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

拉美裔儿童超重和肥胖(OW/OB)和相关慢性病的比率更高，如 如2型糖尿病、非酒精性脂肪性肝病和血脂异常。这种差异在生命的早期就开始了，并持续了下来 进入成年期，并与无数消极的心脏代谢和心理社会健康有关 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)，提供给目标儿童和父母(通常是母亲)。一种新兴战略 是基于父母的治疗(PBT)，只对父母提供干预，而不对孩子进行干预。PBT有 若干好处，包括降低治疗费用、幼儿发育适当性和 更广泛传播的潜力。在正在进行的试验中，我们发现拉美裔家庭参加探视的人数较少， 因此，儿童的治疗效果较差。因此，为拉丁裔家庭量身定做的方案是必要的 能够处理文化价值观，并利用家庭主义的价值。项目2的目标是测试有效性 一项持久的、可行的、与文化相关的计划，以治疗拉丁裔OW/OB并降低慢性病风险 孩子和他们的父母。我们提出了一项随机临床试验来比较拉丁裔家庭的远程医疗PBT 与健康教育(HE)对照组进行关于儿童和父母体重变化与慢性病风险的研究。我们 将招募160个拉丁裔家庭，其中至少有一位父母有OW/OB，至少有一名其他愿意照看的人， 以及一名患有OW/OB的5-10岁儿童，并将他们随机分为6个月的PBT组或对照组。我们将评估结果 治疗前(0个月)、治疗中(3个月)、治疗后(6个月)以及6个月和12个月的随访 向上。具体目标1将在18个月内比较PBT和控制儿童体重(BMIz)的疗效。特定的 目标2将确定PBT对父母BMI、儿童和父母的饮食和体力活动、家庭食物的效果 环境、父母喂养行为、父母教养自信和自我效能感。具体目标3将决定 PBT对儿童和父母患2型糖尿病、肝功能和血脂异常风险的生物标志物的疗效。在……里面 作为探索性目标，我们将评估潜在主持人的影响(例如，父母和孩子的性别和年龄， 文化适应程度、父母教育)和中介因素(例如，家庭食物环境的变化、父母喂养 行为、家庭功能)对干预效果的影响。在跨中心AIM中，此项目的数据将 结合项目1和项目3，审查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裔家庭对不同类型干预措施的反应 用于降低慢性病风险。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来增加接受度和 坚持改变生活方式，并改善慢性病风险，不仅对儿童如此，对父母也是如此。 此外，通过远程医疗提供这种干预将增加这种干预的范围，减少家庭 负担，降低成本，使其更广泛地吸引更广泛的受众传播。

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.