Pain and Weight Treatment: Development and Trial of PAW

摘要 儿童肥胖是美国的一大公共健康危机，影响了16.9%的2-19岁和 20.5%的12-19岁青年。虽然目前以家庭为基础的干预措施在降低体重指数方面是有效的 青少年体重指数(BMI)；大多数青少年在两年内恢复超重。此外，还有 体重管理项目的辍学率很高，27%到73%的家庭没有完成全部体重管理 治疗方案。影响儿童体重管理结果的一个可能机制是慢性疼痛。 尽管慢性疼痛影响了25%到46%的年轻人，但在肥胖的年轻人中，患病率超过 70%。疼痛和肥胖之间的因果关系还没有被很好地理解。在某些情况下，慢性疼痛可能 通过限制年轻人的活动或改变他们的饮食习惯，成为导致年轻人肥胖的诱因。一个 更常见的情况是，肥胖会给身体带来机械压力，从而导致疼痛。要么 这一机制可能会影响青少年参与体重管理计划。然而，干预措施 解决青少年慢性疼痛和肥胖之间的关系是必要的，但没有这样的关系 干预是存在的。我们希望共同治疗这些疾病--肥胖和疼痛--而不仅仅是治疗 肥胖，将导致改善儿科体重管理结果。建议的研究将在 康涅狄格州儿童医学中心(CCMC)的儿童肥胖中心，作为我们Fit5计划的附属项目。 Fit5是CCMC以家庭为基础的团体体重管理治疗计划，面向10岁以下的青少年- 18.这个多学科项目由13个课程组成，重点是行为改变、营养教育 以及认知行为疗法(CBT)框架内的体力活动。简短的4节课辅导性CBT 干预，疼痛和体重治疗(PAW)，将在一组进入体重管理的年轻人中进行试验 治疗和代言肌肉骨骼疼痛。这将分三个阶段进行。首先，将举行专题小组讨论 审查已经为这项研究创建的PAW课程。在第二阶段，一个小规模的随机 将对飞行员PAW进行对照试验(RCT)(n=25)。最后，通过离职面试获得 与纯信息对照相比，关于PAW的初步可行性、可接受性和保留数据 将对疼痛和肥胖症患者进行病情评估。仍有许多工作要做 改善青少年肥胖症的治疗。这项研究的发现将大大推进一系列研究。 需要更好地了解青少年肥胖症的结果和治疗方法 将肥胖症作为一种独立的疾病来对待，而不是将其放在可能 成为参与度、忠诚度和结果的重要决定因素。通过该R21获得的试点数据 赠款提案将用于修改干预措施并寻求R01资金，以支持大规模RCT 爪子。

Abstract Childhood obesity is a major public health crisis in the United States, affecting 16.9% of youth aged 2-19 and 20.5% of youth aged 12-19. While current family-based interventions are effective in reducing body mass index (BMI) in adolescents; the majority of adolescents regain their excess weight within 2 years. In addition, there is a high rate of drop out from weight management programs, with 27% to 73% of families not completing the full treatment protocol. One possible mechanism influencing pediatric weight management outcomes is chronic pain. Although chronic pain affects 25 to 46% of all youth, among youth with obesity, the prevalence is upwards of 70%. The causal relationship between pain and obesity is not well understood. In some cases, chronic pain may be a precipitant that causes youth to develop obesity by limiting their activities or altering their eating habits. A more common scenario is that obesity places mechanical stresses on the body that can cause pain. Either mechanism may impact youth’s participation in a weight management program. However, interventions that address the relationship between chronic pain and obesity in youth are needed, yet no such interventions exist. We expect that co-treating these conditions –obesity and pain- rather than treating just the obesity, will lead to improved pediatric weight management outcomes. The proposed study will take place at the Pediatric Obesity Center at Connecticut Children’s Medical Center (CCMC), as an adjunct to our Fit5 program. Fit5 is CCMC’s family-based, group weight management treatment program for youth between the ages of 10- 18. Consisting of 13 sessions, this multidisciplinary program focuses on behavior changes, nutrition education and physical activity within a cognitive behavioral therapy (CBT) framework. A brief 4 session adjunctive CBT intervention, Pain and Weight treatment (PAW), will be trialed in a group of youth entering weight management treatment and endorsing musculoskeletal pain. This will be done in three phases. First a focus group will be held to review the PAW curriculum which has already been created for this study. In phase two, a small randomized (n = 25 per condition) controlled trial (RCT) will be conducted to pilot PAW. Finally, exit interviews to obtain preliminary feasibility, acceptability and retention data on PAW as compared to an information only control condition for patients with pain and obesity will be conducted. There is much work that continues to be needed to improve treatment for youth with obesity. The findings of this study will advance a line of research much needed to better understand outcomes and treatment for adolescents with obesity by shifting from focusing on obesity as an independent condition, and instead, treating it in the context of its comorbid conditions that may be important determinants of engagement, adherence, and outcomes. The pilot data obtained through this R21 grant proposal will be used to modify the intervention and to seek R01 funding to support a large scale RCT of PAW.