Translating basic habituation research to childhood obesity treatment

项目摘要/摘要 寻找减少长期能量摄入的成功方法仍然是肥胖症患者面临的挑战 治疗。基础的行为学研究发现，习惯化的速度(即 对食物的生理和行为反应与食物的消耗量和更快的适应速度有关 利率降低了食物的摄入量。当食物的种类有限时，食物的习惯性速度就会加快， 产生减少的摄入量。因此，限制高能量密度(红色)食物种类的饮食处方 可以提高减少长期能量摄入的能力，增强长期减肥效果。此外，习惯化 食物的价格表现出很大的个体差异。超重的个体对食物的习惯性比 体重健康和适应速度较慢的人预测标准化儿童的增长更大 体重指数。因此，较慢的食物习惯率可能是罹患糖尿病风险增加的一种行为表型。 体重结果不太理想。那么，加速食物习惯的肥胖干预措施可能会更多 有益于那些有这种行为表型的人。我们一直在进行一系列的翻译研究 这将习惯化理论应用于肥胖治疗，涉及：1)系统地测试基本概念的研究 为了更好地为干预发展提供信息；2)“概念验证”测试；以及3)疗效试验。长期的 目标是开发一种饮食处方，利用习惯化作为一种减少长期 能量摄入。我们在6个月内试行了限量配方(限量品种的红色食品)。 儿童的基于家庭的行为肥胖治疗(FBT)。24个家庭，有一个孩子&>第85百分位数 体重指数(BMI)和8至12岁的儿童被随机分为FBT组或FBT组，其中 饮食品种处方(FBT+综艺)。在6个月时，FBT+综艺的儿童有明显更大的 超重百分比比完全减重(−为15.4%，−为8.9%)。需要研究来检验是否 限制品种可以改善长期的体重减轻，如果这种改善是由于增强的习惯化，并探索 如果有一种行为表型更能从这种饮食方法中受益。我们计划实施 一种新的24个月FBT内的限量食品品种处方，以检查其对24个月BMI的影响。一 体重指数第85个百分位数的8至12岁的156名儿童将随机分为两组，每组24名 在我们为期6个月的先导研究中比较的月干预措施：FBT或FBT+综艺。儿童和成人照顾者 将在0、6、12、18和24个月时对人体测量学、饮食摄入量和习惯化进行评估。我们 将决定：1)FBT+品种对长期减肥的影响；2)FBT+品种的影响 长期习惯化和习惯化率是否在饮食摄入量和BMI之间起中介作用 条件。我们将探索是否可以使用行为表型来确定谁从 品种有限的处方，更好地个体化治疗(“精准医学”)。

PROJECT SUMMARY/ABSTRACT Identifying successful methods for reducing long-term energy intake continues to be a challenge in obesity treatment. Basic behavioral research has found that the rate of habituation (i.e., rate of reduction in physiological and behavioral responding) to food is related to amount of food consumed, and faster habituation rates reduce food intake. The rate of habituation to food can be accelerated when variety in foods is limited, producing decreased intake. Thus, a dietary prescription that limits variety of high-energy-dense (RED) foods may boost ability to reduce long-term energy intake, enhancing long-term weight loss. Furthermore, habituation rates to food show large individual variability. Individuals with overweight habituate slower to food than individuals with a healthy weight, and slower habituation rates predict greater increases in child standardized body mass index. Thus, slower habituation rates to food may be a behavioral phenotype for increased risk of suboptimal weight outcomes. Obesity interventions that accelerate habituation to food may then be more beneficial for those with this behavioral phenotype. We have been conducting a line of translational research that applies habituation theory to obesity treatment, involving: 1) studies systematically testing basic concepts to better inform intervention development; 2) “proof-of-concept” testing; and 3) efficacy trials. The long-term goal is to develop a dietary prescription that harnesses habituation as a mechanism for reducing long-term energy intake. We have piloted a limited variety prescription (limited variety of RED foods) within a 6-month family-based behavioral obesity treatment (FBT) for children. Twenty-four families, with a child > 85th percentile body mass index (BMI) and aged 8 to 12 years, were randomized to FBT or to FBT that included a limited dietary variety prescription (FBT+Variety). At 6-months children in FBT+Variety had a significantly greater reduction in percent overweight than those in FBT (−15.4% vs.− 8.9%). Research is needed to examine if limiting variety improves long-term weight loss, if this improvement is due to enhanced habituation, and explore if there is a behavioral phenotype that more greatly benefits from this dietary approach. We plan to implement a novel limited food variety prescription within a 24-month FBT to examine its effect on 24-month BMI. One hundred fifty-six children aged 8 to 12 years at > 85th percentile BMI will be randomized to one of two, 24- month interventions compared in our 6-month pilot study: FBT or FBT+Variety. Child and adult caregiver assessments will occur at 0, 6, 12, 18, and 24 months on anthropometrics, dietary intake, and habituation. We will determine: 1) the influence of FBT+Variety on long-term weight loss; and 2) the influence of FBT+Variety on long-term habituation and if habituation rate mediates differences in dietary intake and BMI between conditions. We will explore if the behavioral phenotype can be used to identify who benefits most from the limited variety prescription to better individualize treatment (“precision medicine”).