Changing Health And Lifestyle Behaviors of Offspring Following Maternal Bariatric Surgery

摘要/项目总结 超重/肥胖率继续激增，体重严重程度增加，没有年龄组幸免。 助长这一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，是肥胖的一个有力的预测因素， 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， 家庭食物环境（HFE）的守门人，通过育儿实践塑造饮食行为， 建模，所有儿童肥胖预防和发展的关键驱动因素。对于数百万家庭来说， 如果没有新的发现和创新的解决方案， 这些代际趋势。代谢和减肥手术（MBS）是最有效的治疗严重 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/肥胖的受抚养儿童。这些母亲可能会经历令人印象深刻的体重 在MBS之后，他们可能会失去并改变自己的生活方式，但可能不会改变肥胖的原因。 家庭的性质，并减少已知的风险，以后代。母亲MBS可能是一种独特的强大的 (yet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（后代健康和生活方式行为）的迭代开发，这是一个由父母主导的 针对高危儿科人群的行为干预（即，6-12岁的居住后代;体重 指数[BMI] >第70和< 120%的第95位母亲患有严重肥胖症），这是独特的良好- 在MBS后的第一年，母亲们高度参与行为改变和减肥。 目前的申请是HALO的2期先导性和可行性随机临床试验， 50例母婴配对的强化标准治疗（每组随机化n = 25）。除了审查 HALO的可行性，可接受性和产妇的满意度，我们将检查HALO的预防效果 儿童体重增加过多。我们还将评估次要结局的变化，包括被认为是 儿童zBMI变化的机制（例如，儿童每日总卡路里摄入量），HFE的变化（例如， 每人总千卡的存在），以及与儿童喂养有关的养育行为（例如，限制， 监测）。HALO的可行性和初步疗效的证明将作为第三阶段的基础。 R 01应用于在母体MBS的背景下测试持续健康的儿童体重结果。卤素 通过在儿科和儿科之间建立合作伙伴关系， 成人护理，以解决慢性代际疾病。

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.