Choices: Family Physicians Treat Overweight Children

描述(由申请人提供)： 儿童肥胖问题已经成为全国性的流行病，少数族裔儿童的肥胖率甚至更高。医生和诊所没有为肥胖儿童提供足够的护理；对于为低收入和少数族裔人口提供服务的诊所来说，这个问题更加严重。团体办公室访问模式是一种管理慢性病的方法，符合诊所按服务收费的模式，并正越来越多地被用于向有共同需求的患者群体提供护理。我们建议使用团体办公室访问模式，在为墨西哥裔美国低收入患者提供高比例服务的诊所环境中，为性别特定群体中9-11岁的儿童及其父母提供肥胖治疗干预。对儿童的干预目标是减少看电视，减少含糖饮料，净减少份量，改善快餐选择(或减少快餐)，以及更多的一般体力活动。每个课程将包括自我监测、体力活动和认知/学习部分。父母将与他们的孩子一起学习，并将获得关于为什么这些家庭生活方式的改变将使所有家庭成员受益的信息。干预的认知基础是增强复原力，这对这个年龄段的成年人和儿童在各种环境下都是有效的。 本研究采用滞后干预设计，对40名儿童及其家长进行团体办公室访视干预。家庭将被随机分配到立即开始上课或等待六个月的课程。干预大约每周举行12次会议。所有儿童将在基线、3、6、9、12和15个月时进行测量；测量将包括体重和身高、通过电话召回的饮食和体力活动，以及认知变化的测量。年龄超过体重指数第90%的儿童将有资格参加，并且至少有一名父母或监护人定期参加。

DESCRIPTION (provided by applicant): The problem of childhood obesity has become a national epidemic, with even higher rates found among minority children. Physicians and clinics have not provided adequate care for obese children; this problem is even more acute for clinics serving lower income and minority populations. The group office visit model is an approach to managing chronic conditions which fits within the clinic fee-for-service model and is being used increasingly to deliver care to groups of patients with needs in common. We propose the use of the group office visit model to provide an obesity treatment intervention for children 9-11 years of age in gender specific groups and their parents in a clinic setting that serves a high proportion of Mexican American lower income patients. The targets of the intervention for the children are less TV viewing, less sweetened beverages, and net lower portion sizes, improved fast food choices (or less fast food), and more general physical activity. Each session will include self-monitoring, physical activity, and a cognitive/learning component. Parents will learn along with their children, and will gain information about why these family lifestyle changes will benefit all family members. The cognitive basis for the intervention is enhancing resiliency, shown to be effective for both adults and children in this age group across a variety of settings. This pilot study will develop and implement the group office visit intervention for 40 children and their parents in a lagged intervention design. Families will be randomly assigned to begin immediately or wait six months for the class. The intervention will have 12 approximately weekly sessions. All children will be measured at baseline, 3, 6, 9, 12, and 15 months; measurements will include weight and height, diet and physical activity by telephone recalls, and measures of cognitive change. Children will be eligible for participation who are above the 90th percentile of BMI for age, and who can have the regular participation of at least one parent or guardian.