A Coordinated Parent/Child Dyad Weight Loss Intervention: Dyad Plus

青年超重和肥胖的流行正在成为全球健康问题， 通过促进改变生活方式治疗肥胖症的临床干预措施。青少年干预措施 在健康饮食和身体活动方面都有改善，体重只略有减轻 结果。因此，人们越来越感兴趣的是开发策略，以提高临床治疗的有效性。 干预措施，特别是针对肥胖率和辍学率最高的青少年的干预措施， 治疗针对家庭成员治疗青少年肥胖症可能是一种有效的方法，但坚持 家庭治疗可能是次优的，尽管研究表明，亲子干预可以更多 比主要针对儿童的治疗方案更有效。我们建议制定一个协调的 护理模式，并评估相对于标准护理的可行性、可接受性和有效性。 这项拟议中的研究将利用维克森林管理的两个成功的减肥计划 浸信会医疗中心：布伦纳家庭培训（布伦纳适合）和设计。Brenner FIT是一款 以家庭为基础的儿科体重管理诊所，由医生转介给2-18岁的青少年， 11 -14 By Design是一家成人（> 18岁）减肥诊所，包括量身定制的饮食和 身体活动行为咨询我们的初步数据表明，大多数参加的青少年 Brenner FIT至少有一名成年护理人员符合资格，并将从按设计入组中受益。 因此，我们建议制定一个协调方案（Dyad Plus），这将是一个理论上- 基于协调的方法，旨在促进自我监测、积极沟通、联合 解决问题和社会支持，以增加体力活动，健康饮食和减肥 相对于非协调方法或单独的Brenner FIT。我们将随机抽取45名父母/青少年 三种条件之一的二次组合（每种n=15）;仅Brenner FIT，二次组合中，子组和父组均 同时参加了适合年龄的计划，或Dyad Plus，其中儿童和父母都 同时注册，但有协调的组成部分。这项研究将实现以下目标： 具体目标1：为共同参加的青少年和成人肥胖症患者制定协调的干预措施， Brenner FIT和By Design减肥诊所。 具体目标2：在青少年/照顾者二人组中试行协调干预， 在应计、保留和遵守方面的干预。 具体目标3：确定与实施Dyad Plus相关的成本， 设计和Brenner FIT没有协调组件。 该提案意义重大，因为它解决了服务不足人群中紧迫的慢性病（肥胖症） （青少年），并将是第一个制定协调的青少年/成人减肥干预。

The prevalence of overweight and obesity in youth is emerging as a global health concern, necessitating clinical interventions to treat obesity through promotion of lifestyle modification. Interventions in adolescents have demonstrated improvements in healthy eating and physical activity, with only modest weight loss outcomes. As a result, there is growing interest in developing strategies to enhance effectiveness of clinical interventions, especially those targeting adolescents who have the highest rates of obesity and dropout from treatment. Targeting family members to treat obesity in youth can be an effective approach, but adherence to family treatment can be sub-optimal despite research suggesting that parent-child interventions can be more effective than treatment programs that focus primarily on the child. We propose to develop a coordinated care model and assess the feasibility, acceptability, and effectiveness relative to standard care. The proposed study will leverage two successful weight loss programs administered at the Wake Forest Baptist Medical Center: Brenner Families in Training (Brenner FIT) and By Design. Brenner FIT is a family-based pediatric weight management clinic for youth 2-18 years old referred by a physician for overweight or obesity.11-14 By Design is an adult (>18yrs) weight loss clinic that includes tailored dietary and physical activity behavioral counseling. Our preliminary data suggest that most adolescent youth who enroll in Brenner FIT have at least one adult caregiver who is eligible and would benefit from enrollment in By Design. Therefore, we propose the development of a coordinated program (Dyad Plus) that would be a theoretically- based, coordinated approach designed to facilitate self-monitoring, positive communication, joint problem solving, and social support to increase physical activity, healthy eating, and weight loss relative to a non-coordinated approach or Brenner FIT alone. We will randomize 45 parent/adolescent Dyads to one of three conditions (n=15 for each); Brenner FIT only, Dyad where the child and parent both enrolled simultaneously in the age appropriate program, or Dyad Plus where the child and parent both enrolled simultaneously, but with the coordinated component. The study will achieve the following aims: Specific Aim 1: Develop a coordinated intervention for adolescents and adults with obesity co-enrolled in the Brenner FIT and By Design weight loss clinics. Specific Aim 2: Pilot the coordinated intervention in adolescent/caregiver dyads to establish the feasibility of the intervention in terms of accrual, retention, and adherence.17 Specific Aim 3: Establish costs associated with the implementation of Dyad Plus relative to delivering By Design and Brenner FIT without the coordination component. The proposal is significant, as it addresses a pressing chronic disease (obesity) in an underserved population (adolescents) and would be the first to develop a coordinated adolescent/adult weight loss intervention.