Peer Counseling in Family-Based Pediatric Overweight Treatment

描述（由申请人提供）：儿童肥胖症在美国非常普遍。针对年龄较小的超重儿童（6-12岁）的基于家庭的行为体重控制治疗已经确立了疗效，治疗后体重状况持续改善长达10年。美国预防服务工作组最近的建议是，需要中等强度到高强度的干预（>25个接触小时）来帮助超重儿童实现和维持更好的体重控制。然而，大多数健康保险覆盖范围明确禁止超重/肥胖治疗服务或限制提供者服务远远低于推荐水平（例如，每年最多4次营养检查），使得难以维持治疗方案。仅在美国，超重儿童的数量就远远超过了专业人员的治疗能力，约为三分之一。需要一种新的模式来提供以家庭为基础的儿科超重治疗，以降低成本，但维持短期和长期疗效。一个可能的机会，将在目前的建议中发展和初步测试，是一个同伴干预模式，在这个模式中，接受专业提供的干预的家庭随后向其他家庭提供干预。该提案还研究了同伴干预者通过向他人提供干预来继续参与饮食和体育活动的行为改变是否会提高他们自己的长期效力。建议的项目开始于专业干预人员提供基于家庭的行为体重控制治疗超重儿童及其父母（第一代家庭; n=28）的循证方法。在接受治疗后，一半的第一代家庭将被随机分配为其他超重儿童和父母的同伴干预者（第二代家庭; n=28）。其余的第一代家庭既不接受也不提供任何额外的治疗。本计画旨在发展同侪介入训练与实施，并探讨同侪介入在整个介入过程中的可行性与可接受性。该项目还旨在估计同伴干预（接受和提供）对儿童和父母体重结果的影响，并在接受治疗结束时和6个月后进行评估。该R21应用程序开发并开始评估基于家庭的行为儿科超重治疗的创新交付策略，未来有可能进行综合试验，以检查长期体重控制疗效，成本效益和传播。 公共卫生相关性：在美国，近三分之一的儿童超重或肥胖，需要采取干预措施来减少儿童超重/肥胖对身体和心理社会的直接和长期负面影响。有效的以家庭为基础的儿童超重行为干预是存在的，但目前成本太高，而且不容易获得。以同伴为基础提供这种干预措施有可能降低成本，增加覆盖面，但这种新的方法需要开发，并评估可行性，可接受性和初步疗效。

DESCRIPTION (provided by applicant): Childhood obesity is highly prevalent in the U.S. Family-based behavioral weight control treatment for younger overweight children (6-12 years old) has established efficacy, with sustained weight status improvements up to 10 years after treatment. Recent recommendations of the U.S. Preventive Services Task Force are that moderate- to high-intensity interventions (>25 contact hours) are needed to help overweight children achieve and sustain better weight control. However, the majority of health insurance coverage specifically disallows overweight/obesity treatment services or limits provider services far below recommended levels (e.g., up to 4 annual nutrition visits), making it difficult to sustai treatment programs. There are also considerably more overweight children in the U.S. alone, ~1 in 3 children, than professionals could possibly treat. A new model of delivering family-based pediatric overweight treatment that decreases costs, but sustains short- and long-term efficacy, is needed. One possible opportunity, to be developed and initially tested in the current proposal, is a peer intervention model in which families receiving professionally-delivered intervention subsequently provide intervention to other families. The proposal also examines whether peer interventionists' continued engagement in behavior change around eating and physical activity through providing intervention to others improves their own long-term efficacy. The proposed project begins with the evidence-based approach of professional interventionists delivering family-based behavioral weight control treatment to overweight children and their parent(s) (1st generation families; n=28). After receiving treatment, half of 1st generation families will be randomly assigned to serve as peer interventionists to other overweight children and parents (2nd generation families; n=28). The remaining 1st generation families will neither receive nor provide any additional treatment. This project aims to develop peer intervention training and delivery and to examine the feasibility and acceptability of the peer intervention delivery throughout the intervention. This project also aims to derive an estimate of the impact of peer intervention (receiving and providing) on child and parent weight outcomes, with assessments at the end of receiving treatment and 6 months later. This R21 application develops and begins to evaluate an innovative delivery strategy for family-based behavioral pediatric overweight treatment, with the potential for future comprehensive trials to examine longer term weight control efficacy, cost effectiveness, and dissemination. PUBLIC HEALTH RELEVANCE: Nearly 1 in 3 children in the U.S. is overweight or obese and interventions are needed to decrease the immediate and long-term negative physical and psychosocial consequences of childhood overweight/obesity. Efficacious family-based behavioral interventions for pediatric overweight exist, but are currently too costly and not readily available. Peer-based delivery of this intervention has the potential to reduce costs and increase reach, but this novel approach requires development, and evaluation of feasibility, acceptability, and initial efficacy.