Changing Health And Lifestyle Behaviors of Offspring Following Maternal Bariatric Surgery

摘要/项目摘要 超重/肥胖率继续飙升，体重严重程度增加，没有一个年龄段的人幸免于难。 助长这种流行病的是代际联系，反映了遗传、生理、行为和 环境因素。父母肥胖，特别是母亲严重肥胖，是儿童肥胖的有力预测因素。 孩子的后代。父母是影响儿童生活方式行为发展的主要因素，起着 家庭食物环境(HFE)的看门人，并通过育儿实践和 模特，儿童肥胖预防和发展的所有关键驱动因素。对于数以百万计的家庭来说， 如果没有新的发现和创新的解决方案，肥胖症将继续下去，目标是减缓最高风险的年轻人 这些代际趋势。代谢和减肥手术(MBS)是治疗重症 肥胖，大多数患者为女性，年龄约40岁，其中许多是患有 已经超重/肥胖的被供养儿童。这些母亲可能会经历令人印象深刻的体重 在MBS之后失去并做出自己显著的生活方式改变，但可能不会改变肥胖 改善家庭性质，减少已知的对后代的风险。母性住房抵押贷款证券化可能是一种独特的强大 (但目前错过了)有效干预的代际机会。目前的调查人员是 参与HALO(子女的健康和生活方式行为)的迭代开发，由父母领导 针对高危儿童人群(即居住在6-12岁子女；体重)的行为干预 指数[BMI；第70和120%的重度肥胖母亲)，这是唯一良好的- 计时，当母亲们在MBS后的第一年高度致力于行为改变和减肥时。 目前的应用是相对于HALO的第二阶段中试和可行性随机临床试验 50名母亲/儿童双胞胎(每只手臂随机分配n=25人)提高了护理标准。除了检查 Halo的可行性、可接受性和母亲满意度，我们将检查Halo在预防中的效果 儿童超重增加的可能性。我们还将评估次要结果的变化，包括被认为是 儿童zBMI的变化机制(例如，儿童每日总千卡摄入量)、HFE的变化(例如， 每人总千卡的存在)，以及与儿童喂养有关的育儿行为(例如，限制， 监控)。HALO的可行性和初步效果的演示将作为第三阶段的基础 R01应用程序，用于在母亲MBS的背景下测试持续更健康的儿童体重结果。光晕 有可能通过创建儿科和儿科之间的合作伙伴关系来革命性地改变护理路径 成人护理，以解决一种慢性代际疾病。

ABSTRACT/PROJECT SUMMARY Overweight/obesity rates continue to surge, with severity of weight increasing and no age group spared. Fueling this epidemic are intergenerational links reflecting an interplay of genetic, physiological, behavioral and environmental factors. Parental obesity, particularly maternal severe obesity, is a potent predictor of obesity in child offspring. Parents are the primary influence on the development of pediatric lifestyle behaviors, acting as gatekeepers of the home food environment (HFE) and shaping eating behaviors via parenting practices and modelling, all key drivers in childhood obesity prevention and development. For millions of families, the cycle of obesity will continue without new discoveries and innovative solutions targeting youth at highest risk to slow these intergenerational trends. Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, with most patients female and approximately 40 years of age, many of whom are mothers with dependent children who already have overweight/obesity. These mothers may experience impressive weight loss and make their own significant lifestyle changes following MBS yet may not be changing the obesogenic nature of the household and diminishing the known risk to offspring. Maternal MBS may be a uniquely powerful (yet currently missed) intergenerational opportunity to effectively intervene. The present investigators are engaged in the iterative development of HALO (Health And Lifestyle Behaviors In Offspring), a parent-led behavioral intervention targeting a high-risk pediatric population (i.e., residing offspring ages 6-12; body mass index [BMI] > the 70th and < 120% of the 95th percentiles of mothers with severe obesity) that is uniquely well- timed, when mothers are highly engaged in behavior change and losing weight during the first post-MBS year. The current application is the Phase 2 pilot and feasibility randomized clinical trial of HALO relative to enhanced standard of care with 50 mother/child dyads (randomized n = 25 per arm). In addition to examining HALO feasibility, acceptability, and maternal satisfaction, we will examine efficacy of HALO on the prevention of child excess weight gain. We will also assess change in secondary outcomes including factors thought to be mechanisms for change in child zBMI (e.g., child daily intake of total kcals), changes in the HFE (e.g., presence per person of total kcals), and parenting behaviors related to child feeding (e.g., restriction, monitoring). Demonstration of HALO’s feasibility and initial efficacy will serve as the groundwork for a Phase 3 R01 application to test for sustained healthier child weight outcomes in the context of maternal MBS. HALO has the potential to revolutionize care pathways by creating a synergy of partnerships between pediatric and adult care to address a chronic intergenerational disease.