The Effectiveness of Family-based Weight Loss Treatment Implemented in Primary Care - CCC - Lead Application

在初级保健中实施以家庭为基础的减肥治疗的有效性 - CCC - 主要应用

基本信息

批准号：
9922789
负责人：
Leonard H Epstein
金额：
$ 126.64万
依托单位：
STATE UNIVERSITY OF NEW YORK AT BUFFALO
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-06-01 至 2024-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9922789
关键词：
12 year old 18 year old Adult Advisory Committees Attitude Basic Science Behavior Behavioral Behavioral Weight Control Body Weight Body Weight Changes Body Weight decreased Brain Caring Child Child Rearing Clinic Data Diet Disease Dose Eating Effectiveness Ensure Evidence based practice Evidence based treatment Family Family member Food Future Generations Guidelines Health Benefit Health Food Health Personnel Healthcare Home environment Impulsivity Individual Individual Differences Instruction Intention Intervention Lead Learning Long-Term Care Maintenance Measures Medical center Modeling Modification Multi-Institutional Clinical Trial Neurosciences Obesity Outcome Overweight Parents Participant Perception Physical activity Prevention Preventive service Primary Care Physician Primary Health Care Process Provider Randomized Randomized Clinical Trials Recommendation Regulation Research Resources Rewards Risk Sampling Self-control as a personality trait Siblings Site Social Environment System Testing Thinking Time Training Translating Weight Weight Gain Weight maintenance regimen adult obesity base behavior change behavioral economics care fragmentation care providers compare effectiveness contingency management cost cost effective design discount discounting environmental enrichment for laboratory animals evidence base follow-up improved medical specialties obesity in children obesity treatment patient oriented pediatrician practice setting primary care setting public health relevance reinforcer response success treatment as usual usual care arm weight loss program

项目摘要

DESCRIPTION (provided by applicant): Family-based treatment (FBT) is a behavioral weight control intervention that targets children who are overweight/obese and their parents, and has the capacity to improve the weight status of non-targeted family members such as siblings. FBT has significant positive effects on body weight in children for up to 10-years of follow-up, and a robust relationship is observed between child and parent outcomes. FBT's concurrent care of two generations of obesity in the family is more efficacious and cost-effective than if family members are treated by their separate health care providers. Despite its recognized efficacy, FBT is mainly available in specialty clinics and many children fail to receive this guideline-based level of treatment, as recommended by the U.S. Preventive Services Task Force. Primary care offers an optimal setting for delivery of FBT by capitalizing on the established relationship between primary care providers and families. Using interventionists co-located within the primary care setting overcomes barriers posed by fragmentation of care, and lack of provider time and training. One of the challenges to integrating childhood obesity treatment into primary care is optimizing limited health care resources. In behavioral weight loss programs, some individuals learn diet, physical activity, and behavior change information quickly, while others learn more slowly. Individuals also differ in their ability to implement treatment recommendations due to individual differences, such as problems with delaying gratification. FBT accommodates these individual differences by using a personalized system of instruction, or a mastery model, in which the content and dose of treatment is calibrated to the needs of the family, ensuring that treatment effort is consistent with need. This multi-site, clinical trial aims to evaluate over a to year period the effectiveness of FBT delivered by a trained interventionist co-located within primary care plus enhanced usual care delivered by the primary care provider (FBT+EUC) compared to enhanced usual care alone (EUC). Participants will be a representative sample of 528 families with a 6-12 year-old child and a parent who are both overweight/obese. Weight changes in approximately 228 siblings who are overweight/obese and between 2-18 years of age will also be studied. This study will test between group differences in child (Primary Specific Aim 1A) and parent (Primary Specific Aim 1B) weight change, as well as weight change in siblings who are overweight/obese (Secondary Aim 1), changes in parent and child delay of gratification, and how changes in delay of gratification are related to parent and child weight changes (Secondary Aim 2), participant level predictors of treatment success (Secondary Aim 3), and how provider attitudes toward evidence-based treatment and perceptions of FBT may relate to their intention to use co- located FBT in their practices in the future (Exploratory Aim 1). Establishing that FBT can be effectively implemented within real world settings is crucial to creating a system by which children and their families who suffer from obesity can be treated in a centralized primary care setting.

