Primary Care Obesity Prevention: One or Multiple Targets

初级保健肥胖预防：一个或多个目标

• 批准号: 6987998
• 负责人: NICOLAS STETTLER-DAVIS
• 金额: $ 81.86万
• 依托单位: CHILDREN'S HOSP OF PHILADELPHIA
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-23 至 2010-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6987998
• 关键词: attitude; behavior modification; behavioral /social science research tag; body composition; clinical research; clinical trials; data collection methodology /evaluation; disease /disorder prevention /control; focus groups; health behavior; health care professional practice; health economics; longitudinal human study; managed care; middle childhood (6-11); nutrient intake activity; nutrition education; nutrition related tag; obesity; outcomes research; pediatrics; primary care physician; weight control

DESCRIPTION (provided by applicant): Primary care is a promising setting for childhood obesity prevention, in addition to other settings, such as the family, schools, and the community. Unfortunately, most pediatric primary care providers are not trained to deliver behavior modification interventions and, according to our preliminary data, are less likely to address obesity prevention when they perceive insufficient time during well-care visits. In response to this RFA, we propose a controlled trial of obesity prevention, with group randomization at the practice level, of two standardized 12-month intervention strategies, based on the Behavioral Economics theory, and delivered by primary care providers after training in behavior modification. The first strategy will target change in multiple behaviors, while the other will target one behavior (beverage consumption). These two interventions will be compared to an active control intervention unrelated to weight (accident prevention). Eight primary care practices will be randomized to each arm with 21 subjects per practice, for a total of 24 practices and 504 subjects. The primary aim is to demonstrate that either obesity prevention intervention will result in less BMI increase (adjusted using z-score) in children age 8 to 12 years at risk for overweight (BMI 85th-95th percentile), compared to a control intervention, at the end of the intervention. We also hypothesize that, in this context, the multiple-behavior intervention, the single-behavior intervention, or both will result in less adjusted BMI increase than the control intervention at 24 months post-randomization, with no a priori assumption in differences between the two obesity prevention strategies. Blood pressure, insulin resistance, dyslipidemia, and oral health status will be secondary outcomes. Intermediate behavioral outcomes and process data will be collected. For this project, we combined the strengths of respected pediatric obesity and behavioral experts with the Practice-Based Research Network at The Children's Hospital of Philadelphia, which includes both inner city primary care practices and suburban private practices.

描述（由申请人提供）：除了家庭、学校和社区等其他环境外，初级保健是预防儿童肥胖的一个有前途的环境。不幸的是，大多数儿科初级保健提供者没有接受过提供行为矫正干预措施的培训，并且根据我们的初步数据，当他们认为在护理就诊期间没有足够的时间时，他们不太可能解决肥胖预防问题。为了回应这份 RFA，我们提出了一项预防肥胖的对照试验，在实践层面进行分组随机化，基于行为经济学理论，由初级保健提供者在行为矫正培训后提供两种标准化的 12 个月干预策略。第一个策略将针对多种行为的改变，而另一个策略将针对一种行为（饮料消费）。这两种干预措施将与与体重无关的主动控制干预措施（事故预防）进行比较。八个初级保健诊所将随机分配到每组，每个诊所有 21 名受试者，总共 24 个诊所和 504 名受试者。主要目的是证明，与对照干预措施相比，肥胖预防干预措施将导致 8 至 12 岁有超重风险（BMI 85-95%）儿童的 BMI 增加减少（使用 z 分数调整）。干预结束。我们还假设，在这种情况下，在随机化后 24 个月时，多重行为干预、单一行为干预或两者都会导致调整后的 BMI 增加少于对照干预，并且没有先验假设不同行为之间的差异。两种肥胖预防策略。血压、胰岛素抵抗、血脂异常和口腔健康状况将是次要结果。将收集中间行为结果和过程数据。在这个项目中，我们将受人尊敬的儿科肥胖和行为专家的优势与费城儿童医院的基于实践的研究网络结合起来，其中包括内城区初级保健实践和郊区私人诊所。