Improving primary care to prevent childhood obesity

描述(申请人提供)：肥胖症的流行没有一个年龄段幸免，包括我们最小的孩子。学龄前儿童超重与心血管危险因素和哮喘有关，并预示着儿童后期超重。此外，与饮食摄入量、体力活动和不活动有关的行为很可能在这些早期年龄段被“编码”。初级保健临床医生办公室是一个研究相对较少的行为改变场所。这项研究的总体目标是评估一种创新的、可持续的初级保健做法改变干预措施，以预防幼儿肥胖。为了实现这一目标，我们将在哈佛先锋医疗协会的10个儿科诊所进行整群随机对照试验，这是一个位于马萨诸塞州东部的大型多站点团体诊所，有研究合作的记录。这项试验将包括400名2-5岁的儿童，根据他们和他们父母的身体质量指数，肥胖风险增加。主要目的是评估与通常的护理控制条件相比，干预在多大程度上减少了为期6个月的干预和2年随访期内体重指数的变化。我们还将评估干预措施对特定肥胖相关行为的影响、其可行性和接受性，以及其成本效益。干预措施的主要特点包括基于慢性护理模式的初级保健团队方法：临床医生提供的干预措施，以纠正父母和儿童的行为，采用激励咨询，为准备改变而量身定做：以及将外展到儿童护理环境作为强化策略。儿童的行为目标包括减少观看电视/视频：减少儿童卧室里的电视：减少含糖饮料和快餐的消费。需要将临床环境中预防肥胖的潜在有效性与可行性和可持续性结合起来。通过创新的方法，并通过扩大现有的儿童肥胖研究人员、行为改变和成本效益分析专家以及大型多地点医疗团体实践的临床医生领导者之间的现有合作，该项目有望为初级保健中的儿童肥胖预防提供一个新的和可持续的范例。

DESCRIPTION (provided by applicant): The obesity epidemic has spared no age group, including our youngest children. Overweight in preschool age children is associated with cardiovascular risk factors and asthma, and predicts overweight later in childhood. In addition, behaviors related to dietary intake, physical activity, and inactivity are likely "encoded" at these early ages. One relatively understudied site for behavior change is the primary care clinician's office. The overall goal of this research is to assess an innovative, sustainable primary care practice change intervention to prevent obesity among young children. To achieve this goal, we will conduct a cluster-randomized controlled trial in 10 pediatric practices of Harvard Vanguard Medical Associates, a large multi-site group practice in eastern Massachusetts with a track record of research collaboration. The trial will include 400 children age 2-5 years at elevated risk of obesity based on their and their parents' body mass indexes. The primary aim is to assess the extent to which the intervention, compared with the usual care control condition, reduces change in body mass index over a 6-month intervention and 2-year follow-up period. We will also assess the intervention's effect on specified obesity-related behaviors, its feasibility and acceptance, and its cost-effectiveness. Major features of the intervention include a primary care team approach based on the Chronic Care Model: a clinician-delivered intervention to modify behaviors of parents and children that employs motivational counseling, tailored to readiness to change: and outreach to child care settings as a reinforcing strategy. Behavioral goals for the children include reduction in TV/video viewing: fewer TVs in children's bedrooms: and reduction in sugar-sweetened beverage and fast food consumption. A need exists to combine the potential effectiveness of obesity prevention in the clinical setting with feasibility and sustainability. Through innovative methods and by extending existing collaborations among established childhood obesity researchers, experts in behavior change and cost-effectiveness analysis, and clinician-leaders of a large multi-site medical group practice, this project is poised to provide a new and sustainable paradigm for childhood obesity prevention in primary care.