Treating Childhood Obesity with Family Life Style Change

肥胖症是一个主要的公共卫生问题，相关的医疗保健费用估计每年超过980亿至1290亿美元。然而，很明显，肥胖的儿童在成年后患肥胖症的风险增加，并且在儿童时期开始的成年期肥胖症的严重程度要大得多。此外，甚至在成年之前，超重和肥胖儿童就已经经历了与超重状况有关的医疗和心理社会影响。 医学界现在认识到儿童肥胖是一种慢性疾病。治疗它是令人沮丧的和耗时的大多数医生。许多人认为缺乏专业知识或资源是回避解决患者超重或肥胖问题的原因。目前儿童肥胖症的识别、评估和治疗建议是基于专家共识，因为可推广的循证评估和治疗方法是有限的。这些指导方针强调父母和孩子的行为改变，这将导致健康的饮食和积极的生活方式。强调父母和孩子与临床医生的定期接触，但对治疗和维持体重减轻以及伴随着通过在初级保健环境中促进的健康生活方式改变而实现的体重减轻的积极健康益处所需的干预和随访的强度知之甚少。 为了回答这个问题，我们计划进行为期6个月的以家庭为中心的密集干预，然后是为期6个月的维持阶段，主要针对超重和肥胖儿童的父母，年龄在4至7岁，在初级保健提供者的办公室提供，将与初级保健提供者办公室提供的增强标准护理进行比较。初级保健中心将随机接受干预或加强护理标准。受试者将接受为期2年的随访。

DESCRIPTION (provided by applicant): Obesity is a major public health problem with associated health care costs estimated to be in excess of $98 billion to 129 billion per year. However, it is clear that fatter children have an increased risk of obesity in adulthood and the severity of obesity in adulthood when it begins in childhood is considerably greater. Furthermore, even before reaching adulthood, overweight and obese children are experiencing medical and psychosocial effects related to their overweight condition. The medical community now recognizes that childhood obesity represents a chronic disease. Treating it is frustrating and time consuming for most physicians. Many cite lack of expertise or resources as reasons for shying away from addressing their patients overweight or obesity problem. Current recommendations for the identification, evaluation, and treatment of childhood obesity are based on expert consensus since generalizable evidence-based approaches to evaluation and treatment are limited. These guidelines emphasize both parent and child behavioral changes that will result in healthy eating and an active lifestyle. Regular contact of parent and child with the clinician is emphasized, yet little is known about the intensity of intervention and follow-up that is required to treat and sustain both weight loss and the positive health benefits that accompany weight loss achieved through healthy lifestyle changes promoted in the primary care setting. In order to answer this question, we plan a 6-month intense family-centered intervention, followed by a 6-month maintenance phase, primarily directed at parents of overweight and obese children, ages 4 to 7 years, delivered at the primary care provider's office which will be compared to an enhanced standard of care that will be delivered at the primary care provider's office. Primary care sites will be randomized to receive either the intervention or the enhanced standard of care. Participants will be followed for a total of 2 years.