Working with the PROS (Pediatric Research in Office Settings) Network of the American Academy of Pediatrics (AAP), the American Dietetic Association (ADA), and the Centers for Disease Control (CDC), we will conduct an efficacy trial among 30 PROS practices to test two interventions that address many of the key barriers to obesity counseling in pediatric primary care. The target population will be 600 youth ages 2-8 with a BMI >= 85th and =<97th percentile. We will employ a cluster-randomized design with PROS practice as the unit of randomization with three experimental groups. Group 1 (Usual Care-UC) will include determination of BMI percentile at baseline, 1 year, and 2 year follow up. UC practitioners will provide parents with a series of educational tip sheets as well as an educational video tape. UC pediatricians (PEDS) will also receive a = day study orientation session that will include a brief CME-type workshop addressing obesity treatment. Group 2 (PED only) will include the same assessments, enrollment criterion and educational materials as UC. In addition, Group 2 PEDs will receive 2.0 days of in-person training in Motivational Interviewing (MI) plus 2 telephone based counseling supervision sessions, and an interactive DVD MI booster training system to be developed during year 1. PEDs in Group 2 will schedule 3 proactive counseling sessions with a parent of the index child in Year 1 and 1 additional visits in year 2. Group 2 PEDS will be reimbursed $50 per visit. Group 3 (PED+RD) will include the same training and intervention components as Group 2, but will add counseling from a trained dietitian (RD). RDs will deliver 6 MI-based counseling sessions over 2 years, frontloaded with 4 contacts in year 1 and 2 in year 2. The RD sessions will be delivered both in-person and by telephone. RDs will receive 2.0 days of in-person MI training jointly with PEDS, plus 2 telephone-based supervision sessions. RDs will be compensated $50 per in-person visit and $35 for telephone sessions. The project is significantly informed by a recently completed pilot study conducted with AAP PROS, along with the team that will conduct the proposed study. The primary outcome for the trial will be child's BMI percentile at 2 year followup. Secondary outcomes include physical activity by accelerometry, diet and activity via 24hr recall and self report questionnaire, and parental feeding practices. Process, mediation, and cost effectiveness analyses will also be conducted. Pediatric obesity remains a major public health problem. There is a paucity of evidenced- based intervention models to assist primary care practitioners to treat their overweight pediatric patients. The results of this study could impact training, policy, and reimbursement of obesity care in pediatric practice.
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