Caregivers as the Agent of Change for Childhood Obesity and Chronic Disease Risk Among Latino Families

拉丁裔儿童超重和肥胖（OW/OB）以及相关慢性疾病的发病率较高， 如2型糖尿病、非酒精性脂肪肝和血脂异常。这种差异在生命早期就开始了， 进入成年期，并与无数的负面心脏代谢和心理健康有关 后果目前，最有效的儿童体重管理方案是以家庭为基础的 治疗（FBT），这是交付给目标儿童和父母（通常是母亲）。新兴战略 是基于父母的治疗（PBT），它只为父母提供干预，而不包括孩子。PBT具有 几个好处，包括降低治疗费用，发育适合年幼的儿童， 更广泛传播的潜力。在正在进行的试验中，我们发现拉丁裔家庭参加的访问较少， 因此，儿童的治疗效果较差。因此，需要为拉丁美洲家庭量身定制的计划， 可以处理文化价值观并利用家庭主义的价值。项目2的目标是测试 一个持久的，可行的，文化相关的计划，以治疗OW/OB和减少慢性疾病的风险，在拉丁美洲 孩子和他们的父母。我们提出了一个随机临床试验，比较远程医疗PBT为拉丁美洲家庭 健康教育（HE）对照组的儿童和父母体重的变化和慢性病的风险。我们 将招募160个拉丁裔家庭，其中至少有一名父母患有OW/OB，至少有一名其他愿意照顾的人， 和一名5-10岁的OW/OB儿童，并将他们随机分为6个月PBT组或对照组。我们将评估结果 治疗前（第0个月）、治疗中（第3个月）、治疗后（第6个月）以及6个月和12个月随访时- 起来具体目标1将比较PBT与对照组在18个月内对儿童体重（BMIz）的疗效。具体 目的2将确定PBT对父母BMI、儿童和父母饮食和体力活动、家庭食物 环境、父母喂养行为与父母教养信心和自我效能感的关系。第3章将决定 PBT对儿童和父母2型糖尿病、肝功能和血脂异常风险生物标志物的疗效。在 我们将评估潜在调节者的影响（例如，父母和孩子的性别和年龄， 文化适应水平、父母教育）和调解人（例如，改变家庭饮食环境，父母喂养 行为、家庭功能）对干预效果的影响。在跨中心目标中，本项目的数据将 结合项目1和项目3，研究拉丁裔儿童慢性病风险的多层次决定因素， 以及社会和环境因素如何影响拉丁美洲家庭对不同类型干预措施的反应 来降低慢性病的风险。为患有OW/OB的拉丁裔儿童制定干预措施， 需要围绕食物的文化价值观和家庭结构的重要性，以提高接受度， 坚持生活方式的改变，并改善慢性病的风险，不仅在儿童，而且在父母。 此外，通过远程保健提供这种干预措施将增加这种干预措施的覆盖面，减少家庭暴力， 减轻负担，降低成本，并使其更广泛地吸引更广泛的受众。

Latino children have higher rates of overweight and obesity (OW/OB) and related chronic diseases, such as type 2 diabetes, non-alcoholic fatty liver disease, and dyslipidemia. This disparity starts early in life, persists into adulthood, and is associated with a myriad of negative cardiometabolic and psychosocial health consequences. At present, the most effective program for weight management in children is family-based treatment (FBT), which is delivered to the target child and a parent (typically the mother). An emerging strategy is parent-based treatment (PBT), which provides intervention to the parent only, without the child. PBT has several benefits, including decreased treatment costs, developmental appropriateness for younger children and potential for broader dissemination. In ongoing trials, we have found that Latino families attend less visits and consequently treatment in children is less effective. Thus, a tailored program for Latino families is needed that can address cultural values and capitalize on the value of familismo. The goal of Project 2 is to test the efficacy of a durable, feasible, culturally relevant program to treat OW/OB and reduce chronic disease risk in Latino children and their parents. We propose a randomized clinical trial to compare a telehealth PBT for Latino families with a health education (HE) control group on changes in child and parent weight and chronic disease risk. We will recruit 160 Latino families consisting of at least one parent with OW/OB, at least one other willing caregiver, and a 5-10-year-old child with OW/OB and randomize them to 6-month PBT or control. We will assess outcomes before treatment (month 0), mid-treatment (month 3), post-treatment (month 6), and at 6- and 12-month follow- up. Specific Aim 1 will compare the efficacy of PBT versus control on child weight (BMIz) over 18 months. Specific Aim 2 will determine the efficacy of PBT on parent BMI, child and parent diet and physical activity, home food environment, parent feeding behaviors and parenting confidence and self-efficacy. Specific Aim 3 will determine the efficacy of PBT on child and parent biomarkers of risk of type 2 diabetes, liver function and dyslipidemia. In an exploratory aim we will evaluate the impact of potential moderators (e.g., parent and child gender and age, acculturation level, parent education) and mediators (e.g., change in home food environment, parent feeding behaviors, family functioning) on intervention efficacy. In a cross-center aim, data from this Project will be combined with Projects 1 and 3 to examine the multi-level determinants of chronic disease risk in Latino children, and how social and environmental factors affect the response to different types of interventions in Latino families for reducing chronic disease risk. The development of interventions for Latino children with OW/OB that address cultural values around food and the importance of family structure are needed to increase acceptance and adherence to lifestyle changes, and to improve chronic diseases risk, not just in children but also in parents. Further, delivering this intervention via telehealth will increase the reach of this intervention, decrease family burden, lower the cost and make it more broadly appealing for dissemination to a wider audience.