This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. The epidemic of childhood obesity continues to grow. Now approximately 30-40% of Orange County children have a BMI>85th percentile by age 17, signifying that they are overweight for height. Along with the increasing number of children considered overweight, the number of children frankly obese (BMI>95th percentile) and children with obesity comorbidity is growing at an alarming rate (15-20%) as well (3). Children with BMI>95th percentile are at high risk of developing type 2 diabetes and other comorbidities like obstructive sleep apnea, non-alcoholic steatohepatitis, asthma, orthopedic impairment, and severe depression or other psychosocial syndromes. Thus, childhood obesity is fast becoming our children's most important health problem. Our goal here is to begin to examine the potential success of a case-management approach to the treatment of childhood obesity. The case manager will be Julia Rich, RN, who has worked at UCI in nursing for 15 years and has experience in the management of a variety of pediatric and adult chronic conditions. This initial study is not designed as an outcome study; rather, the research component of this project is focused largely on process evaluation of the case management approach for the treatment of childhood obesity. It is now clear that only programs which include intensive lifestyle intervention emphasizing increased physical activity and healthier diets are effective (1; 2). It is also clear that involvement of the entire family in the process of lifestyle change for the obese child is essential. Readiness for change, understanding emotional cues to overeating and strong emotional support to enable and maintain the change process are also critical. This is, of course, intuitively obvious-it is important to note that a proper balance of energy intake and expenditure will 'cure' childhood obesity. This distinguishes obesity from more typical syndromes and diseases in which the underlying approach to combat pathophysiological mechanisms remains obscure (e.g., juvenile arthritis, type 1 diabetes, cystic fibrosis). There is growing data that a case-management approach will be required. In the case of childhood obesity, every family, neighborhood, and child is different; thus, it is logical to propose that successful therapy must include individualization of therapy through a case manager. In fact, this was demonstrated robustly in the recent Diabetes Prevention Protocol which showed that case managers working with prediabetic adults to increase physical activity were more effective than the drug metformin in reducing the onset of frank type 2 diabetes (4). The Case Management approach toward the care of chronically ill children and adults has been thoroughly evaluated for a variety of diseases like asthma, obesity, and diabetes in adults, but has not been evaluated in children (5; 6). A Collaborative Pediatric Obesity Clinic has been established with funding from the HealthCare Foundation of Orange County. This 'platform' will permit a more comprehensive approach toward the care of children with obesity, particularly from lower socioeconomic backgrounds, than has ever been offered in our region. Moreover, the Clinic will permit us to begin to examine the potential role of case management for the morbidly obese child. The unique feature of our approach is that the case manager will attempt to link children (who have been screened--see below) with ongoing, existing, community programs that offer services to improve nutrition and physical activity to children. This is important because the alternatives--such as providing personal trainers or low-calorie, low fat meals directly to families--are not likely to be offered by health care insurers. Fortunately, there are a growing number of community based, diet and physical activity programs targeted at lower socioeconomic children in our region. For example, Latino Health Access runs a program of 'promotores' designed specifically to work with obese children and their families. Californian State University at Fullerton and Chapman College have developed community based programs designed to enhance physical activity and improve diet in lower socioeconomic children with obesity. One premise is that many of the problems associated with childhood obesity can be solved if a child/family is linked with ongoing programs and followed in a systematic manner. Our research will be focused on how well our nurse case manager is able to, in fact, link obese children and their families with potentially successful programs. This would support the notion that affordable and sustainable programs for childhood obesity actually do exist in reasonable proximity to many affected children in our region. This is very much a pilot feasibility study, and the outcomes focus primarily on process evaluation assessed qualitatively. The major questions we hope to answer with this study are: 1. Is it possible for a case manager to establish a sustained relationship with an obese child and his or her family? A 'sustained relationship' in this context consists of 1-3 contacts per week (e.g., visits or phone calls). 2. Are there existing community programs suitable that can increase physical activity in children with obesity? 3. Are there existing community programs that can support family's selecting healthy food choices? It is important to note that a simple survey cannot replace the kind of information that a Case Manager will obtain when actually trying to connect a child and family with existing community progr
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