Childhood obesity treatment targeting specific behaviors

描述(由申请者提供)：美国正处于肥胖症流行之中，影响着年幼的儿童。儿科初级保健环境是解决这一问题的理想场所，因为大多数家庭经常与儿科医生接触，儿童的健康状况在这一环境中得到定期评估。一个儿童问题专家委员会提出了在初级保健环境中治疗体重指数超过第85个百分位数的儿童的建议。需要符合委员会建议的计划，其中包括：1)尽可能年轻地开始治疗；2)以家庭为重点，父母是治疗的主要改变剂；3)使用行为矫正技术来改变饮食和活动行为；4)一次在饮食和活动中做出2到3个非常具体的改变。因此，此R21应用程序的目标是开发、实施和评估符合委员会建议并可在初级保健环境中实施的为期6个月的儿童肥胖行为干预。该项目的第二个目标是确定哪些饮食和活动行为应该成为干预的目标。由儿科医生评估和推荐的135名4至8岁体重指数为85百分位数的儿童将随机分为三种情况之一：1)时事通讯情况；2)增加体力活动(60分钟/天)和减少含糖饮料摄入量(&lt；3份/周)(传统)的行为养育计划；或3)减少看电视(&lt；2小时/天)并增加低脂牛奶摄入量(2份/天)(替代品)的行为养育计划。对体重、身高和标准化BMI(z-BMI)的跟踪评估将在3、6、9和12个月进行，z-BMI是主要的因变量。儿科医生将在评估后向家庭提供关于体重和身高状况的后续信件。这项试点研究使我们能够确定儿科肥胖干预的可行性和有效性，这种干预优化了儿科医生的角色，并满足了委员会在初级保健环境中进行治疗的建议。此外，通过比较针对传统行为或替代行为的效果，将获得数据，用于对这两种方法对长期减肥的影响进行全面试验的能量分析。

DESCRIPTION (provided by applicant): The US is in the midst of an obesity epidemic, affecting young children. The pediatric primary care setting is an ideal place to address this problem since most families have frequent contact with their pediatrician and a child's health status is regularly assessed in this setting. Recommendations for treating children with a body mass index (BMI) over the 85th percentile in the primary care setting have been developed by an Expert Committee on childhood. Programs are needed that meet the recommendations from the Committee, which include: 1) beginning treatment as young as possible; 2) focusing on the family, with the parent being the primary change agent for treatment; 3) using behavior modification techniques to change eating and activity behaviors; and 4) making 2 or 3 very specific changes in diet and activity at one time. Thus, the aim of this R21 application is to develop, implement, and evaluate a 6-month behavioral childhood obesity intervention that meets the Committee's recommendations and can be implemented in a primary care setting. A second aim of this project is to determine which eating and activity behaviors should be targeted in the intervention. One hundred thirty-five children, aged 4 to 8 years with a BMI > 85th percentile, assessed and referred by their pediatricians, will be randomized to one of three conditions: 1) a newsletter condition; 2) a Behavioral Parenting Program that increases physical activity (60 min/day) and decreases sweetened drink consumption (< 3 servings/week) (Traditional); or 3) a Behavioral Parenting Program that reduces TV watching (< 2 hours/day) and increases low-fat milk consumption (2 servings/day) (Substitutes). Follow-up assessments on weight, height, and standardized BMI (z-BMI), the primary dependent variable, will be conducted at 3, 6, 9, and 12 months. Pediatricians will provide follow-up letters to families, regarding weight and height status, following the assessments. This pilot study allows us to determine the feasibility and efficacy of a pediatric obesity intervention that optimizes the role of the pediatrician and meets the Committee's recommendations for treatment in a primary care setting. Moreover, by comparing the effects of targeting the traditional or substitute behaviors, data will be obtained for a power analysis for a full-scale trial of the effects of these two approaches on long-term weight loss.