Poulsen Melissa N, Hosterman Jennifer Franceschelli, Wood G Craig, Cook Adam, Wright Lyndell, Jamieson Scott T, Naylor Allison, Lutcher Shawnee, Mowery Jacob, Seiler Christopher J, Welk Gregory J, Bailey-Davis Lisa
Department of Population Health Sciences, Geisinger, Danville, PA, United States.
Center for Nutrition and Weight Management, Geisinger, Danville, PA, United States.
Front Nutr. 2022 Jul 11;9:932514. doi: 10.3389/fnut.2022.932514. eCollection 2022.
Guidelines recommend primary care providers refer children with obesity to behavioral interventions, but given limited program availability, access, and parental engagement, referrals remain rare. We developed telehealth coaching interventions for families whose children received care at a health system in Pennsylvania, United States in 2019-2020. Intervention referrals were facilitated by the pediatrician and/or project team for 6-12-year-old children with obesity following well-child visits. Participants chose one of three 26-week interventions focused on healthy eating, physical activity, or a hybrid clinical/nutrition intervention. Interventions engaged parents as change agents, enhancing self-efficacy to model and reinforce behavior and providing resources to help create a healthy home environment. We enrolled 77 of 183 eligible parent/child dyads. We used mixed methods to evaluate the interventions. Repeated measures models among participants showed significant reductions in obesogenic nutrition behaviors post-intervention and at 1-year follow-up, including a reduction in sugar-sweetened beverage intake of 2.14 servings/week (95% confidence interval: -3.45, -0.82). There were also improvements in obesoprotective nutrition behaviors (e.g., frequency of family meals, parental self-efficacy related to meal management). One year post-baseline, we observed no significant differences in changes in body mass index (BMI) z-scores comparing child participants with matched controls. Given potential impacts of COVID-19 community restrictions on study outcomes, we conducted qualitative interviews with 13 participants during restrictions, which exemplified how disrupted routines constrained children's healthy behaviors but that intervention participation prepared parents by providing cooking and physical activities at home. Findings support the potential of a telehealth-delivered nutrition intervention to support adoption of healthy weight behaviors.
指南建议初级保健提供者将肥胖儿童转介至行为干预项目，但由于项目可用性、可及性有限以及家长参与度不高，转介情况仍然很少见。2019 - 2020年，我们为在美国宾夕法尼亚州一个医疗系统接受治疗的儿童家庭开发了远程健康指导干预措施。在儿童进行健康体检后，由儿科医生和/或项目团队为6至12岁的肥胖儿童提供干预转介。参与者从三项为期26周的干预措施中选择一项，这些措施分别侧重于健康饮食、体育活动或临床/营养混合干预。干预措施让家长成为改变的推动者，增强他们示范和强化行为的自我效能，并提供资源以帮助营造健康的家庭环境。我们从183对符合条件的家长/儿童二元组中招募了77对。我们采用混合方法对干预措施进行评估。参与者中的重复测量模型显示，干预后及1年随访时，致肥胖营养行为显著减少，包括含糖饮料摄入量每周减少2.14份（95%置信区间：-3.45，-0.82）。在预防肥胖的营养行为方面也有改善（例如家庭聚餐频率、家长与膳食管理相关的自我效能）。在基线后一年，与匹配的对照组相比，我们观察到儿童参与者的体重指数（BMI）z评分变化没有显著差异。考虑到COVID - 19社区限制对研究结果的潜在影响，我们在限制期间对13名参与者进行了定性访谈，这些访谈表明日常活动的中断如何限制了儿童的健康行为，但干预措施的参与通过在家提供烹饪和体育活动让家长有所准备。研究结果支持了通过远程健康提供营养干预以支持采用健康体重行为的潜力。
