Preventing Childhood Obesity Through a Mindfulness-based Parent Stress Intervention

摘要 儿童肥胖症是一个重大的公共卫生问题，它易导致成人肥胖症， 肥胖相关疾病。肥胖症在低收入家庭和肥胖父母的孩子中特别常见， 他们也报告了更高的压力。父母的高压力与身体活动减少有关， 暴饮暴食，父母和孩子的体重增加。虽然营养和行为预防 对低收入家庭进行了测试，父母的压力并没有针对高度紧张，低收入肥胖 高危学龄前儿童的父母在之前的R21试点项目中，我们开发了一个新颖的程序，育儿 注意健康，针对父母的压力，包括营养和身体活动咨询（PMH+N）， 减少压力，改善育儿和健康的家庭选择，以防止2-5岁儿童肥胖 孩子研究结果表明，PMH+N是可行的，可接受的，并改善父母的压力和养育， 防止儿童体重指数（BMI）百分位数相对于接触营养控制（C+N）的增加。 基于有希望的初步研究结果，我们现在提出一个为期5年的R 01项目，以评估PMH+N与C+N在 一个大样本的父母-孩子的二对，并包括一个长期的2年随访，以建立持久的影响 PMH+N对减轻父母压力，改善养育方式以促进健康饮食和体育活动的作用（PA） 在父母和孩子，反过来，防止儿童肥胖的风险，在学龄前儿童从高度紧张，低， 收入家庭。低收入、高压力、肥胖的父母-子女配对（N=240，2-5岁儿童）将 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）挑战，以评估观察到的亲子互动作为治疗前/治疗后的生物行为指标 评估养育和压力反应的干预措施。具体目标如下：（1）测试 12周PMH+N与C+N在减轻父母压力和改善养育和健康方面的疗效 父母和孩子减少儿童肥胖风险的行为;（2）检查父母的压力反应，观察 父母养育、家庭食物摄入和体力活动作为PMH+N与C+N对父母和 （3）研究PMH+N与C+N对父母教养和健康行为以及儿童BMI的持久影响。 BMI百分位数在2年随访期内降低肥胖风险的作用;（4）检查 父母压力、父母教养与健康行为、父母体重和代谢功能的变化 2年随访期间进行干预。成功完成拟议的跨学科项目将提供 支持采取创新方法，减少低收入、有压力家庭的幼儿肥胖风险 同时也解决了高风险成年父母的压力和肥胖问题。调查结果将提供关键的纵向 关于父母压力以及家庭和养育因素在高危儿童肥胖症发展中的数据， 可能为未来的公共卫生干预提供信息，以遏制儿童和成人肥胖症的日益流行。

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.