Primary Care Treatment for Overweight Adolescent Females

描述（由申请人提供）：在过去的二十年中，超重或肥胖的青少年比例几乎增加了两倍，从5%。到14%。尽管相当多的研究集中在成年人的体重控制上，越来越多的研究针对儿童肥胖，但青少年的治疗还没有得到充分的研究。我们将研究以初级保健为基础的多组分生活方式干预对超重青少年女性及其家庭的临床疗效和增量成本效益。参与者将是250名年龄在13-15岁之间的女性，体重指数（kg/m2）在2000年全国标准的第95到99个百分位数之间。参与者将被随机分配到多组分、基于行为的体重控制干预或常规护理控制条件。干预措施将根据性别和发育阶段进行调整，并将包括青少年儿科医生的协调反馈和持续咨询。此外，干预将包括青少年小组会议，家长小组会议，以及与辅导员的后续电话联系。该试验研究了生活方式改变（饮食和活动的改变）对体重和相关发病率的影响，重点是能量平衡。我们干预的活动部分包括以瑜伽为基础的成分，以无威胁的方式促进超重青少年的身体意识。所有参与者的随访数据收集将在随机分组后的6、12和24个月进行。主要的结果测量将是BMI z分数的变化。次要结局包括身体活动、饮食摄入、抑郁、饮食失调、选定的生理和心理指标以及医疗保健利用成本的变化。该应用程序提供了现有青少年肥胖研究的以下新进展：A)该干预措施是根据青春期女性的特殊需求进行发展调整的，b)它扩大了干预措施的范围，在适当的情况下包括对情绪调节和饮食失调的关注，c)这种多成分包括儿科医生、小组会议和个人电话联系，d)它充分利用了综合健康计划中初级保健环境的独特特点，d)儿科医生长期参与干预。符合慢性病护理模式

DESCRIPTION (provided by applicant): In the past two decades, the percentage of adolescents who are overweight or obese has almost tripled, from 5.to 14%. Although considerable research has focused on adult-weight control, and a growing body of research examines childhood obesity, treatments for adolescents have not been adequately studied. We will examine the clinical efficacy and incremental cost-effectiveness of a primary care-based, multi-component lifestyle intervention for overweight adolescent females and their families. Participants will be 250 females aged 13-15 with a body mass index (kg/m2) between the 95th and 99th percentile for the year 2000 national norms. Participants will be randomly assigned to a multi-component, behaviorally-based, weight control intervention or a usual care control condition. The intervention will be tailored for gender and developmental stage, and will include coordinated feedback and ongoing counseling from the adolescent's pediatrician. In addition, the intervention will include group meetings for teens, group meetings for parents, and follow-up telephone contacts with counselors. The trial examines the impact of lifestyle modification (changes in eating and activity) on weight and associated morbidity, with an emphasis on energy balance. The activity portion of our intervention includes a yoga-based component to promote body awareness in a no threatening manner for overweight adolescents. Follow-up data collection for all participants will be conducted at 6, 12, and 24 months following randomization. The primary outcome measure will be change in BMI z scores. Secondary outcomes include changes in physical activity, dietary intake, depression, disordered eating, selected physiological and psychological measures, and cost of medical care utilization. This application provides the following novel advances of existing youth obesity research: a) the intervention is developmentally adapted for the specific needs of adolescent females, b) it extends the reach of the intervention to include a focus on mood regulation and disordered eating, where appropriate, c) this multi-component includes pediatricians, group meetings, and individual telephone contacts, d) it fully utilizes the unique features of a primary care setting in an integrated health plan, and d) the pediatrician has an enduring involvement in the intervention, consistent with the chronic disease model of care