based family intervention program that links children and parents to pediatricians, and tests its efficacy in a six-month randomized controlled trial.