Obesity is the most common chronic disease presenting to the primary care practitioner who cares for children. Obesity in children and adolescents imposes a huge burden on their physical health and emotional well-being;it leads to an increased probability of becoming overweight adults with an increased risk for hypertension, osteoarthritis, type 2 diabetes, and high cholesterol compared to normal weight children. Most interventions designed to treat obesity in children have focused on the school-age child. With rare exceptions, these programs have been only modestly successful, leading us to focus our intervention on younger children (3 to 6 years of age) whose dietary and physical activity habits may be easier to change. To extend the reach of our intervention, in both duration and scope, we will partner with the Center for Health Enhancement Systems Studies at the University of Wisconsin-Madison. The Center has been in the forefront in developing innovative information and communication technologies to support patients and their informal caregivers facing chronic and fatal disease for 35 years. Their platform for information and communication, CHESS (the Comprehensive Health Enhancement Support System) is among the most extensively studied set of communication tools, having been the subject of numerous needs assessments, randomized clinical trials and field tests. We will modify the CHESS platform to meet the needs of young families with overweight or obese children. Our previous experiences have led us to develop elements of a new program: (1) we will target the parents of overweight or obese 3 to 6 year old children in the primary care setting to be the sole agents of change;(2) we will propose a non-restrictive nutritious "diet" focused on increasing fruits and vegetables with most attention to proper portion size;(3) we will promote an active life style with increased physical activity and outdoor play. Our intervention will start with 6 "in-person" group counseling sessions in the primary care setting accompanied by continuous input via the web over 12 months with a strong component focusing on "parenting skills" and increasing social supports (through the CHESS network) for fostering healthy lifestyles. The website will include information resources, answers to frequently asked questions, personal stories and an interactive discussion group. The web-based component can be accessed at convenient times and thereby will promote long-term adherence at low cost.
Specific Aim 1 is to assess the feasibility of an intervention combining 6 "in- person" group counseling sessions conducted in the primary care setting by a nurse plus a one year, web- based home component to actively engage parents of overweight or obese children as measured by their attendance at counseling sessions and follow-up visits to the primary care office.
Specific Aim 2 is to assess the effectiveness of this intervention program to assist parents of overweight or obese 3-6 year old children in promoting (a) reduction of child BMI-z scores, (b) healthy behavior changes (related to nutrition and physical activity) for their children, and (c) improved parenting skills.
Obesity in children and adults is one of the most common and serious chronic diseases requiring care by the primary care practitioner. Family-based behavioral interventions have been the most successful but require ongoing contact. This proposal will test the feasibility and effectiveness of brief 'in-person'counseling and a long-term web-based intervention model. If successful, this intervention will be inexpensive, easy to replicate and export, and deliverable at the convenience of young families.