Pediatric Practice-based Obesity Intervention to Support Families: FITLINE

项目总结/摘要 美国儿科学会（AAP）建议采用分阶段的方法来管理儿科疾病。 超重和肥胖，从第一阶段开始，预防加，鼓励家庭改善生活方式 与饮食和活动有关的选择，以改善BMI状态。大多数儿科实践都很难 然而，实施这些指南，由于有限的时间和获得减肥专家，他们 可以转介他们的病人和家庭，并负担家庭在获得面对面的减肥服务。在 作为回应，我们的团队开发了FITLINE儿科实践为基础的转诊计划，提供实践 一个容易获得的资源，以帮助家庭作出AAP建议的生活方式的改变。程序 包括两个组成部分：（1）基于Let's Go 5-2-1-0的儿科实践部分 干预涉及评估和记录BMI的系统，健康习惯筛选器和简要提供者- 提供干预，转介到FITLINE咨询计划，以及FITLINE的反馈 营养师;（2）家长支持部分，包括每周8次的FITLINE电话咨询 由位于中心的营养师打电话给父母，为他们提供针对家庭独特需求的指导， 文化，以帮助他们设定目标，并作出有针对性的生活方式的变化，建议AAP的第一阶段， 预防附加方案，并附有家长手册。拟议的五年随机对照 一项基于儿科实践的试验将比较两种基于实践的干预措施在改善 饮食和体力活动以及降低超重和肥胖的8-12奥尔兹儿童的BMI 实践：（1）PP-FITLINE，包括儿科实践为基础的组成部分加上FITLINE咨询， 小册子，或（2）PP材料，由相同的实践为基础的组成部分，但只有母材料 邮寄超过8周，没有转介到FITLINE咨询。16个儿科初级保健实践将是 随机分配至PP-FITLINE（N=8）或PP-Mailings（N=8）条件。五百一十二 父母及其8-12岁的儿童，体重指数（BMI）>第85百分位数（超重或肥胖） 将从实践中招募，以在12个月随访时达到N=400。将完成评估 基线时以及基线后6个月和12个月。本研究的具体目的是确定 PP-FITLINE计划在降低超重和肥胖儿童BMI以及改善 儿童的饮食和身体活动行为;探索PP-FITLINE效果的可能机制 计划的BMI，饮食和体力活动;并估计成本效益的PP-FITLINE比较 PP邮件计划。如果PP-FITLINE计划被认为是有效和具有成本效益的， 一个创新的模式，可以扩大规模，广泛实施第一阶段，预防加， AAP专家委员会的建议通过全国儿科实践， 在儿科实践中制定体重管理护理的新标准。

Project Summary/Abstract The American Academy of Pediatrics (AAP) recommends a staged approach to the management of pediatric overweight and obesity, starting with Stage 1, Prevention Plus, which encourages families to improve lifestyle choices related to eating and activity in order to improve BMI status. Most pediatric practices have difficulty implementing these guidelines, however, due to limited time and access to weight loss experts to whom they can refer their patients and families, and burden to families in accessing in-person weight loss services. In response, our team developed the FITLINE pediatric practice-based referral program which provides practices an easily accessible resource to help families make AAP-recommended lifestyle changes. The program includes two components: (1) a pediatric practice-based component based on the Let's Go 5-2-1-0 intervention involving systems to assess and document BMI, a healthy habits screener and brief provider- delivered intervention, referral to the FITLINE counseling program, and feedback from the FITLINE nutritionist; and (2) a parent support component consisting of eight weekly FITLINE telephone counseling calls by centrally located nutritionists to provide parents coaching tailored to their family's unique needs and culture to help them set goals and make targeted lifestyle changes recommended by the AAP for Stage 1, Prevention Plus, accompanied by a parent booklet. The proposed five-year cluster randomized controlled pediatric practice-based trial will compare the effectiveness of two practice-based interventions on improving diet and physical activity and reducing BMI among overweight and obese 8-12 year olds seen in pediatric practice: (1) PP-FITLINE, consisting of the pediatric practice-based component plus FITLINE counseling and booklet, or (2) PP-Materials, consisting of the same practice-based component, but only the parent materials mailed over 8 weeks, with no referral to FITLINE counseling. Sixteen pediatric primary care practices will be randomized to either the PP-FITLINE (N=8) or the PP-Mailings (N=8) condition. Five hundred and twelve parents and their children ages 8-12 with a body mass index (BMI) of > 85th percentile (overweight or obese) will be recruited from the practices to achieve N=400 at 12 month follow-up. Assessments will be completed at baseline and 6- and 12-months post-baseline. The specific aims of this study are to determine the effectiveness of the PP-FITLINE program in reducing BMI in overweight and obese children and improving the child's diet and physical activity behaviors; explore possible mechanisms of the effect of the PP-FITLINE program on BMI, diet and physical activity; and estimate the cost-effectiveness of the PP-FITLINE compared with the PP-Mailing program. If found to be effective and cost-effective, the PP-FITLINE program will provide an innovative model which can be scaled up for widespread implementation of Stage 1, Prevention Plus of the AAP expert committee recommendations through pediatric practices nationwide, contributing significantly to the development of new standards for weight management care in pediatric practice.