Using a Guided Self-Help Treatment Model for Childhood Obesity Management in the Primary Care Setting
Grantee: University of California, San Diego
Principal Investigator: Kyung Rhee
Project Number: R40MC29452
Project Date: 04/01/2016
Age group(s)
- Early Childhood (3-5 years)
- Middle Childhood (6-11 years)
Targeted/Underserved Population
- Hispanic/Latino
- Asian/Pacific Islander
Abstract
One-third of our nations' children are overweight or obese (OW/OB). The Affordable Care Act (ACA) aims to improve obesity-related prevention and treatment coverage for children by improving access to health care services that support healthy weight. Unfortunately, there are few effective services available. The cornerstone of obesity treatment involves intensive family based behavioral therapy, yet these programs often exist in tertiary care academic settings that have long wait lists and are too far away for families to access. Primary care providers (PCP) have been called on by several organizations to be the front line of obesity management, yet they are limited by a lack of time, resources, and skills. Thus, if we are to offer effective obesity management in the healthcare setting, other care models need to be developed and tested. We have developed a Guided Self-Help (GSH) treatment for obesity that can be delivered in the primary care setting by a nurse or allied health professional. This program relies on classic behavioral therapy strategies, self-regulation theory, and provides the support needed for patient/family self-management of weight loss. The program consists of 12 bi-weekly family sessions in the primary care office instead of the traditional 20-week, intensive, group-based behavioral therapy program at a tertiary care academic center. This program has been shown to be effective, and implementation of this model would improve access to quality weight management services for OW/OB children from all socioeconomic levels and geographic regions. If successful, we may be able to provide evidence that the structure of the primary care setting should be modified to accommodate this type of program. With improved availability and access to care, we may be able to more effectively decrease rates of childhood obesity. Our goal is to train licensed vocational nurses in the clinic to be health coaches and deliver GSH treatment to OW/OB children between the ages of 5-13 years old. Two pediatric practices in San Diego, servicing neighborhoods that are 48-58% Hispanic and where 10-18% live below the poverty level, have agreed to participate. Conducting a pragmatic clinical trial, we will randomize families within each clinic to one of 2 arms: 1) GSH delivered in the healthcare center, or 2) usual care (i.e., PCP providing obesity management with the help of a decision support tool in the electronic health record and referrals to a tertiary care weight control program). We believe that families receiving GSH will be more likely to enroll in behavioral treatment for obesity, attend sessions, and decrease child BMI/BMI percentile than families in the usual care group. Primary outcome measures will include enrollment, attendance, and change in child BMI/BMI percentile. Secondary exploratory measures will include change in child dietary and physical activity behaviors, parent support behaviors, and parent self-efficacy and empowerment to engage in weight loss. Cost-effectiveness analysis of this model on changes in child BMI and health related QOL will also be conducted. Data will be collected at the 0, 6, and 12 month time point via medical chart review, direct measurement of heights and weights, and self-report measures. The goal of this proposal is to implement a new and innovative method of treating childhood obesity in the primary care setting and to evaluate the effectiveness of this model. If successful, this model can be disseminated widely throughout the country and increase our ability to provide effective, easily accessible care to OW/OB children.Publications
Listed is descending order by year published.
Rhee KE, Kessl S, Lindback S, Littman M, El-Kareh RE. Provider views on childhood obesity management in primary care settings: a mixed methods analysis.BMC Health Serv Res. 2018 Jan 30;18(1):55-65.
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