描述（申请人提供）：基于家庭的治疗（FBT）是一种针对超重/肥胖儿童及其父母的行为体重控制干预措施，能够改善非目标家庭成员（例如兄弟姐妹）的体重状况。在长达 10 年的随访中，FBT 对儿童的体重具有显着的积极影响，并且观察到儿童和父母的结果之间存在牢固的关系。 FBT 对家庭中两代肥胖者的同时护理比家庭成员由各自的医疗保健提供者接受治疗更有效且更具成本效益。尽管 FBT 的功效得到公认，但它主要在专科诊所提供，许多儿童未能接受这种基于指南的治疗美国预防服务工作组建议的治疗水平。初级保健利用初级保健提供者和家庭之间已建立的关系，为 FBT 的实施提供了最佳环境。在初级保健机构内使用干预专家可以克服因护理分散以及缺乏提供者时间和培训而造成的障碍。将儿童肥胖治疗纳入初级保健的挑战之一是优化有限的医疗保健资源。在行为减肥计划中，有些人学习饮食、身体活动和行为改变信息的速度很快，而另一些人学习的速度较慢。由于个体差异，例如延迟满足的问题，个体执行治疗建议的能力也有所不同。 FBT 通过使用个性化的指导系统或掌握模型来适应这些个体差异，其中治疗的内容和剂量根据家庭的需要进行校准，确保治疗努力与需要一致。这项多地点临床试验旨在评估一年内由受过培训的干预医生在初级保健中提供的 FBT 以及由初级保健提供者提供的增强型常规护理 (FBT+EUC) 与增强型常规护理相比的有效性单独（EUC）。参与者将是 528 个有 6-12 岁儿童和父母超重/肥胖家庭的代表性样本。还将研究大约 228 名 2 至 18 岁之间超重/肥胖的兄弟姐妹的体重变化。这项研究将测试儿童的组间差异（主要具体目标 1A）和父母（主要具体目标 1B）的体重变化，以及超重/肥胖的兄弟姐妹的体重变化（次要目标 1）、父母和孩子延迟满足的变化以及延迟满足的变化之间的关系父母和孩子体重变化（次要目标 2）、治疗成功的参与者水平预测因素（次要目标 3），以及提供者对循证治疗的态度和态度对 FBT 的看法可能与他们未来在实践中使用同地 FBT 的意图有关（探索性目标 1）。确定 FBT 可以在现实世界中有效实施对于创建一个系统至关重要，通过该系统，患有肥胖症的儿童及其家人可以在集中的初级保健环境中得到治疗。

项目成果

期刊论文数量（3）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Delay Discounting and the Income-Food Insecurity-Obesity Paradox in Mothers.

DOI：
10.1155/2023/8898498
发表时间：
2023
期刊：
JOURNAL OF OBESITY
影响因子：
3.3
作者：
Epstein, Leonard H.;Rizwan, Ashfique;Paluch, Rocco A.;Temple, Jennifer L.
通讯作者：
Temple, Jennifer L.

Implementing family-based behavioral treatment in the pediatric primary care setting: Design of the PLAN study.

DOI：
10.1016/j.cct.2021.106497
发表时间：
2021-10
期刊：
CONTEMPORARY CLINICAL TRIALS
影响因子：
2.2
作者：
Epstein, Leonard H.;Schechtman, Kenneth B.;Kilanowski, Colleen;Ramel, Melissa;Moursi, Nasreen A.;Quattrin, Teresa;Cook, Steven R.;Eneli, Ihouma U.;Pratt, Charlotte;Geller, Nancy;Campo, Rebecca;Lew, Daphne;Wilfley, Denise E.
通讯作者：
Wilfley, Denise E.

Parents, but not their children, demonstrate greater delay discounting with resource scarcity.