Improving primary care to prevent childhood obesity

改善初级保健以预防儿童肥胖

• 批准号: 7943569
• 负责人: MATTHEW W GILLMAN
• 金额: $ 6.18万
• 依托单位: HARVARD PILGRIM HEALTH CARE, INC.
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-15 至 2013-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7943569
• 关键词: 5 year old; Address; Administrator; Age; Asthma; Behavior; Behavioral; Body Weight decreased; Body mass index; Child; Child Behavior; Child Care; Childhood; Cities; Clinic; Collaborations; Consumption; Counseling; Data; Development; Dietary Fiber; Dietary intake; Eating; Effectiveness; Effectiveness of Interventions; Energy Intake; Energy Metabolism; Ensure; Environment; Epidemic; Epidemiology; Experimental Designs; Family; Family Physicians; Fatty acid glycerol esters; Food; Frequencies; Funding; Future; Goals; Grant; Group Practice; Healthcare; Height; Human Resources; Individual; Institutes; Insulin; Intake; Integrated Health Care Systems; Interdisciplinary Study; International; Intervention; Knowledge; Leptin resistance; Life; Longevity; Massachusetts; Measurement; Medical; Mexican; Mexico; Nursery Schools; Nurses; Nutrient; Obesity; Overweight; Parents; Patients; Physical activity; Population; Preschool Child; Prevalence; Preventive Intervention; Primary Health Care; Provider; Public Health; Randomized; Randomized Controlled Trials; Readiness; Relative (related person); Research; Research Infrastructure; Research Personnel; Resources; Science; Services; Site; Social Security; Specific qualifier value; Television; Testing; Time; Training; Trust; United States National Institutes of Health; Weight; Weight Gain; Work; age group; aged; base; behavior change; cardiovascular risk factor; chronic care model; combat; cost; cost effectiveness; empowered; experience; fast food; follow-up; fruits and vegetables; group intervention; improved; innovation; interest; intervention effect; medical schools; novel strategies; obesity in children; obesity prevention; obesity risk; outreach; parent grant; prevent; prevention service; primary outcome; programs; public health relevance; sex; success; sugar; sweetened beverage; time use; tool; treatment as usual

DESCRIPTION (provided by applicant): Over the past 20 years, the prevalence of obesity in Mexico has more than doubled among individuals across the lifespan, including even the youngest populations. Once present, obesity is difficult to treat. To halt the obesity epidemic, we need to intervene early in life before excess weight gain takes hold. An important and untapped resource to halting this obesity epidemic is the primary care provider. Primary care providers, including family physicians and nurses, are interested in combating the rise of obesity in their patients, and families trust the advice they get from their providers. The overall goal of this research is to test the feasibility and effectiveness of an innovative clinic-based intervention to promote healthy eating and activity behaviors among Mexican children aged 2-5 years at elevated risk of obesity. Our proposed intervention will build upon our work with High Five for Kids, a U.S.-based, NIH funded obesity prevention intervention that involved restructuring primary care based on the chronic care model and training clinicians to provide behavior change counseling to parents of children age 2-5 years. To achieve this goal, we will conduct a randomized controlled trial (RCT) in 10 family medical clinics of the Mexican Institute of Social Security (IMSS), a large integrated health care system that provides health care for over 45 million Mexicans. 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 6-month follow-up period. We will also assess the intervention's effect on specified obesity-related behaviors and its feasibility and acceptance. The proposed study unites a multidisciplinary research team with diverse strengths; the Harvard researchers provide expertise in the epidemiology of childhood overweight in the development of innovative obesity prevention interventions, while the IMSS researchers provide expertise in experimental design and an established record of research collaboration with IMSS clinics. This research will be conducted primarily in Mexico City at IMSS in collaboration with Ricardo Pirez-Cuevas, as an extension of NIH Grant No. 5R01HD050966-05, 8-22-2005 to 06-30-2010, with a planned one-year no-cost extension to 06-30-2011. PUBLIC HEALTH RELEVANCE: The proposed study takes advantage of the extensive infrastructure created with NIH funding for the High Five for Kids study and tests the effectiveness of an untapped resource for obesity prevention in Mexico - the primary care provider. This research will move the field of obesity prevention forward by assessing the effectiveness and feasibility of an innovative clinic-based intervention that combines the intensity needed to curb excess weight gain among preschool children with the essential features needed to sustain the program within primary care clinics in Mexico.

描述（由申请人提供）：在过去的20年中，墨西哥肥胖症的患病率在整个生命周期中的个体中，甚至包括最年轻的人群都增加了一倍以上。一旦存在，肥胖就很难治疗。为了停止肥胖流行，我们需要在生命早期进行干预，然后再增加体重增加。 制止这种肥胖流行的重要且未开发的资源是初级保健提供者。包括家庭医生和护士在内的初级保健提供者有兴趣打击患者肥胖的兴起，家庭信任他们从提供者那里得到的建议。这项研究的总体目的是测试基于诊所的创新干预措施的可行性和有效性，以促进2-5岁儿童的健康饮食和活动行为，肥胖风险升高。我们提出的干预措施将基于我们与High For For Kids的工作，这是一项美国NIH资助的预防肥胖预防干预措施，涉及基于慢性护理模型和培训临床医生对2-5岁儿童父母的行为改变咨询的培训。为了实现这一目标，我们将在墨西哥社会保障研究所（IMSS）的10个家庭医疗诊所进行随机对照试验（RCT），这是一个大型综合医疗保健系统，可为超过4500万墨西哥人提供医疗保健。主要目的是评估与通常的护理控制条件相比，干预措施在6个月的干预和6个月的随访期内减少体重指数的变化。我们还将评估干预措施对特定的肥胖相关行为的影响及其可行性和接受。 拟议的研究使一个具有多种优势的跨学科研究团队团结在一起。哈佛大学的研究人员在开发创新的肥胖预防干预措施方面提供了童年超重的流行病学专业知识，而IMSS的研究人员则提供了实验设计方面的专业知识，并与IMSS诊所建立了研究合作的既定记录。这项研究将主要在IMSS的墨西哥城与Ricardo Pirez-Cuevas合作，作为NIH赠款编号5R01HD05050966-05、8-22-2005至06-30-2010的扩展，并计划一年一年的一年延伸至06-30-30-2011。 公共卫生相关性：拟议的研究利用了NIH为儿童学习而创建的广泛的基础设施，并测试了墨西哥未开发的肥胖症预防资源的有效性 - 初级保健提供者。这项研究将通过评估基于创新的诊所干预的有效性和可行性来推动肥胖症预防的领域，该干预措施结合了抑制学龄前儿童过度体重增加所需的强度以及在墨西哥初级保健诊所内维持该计划所需的基本特征。