Treatment of Childhood Obesity in Primary Care
| Status: | Completed |
|---|---|
| Conditions: | Obesity Weight Loss |
| Therapuetic Areas: | Endocrinology |
| Healthy: | No |
| Age Range: | 9 - 12 |
| Updated: | 4/21/2016 |
| Start Date: | May 2006 |
| End Date: | December 2010 |
This project will apply the concepts from the Chronic Care Model to the problem of pediatric
obesity and proposes: 1) to assess the effectiveness of teaching primary care providers (in
diverse practice settings) to use specific communication strategies with parents of
overweight and obese children to help them take steps with their child toward healthy
behavior change; 2) to offer core components of an efficacious evidence-based pediatric
obesity treatment within the pediatric primary care setting to determine if participating
children will achieve clinically meaningful weight loss (assessed as weight and BMI
percentile changes at the end of treatment and at a six month follow-up); and 3) to assess
the ability of trained, behavioral psychologists to offer the treatment so that desired
child outcomes are achieved. The primary project outcomes will include: 1) increase in
self-reported physician confidence in use of counseling skills related to pediatric
overweight; and 2) change in child's diet, physical activity, weight and BMI percentile at
the end of treatment and at 6-month follow-up.
obesity and proposes: 1) to assess the effectiveness of teaching primary care providers (in
diverse practice settings) to use specific communication strategies with parents of
overweight and obese children to help them take steps with their child toward healthy
behavior change; 2) to offer core components of an efficacious evidence-based pediatric
obesity treatment within the pediatric primary care setting to determine if participating
children will achieve clinically meaningful weight loss (assessed as weight and BMI
percentile changes at the end of treatment and at a six month follow-up); and 3) to assess
the ability of trained, behavioral psychologists to offer the treatment so that desired
child outcomes are achieved. The primary project outcomes will include: 1) increase in
self-reported physician confidence in use of counseling skills related to pediatric
overweight; and 2) change in child's diet, physical activity, weight and BMI percentile at
the end of treatment and at 6-month follow-up.
Overweight in children, adolescents and adults has increased dramatically during the last
two decades in developed and developing nations, leading to a global epidemic. Current
trends in childhood overweight are a function of both poor nutrition and an increase in
sedentary activities.
Pediatric health care providers are ideally situated to address this problem, especially
since children are seen frequently for preventive care during the early years when
intervention may be more likely to yield long-term change. However, most pediatric providers
do not have the needed training to manage obesity effectively. This project will use the
chronic care model to foster the effectiveness of an office-based intervention aimed at
altering dietary intake and physical activity for children whose BMI reflects overweight and
their parents. With the support of the health care system (through new reimbursement
strategies), office redesign (assignment of tasks to the health assistant, physician and
behavioral interventionist), self-management techniques (patient training) and enhanced
community resources, a successful program for improved nutrition and physical activity will
be built.
Specific Aim 1 of this study is to increase physician use of counseling techniques that are
effective in promoting positive behavior change regarding nutrition and physical activity in
the pediatric primary care setting. This aim will be accomplished by offering a training
intervention for primary care pediatricians and health assistants. The intervention will:
1. Increase physician recognition of risk factors for overweight.
2. Teach physicians to use brief motivational strategies with parents and children that
will assist them in taking steps toward healthier behavior as it relates to nutrition
and physical activities, including but not limited to enrolling in a group behavioral
treatment program.
Specific Aim 2 is to assess the effectiveness of implementing a pediatric primary care
office-based nutrition/physical activity behavioral intervention for overweight and obese
children and their parents.
In specific aim 2 we will employ trained behavioral interventionists to offer a family-based
behavioral intervention targeting healthy eating and decreased sedentary behavior/increased
physical activity to overweight/obese children ages 9-12 and their parents; and to evaluate
parent and child adherence to attendance and behavioral intervention factors.
Self-monitoring reports of the child's behavioral changes (e.g., decrease in number of "red
foods"[foods high in calories and fat] consumed weekly and decreased time spent each week
watching TV, using the computer, and playing video games) will be described, as will any
changes in BMI.
Experienced behavioral interventionists will be trained in behavioral theory principles
fundamental to the intervention that involve helping children and their parents to change
behavior and maintain the changes by Dr. Ewing (Co-Investigator). Dr Ewing, who has
completed Human Subjects and HIPAA training at the University of Pittsburgh will come to
Madison, Wisconsin to do a training session for the behavioral interventionists and study
coordinator. In addition, she will provide instruction in principles of weight management,
the role of healthy eating and physical activity in maintaining a healthy weight, and the
empirical support for the intervention that will be offered. Finally, the interventionists
will receive training to conduct each of the individual sessions.
The American Academy of Pediatrics (AAP) recommends that overweight children be screened for
fasting blood glucose, fasting blood insulin, and serum lipids. Pre and post lab values that
are available for participating children will be recorded.
two decades in developed and developing nations, leading to a global epidemic. Current
trends in childhood overweight are a function of both poor nutrition and an increase in
sedentary activities.
Pediatric health care providers are ideally situated to address this problem, especially
since children are seen frequently for preventive care during the early years when
intervention may be more likely to yield long-term change. However, most pediatric providers
do not have the needed training to manage obesity effectively. This project will use the
chronic care model to foster the effectiveness of an office-based intervention aimed at
altering dietary intake and physical activity for children whose BMI reflects overweight and
their parents. With the support of the health care system (through new reimbursement
strategies), office redesign (assignment of tasks to the health assistant, physician and
behavioral interventionist), self-management techniques (patient training) and enhanced
community resources, a successful program for improved nutrition and physical activity will
be built.
Specific Aim 1 of this study is to increase physician use of counseling techniques that are
effective in promoting positive behavior change regarding nutrition and physical activity in
the pediatric primary care setting. This aim will be accomplished by offering a training
intervention for primary care pediatricians and health assistants. The intervention will:
1. Increase physician recognition of risk factors for overweight.
2. Teach physicians to use brief motivational strategies with parents and children that
will assist them in taking steps toward healthier behavior as it relates to nutrition
and physical activities, including but not limited to enrolling in a group behavioral
treatment program.
Specific Aim 2 is to assess the effectiveness of implementing a pediatric primary care
office-based nutrition/physical activity behavioral intervention for overweight and obese
children and their parents.
In specific aim 2 we will employ trained behavioral interventionists to offer a family-based
behavioral intervention targeting healthy eating and decreased sedentary behavior/increased
physical activity to overweight/obese children ages 9-12 and their parents; and to evaluate
parent and child adherence to attendance and behavioral intervention factors.
Self-monitoring reports of the child's behavioral changes (e.g., decrease in number of "red
foods"[foods high in calories and fat] consumed weekly and decreased time spent each week
watching TV, using the computer, and playing video games) will be described, as will any
changes in BMI.
Experienced behavioral interventionists will be trained in behavioral theory principles
fundamental to the intervention that involve helping children and their parents to change
behavior and maintain the changes by Dr. Ewing (Co-Investigator). Dr Ewing, who has
completed Human Subjects and HIPAA training at the University of Pittsburgh will come to
Madison, Wisconsin to do a training session for the behavioral interventionists and study
coordinator. In addition, she will provide instruction in principles of weight management,
the role of healthy eating and physical activity in maintaining a healthy weight, and the
empirical support for the intervention that will be offered. Finally, the interventionists
will receive training to conduct each of the individual sessions.
The American Academy of Pediatrics (AAP) recommends that overweight children be screened for
fasting blood glucose, fasting blood insulin, and serum lipids. Pre and post lab values that
are available for participating children will be recorded.
Inclusion Criteria:
- >95% BMI
- developmentally normal
- referred by primary care provider
Exclusion Criteria:
- currently involved in an organized weight control program
- Preexisting high blood pressure
- Preexisting high lipids
- Preexisting diabetes due to obesity
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