Preventing Childhood Obesity Through a Mindfulness-based Parent Stress Intervention

摘要 儿童肥胖是一个重大的公共卫生问题，它容易导致成人肥胖并严重 与肥胖相关的疾病。肥胖在低收入家庭和肥胖父母的孩子中尤为常见， 世卫组织也报告了更高的压力水平。父母的高压力与体力活动减少有关， 暴饮暴食，父母和他们的孩子体重增加。虽然营养和行为预防措施有 针对低收入家庭进行了测试，父母的压力并不针对高压力、低收入肥胖者 高危学龄前儿童的父母。在之前的R21试点项目中，我们开发了一个新的项目，即育儿 专注于健康，目标是父母的压力，包括营养和体力活动咨询(PMH N)， 为了减轻压力，改善育儿方式和健康的家庭选择，以防止2-5岁儿童肥胖 孩子们。研究结果表明，PMH N是可行的、可接受的，并改善了父母的压力和父母教养方式 防止儿童体重指数(BMI)百分位数相对于接触控制营养(C，N)增加。 基于有希望的初步发现，我们现在提出一个为期5年的R01项目，以评估PMH N与C N在 大样本的亲子二人组，包括两年的长期随访，以建立持久的影响 PMH N关于减轻父母压力，改善育儿方式以促进健康饮食和体育锻炼(PA) 在父母和儿童中，反过来，防止儿童肥胖风险在学龄前儿童从高压力，低压力 收入家庭。低收入、高度紧张、肥胖的亲子二人组(N=240，2-5岁儿童)将是 随机分配接受为期12周的PMH N或C N干预并参与玩具等待 任务(TWT)评估观察到的亲子互动作为生物行为测量前/后的挑战 评估父母教养和压力反应的干预措施。将解决以下具体目标：(1)测试 12周PMH N与C N在减轻父母压力、改善父母养育和健康方面的效果 父母和孩子降低儿童肥胖风险的行为；(2)检查父母的压力反应，观察 父母教养、家庭食物摄入量和体力活动是PMH-N与C-N对父母和 儿童体重指数；(3)检验PMH N和C N对父母养育、健康行为和儿童的持久影响 BMI百分位数在两年随访期内降低肥胖风险；以及(4)检查以下因素的持久影响 父母压力、养育方式、健康行为、父母体重和代谢功能的变化 干预措施：随访2年。成功完成拟议的跨学科项目将提供 支持一种创新的方法来降低低收入、有压力的家庭的儿童早期肥胖风险 同时也解决了高危成年父母的压力和肥胖问题。研究结果将提供关键的纵向 关于父母压力以及家庭和父母教养因素在高危儿童肥胖发展中的数据， 可以为未来的公共卫生干预措施提供信息，以遏制肥胖在儿童和成人中日益流行的现象。

ABSTRACT Childhood obesity is a significant public health problem that predisposes to adult obesity and serious obesity-related diseases. Obesity is particularly common in low-income families and children of obese parents, who also report higher levels of stress. High stress in parents is associated with decreased physical activity, overeating, and increased weight in parents and their children. While nutrition and behavioral preventions have been tested for low-income families, parent stress has not been targeted in highly stressed, low-income obese parents of at-risk preschoolers. In a previous pilot R21 project, we developed a novel program, Parenting Mindfully for Health, that targets parent stress and includes Nutrition and physical activity counseling (PMH+N), to reduce stress, improve parenting and healthy family choices to prevent childhood obesity in 2-5-year-old children. Findings indicated that PMH+N is feasible, acceptable, and improved parent stress and parenting to prevent increases in child body mass index (BMI) percentile relative to the contact Control with Nutrition (C+N). Building on promising preliminary findings, we now propose a 5-year R01 project to assess PMH+N vs. C+N in a large sample of parent-child dyads, and including a long-term 2-year follow-up to establish enduring effects of PMH+N on reducing parent stress, improving parenting to promote healthy eating and physical activity (PA) in parents and children, and in turn, prevent childhood obesity risk in preschoolers from highly-stressed, low- income families. Low-income, highly-stressed, obese parent-child dyads (N=240, children aged 2-5) will be randomly assigned to receive a 12-week PMH+N or C+N intervention and participation in a Toy Wait Task(TWT) challenge to assess observed parent-child interaction as a bio-behavioral measure pre/post intervention to assess parenting and stress responses. The following specific aims will be addressed: (1) test the efficacy of 12-week PMH+N vs. C+N in reducing parent stress and improving parenting and health behaviors in parent and child to decrease childhood obesity risk; (2) examine parent stress response, observed parenting, and family food intake and physical activity as mediators of PMH+N vs. C+N effects on parent and child BMI; (3) examine the enduring effects of PMH+N vs. C+N on parenting and health behaviors and child BMI percentile in reducing obesity risk over a 2-year follow-up period; and (4) examine the enduring effects of changes on parent stress, parenting and health behaviors, parent weight and metabolic functioning post intervention during 2-year follow-up. Successful completion of the proposed interdisciplinary project will provide support for an innovative approach to decrease early childhood obesity risk in low-income, stressed families while also addressing stress and obesity in high-risk adult parents. Findings will provide critical longitudinal data on parent stress and family and parenting factors in the development of obesity in at-risk children, that may inform future public health interventions to curb the growing epidemic of obesity in children and adults.