Treatment of Childhood Obesity in Primary Care
Condition: Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional
Phase: Phase 3

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Motivational Interviewing (physicians); Behavior Modification (families)
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Identifying and referring children with BMI >93%.; Group meetings and individual family meetings based on behavior modification for healthy lifestyle changes.
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: Obesity; Overweight; Children; Behavioral; Motivational; Family; Primary care