Exploring the Familial Reach of Adolescent Obesity Treatment

探索青少年肥胖治疗的家庭影响力

• 批准号: 10450241
• 负责人: Melanie K Bean
• 金额: $ 24.99万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-10 至 2024-02-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10450241
• 关键词: Adolescence; Adolescent; Adolescent obesity; Adult; Age; Behavioral; Black race; Body Weight Changes; