Pediatric Practice-based Obesity Intervention to Support Families: FITLINE

项目摘要/摘要 美国儿科学会(AAP)建议采用分阶段的方法来管理儿科 超重和肥胖，从第一阶段开始，预防加，鼓励家庭改善生活方式 与饮食和活动相关的选择，以改善BMI状态。大多数儿科实践都有困难 然而，由于时间和与他们联系的减肥专家的接触有限，执行这些指南 可以转介他们的患者和家人，并在获得面对面减肥服务方面给家人带来负担。在……里面 作为回应，我们的团队开发了FITLINE基于儿科实践的转诊计划，提供实践 一个易于访问的资源，帮助家庭做出AAP推荐的生活方式改变。该计划 包括两个组成部分：(1)以5-2-1-0为基础的基于儿科实践的组成部分 干预涉及评估和记录BMI的系统，健康习惯筛查和简报提供者- 提供干预，转介到FITLINE咨询计划，以及FITLINE的反馈 营养师；和(2)家长支持部分，包括每周八次的FITLINE电话咨询 位于中心位置的营养师呼吁为父母提供量身定做的指导，以满足他们家庭的独特需求和 文化，帮助他们设定目标，并根据AAP为第一阶段建议的有针对性的生活方式改变， 《预防与补充》，并附有家长小册子。建议的五年整群随机对照 基于实践的儿科试验将比较两种基于实践的干预措施在改善 8-12岁超重和肥胖儿童的饮食和体力活动与降低BMI 实践：(1)PP-FITLINE，由以儿科实践为基础的部分加上FITLINE咨询和 小册子，或(2)PP材料，由相同的基于实践的组件组成，但仅包含母材料 邮寄了超过8周，没有转介到FITLINE咨询。16个儿科初级保健实践将是 随机到PP-FITLINE(N=8)或PP-Mailings(N=8)条件。512 体重指数(BMI)为85百分位数(超重或肥胖)的8-12岁父母及其子女 将从实践中招聘，以在12个月的后续行动中达到N=400。评估将完成 在基线和基线后6个月和12个月。这项研究的具体目的是确定 PP-FITLINE计划降低超重和肥胖儿童BMI的效果及改善 儿童的饮食和体力活动行为；探索PP-FITLINE影响的可能机制 关于体重指数、饮食和体力活动的计划；并评估PP-FITLINE的成本效益 使用PP邮件程序。如果发现有效且成本效益高，PP-FITLINE计划将提供 一种可扩大的创新模式，可广泛实施第一阶段，预防加 AAP专家委员会在全国范围内通过儿科实践提出建议，做出了重大贡献 制定儿科实践中体重管理护理的新标准。

Project Summary/Abstract The American Academy of Pediatrics (AAP) recommends a staged approach to the management of pediatric overweight and obesity, starting with Stage 1, Prevention Plus, which encourages families to improve lifestyle choices related to eating and activity in order to improve BMI status. Most pediatric practices have difficulty implementing these guidelines, however, due to limited time and access to weight loss experts to whom they can refer their patients and families, and burden to families in accessing in-person weight loss services. In response, our team developed the FITLINE pediatric practice-based referral program which provides practices an easily accessible resource to help families make AAP-recommended lifestyle changes. The program includes two components: (1) a pediatric practice-based component based on the Let's Go 5-2-1-0 intervention involving systems to assess and document BMI, a healthy habits screener and brief provider- delivered intervention, referral to the FITLINE counseling program, and feedback from the FITLINE nutritionist; and (2) a parent support component consisting of eight weekly FITLINE telephone counseling calls by centrally located nutritionists to provide parents coaching tailored to their family's unique needs and culture to help them set goals and make targeted lifestyle changes recommended by the AAP for Stage 1, Prevention Plus, accompanied by a parent booklet. The proposed five-year cluster randomized controlled pediatric practice-based trial will compare the effectiveness of two practice-based interventions on improving diet and physical activity and reducing BMI among overweight and obese 8-12 year olds seen in pediatric practice: (1) PP-FITLINE, consisting of the pediatric practice-based component plus FITLINE counseling and booklet, or (2) PP-Materials, consisting of the same practice-based component, but only the parent materials mailed over 8 weeks, with no referral to FITLINE counseling. Sixteen pediatric primary care practices will be randomized to either the PP-FITLINE (N=8) or the PP-Mailings (N=8) condition. Five hundred and twelve parents and their children ages 8-12 with a body mass index (BMI) of > 85th percentile (overweight or obese) will be recruited from the practices to achieve N=400 at 12 month follow-up. Assessments will be completed at baseline and 6- and 12-months post-baseline. The specific aims of this study are to determine the effectiveness of the PP-FITLINE program in reducing BMI in overweight and obese children and improving the child's diet and physical activity behaviors; explore possible mechanisms of the effect of the PP-FITLINE program on BMI, diet and physical activity; and estimate the cost-effectiveness of the PP-FITLINE compared with the PP-Mailing program. If found to be effective and cost-effective, the PP-FITLINE program will provide an innovative model which can be scaled up for widespread implementation of Stage 1, Prevention Plus of the AAP expert committee recommendations through pediatric practices nationwide, contributing significantly to the development of new standards for weight management care in pediatric practice.