Primary care is a promising setting for childhood obesity prevention, in addition to other settings, such as the family, schools, and the community. Unfortunately, most pediatric primary care providers are not trained to deliver behavior modification interventions and, according to our preliminary data, are less likely to address obesity prevention when they perceive insufficient time during well-care visits. In response to this RFA, we propose a controlled trial of obesity prevention, with group randomization at the practice level, of two standardized 12-month intervention strategies, based on the Behavioral Economics theory, and delivered by primary care providers after training in behavior modification. The first strategy will target change in multiple behaviors, while the other will target one behavior (beverage consumption). These two interventions will be compared to an active control intervention unrelated to weight (accident prevention). Eight primary care practices will be randomized to each arm with 21 subjects per practice, for a total of 24 practices and 504 subjects. The primary aim is to demonstrate that either obesity prevention intervention will result in less BMI increase (adjusted using z-score) in children age 8 to 12 years at risk for overweight (BMI 85th-95th percentile), compared to a control intervention, at the end of the intervention. We also hypothesize that, in this context, the multiple-behavior intervention, the single-behavior intervention, or both will result in less adjusted BMI increase than the control intervention at 24 months post-randomization, with no a priori assumption in differences between the two obesity prevention strategies. Blood pressure, insulin resistance, dyslipidemia, and oral health status will be secondary outcomes. Intermediate behavioral outcomes and process data will be collected. For this project, we combined the strengths of respected pediatric obesity and behavioral experts with the Practice-Based Research Network at The Children's Hospital of Philadelphia, which includes both inner city primary care practices and suburban private practices.
| Stettler, N; Wrotniak, B H; Hill, D L et al. (2015) Prevention of excess weight gain in paediatric primary care: beverages only or multiple lifestyle factors. The Smart Step Study, a cluster-randomized clinical trial. Pediatr Obes 10:267-74 |
| Stettler, N (2007) Nature and strength of epidemiological evidence for origins of childhood and adulthood obesity in the first year of life. Int J Obes (Lond) 31:1035-43 |
