Improving primary care to prevent childhood obesity

改善初级保健以预防儿童肥胖

• 批准号: 6988721
• 负责人: MATTHEW W GILLMAN
• 金额: $ 66.08万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-08-22 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6988721
• 关键词: behavior modification; behavioral /social science research tag; body composition; body height; body weight; child health care personnel; clinical research; clinical trials; comprehensive care; cost effectiveness; counseling; disease /disorder prevention /control; health behavior; health care quality; health surveys; human subject; human therapy evaluation; longitudinal human study; motivation; nutrition related tag; obesity; patient oriented research; pediatrics; physicians; preschool child (1-5); television

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.

描述（由申请人提供）：肥胖流行影响到所有年龄段，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、体力活动和不活动相关的行为可能是在这些早期阶段“编码”的。 初级保健临床医生办公室是一个相对未被充分研究的行为改变场所。 这项研究的总体目标是评估一种创新的、可持续的初级保健实践改变干预措施，以预防幼儿肥胖。为了实现这一目标，我们将在哈佛先锋医学协会 (Harvard Vanguard Medical Associates) 的 10 个儿科诊所进行整群随机对照试验，该协会是马萨诸塞州东部的一家大型多地点团体诊所，拥有研究合作的良好记录。该试验将包括 400 名 2 至 5 岁的儿童，根据他们及其父母的体重指数，肥胖风险较高。主要目的是评估与常规护理控制条件相比，干预措施在 6 个月干预和 2 年随访期间减少体重指数变化的程度。我们还将评估干预措施对特定肥胖相关行为的影响、其可行性和接受度以及成本效益。干预措施的主要特点包括基于慢性护理模式的初级护理团队方法：临床医生提供的干预措施，采用动机咨询来改变父母和儿童的行为，专为改变做好准备而设计：以及向儿童保育机构进行推广，作为强化措施战略。儿童的行为目标包括减少电视/视频观看：减少儿童卧室中的电视；以及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。通过创新方法，并扩展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站点医疗集团实践的临床医生领导者之间的现有合作，该项目有望为儿童肥胖症提供新的可持续范例。初级保健中的儿童肥胖预防。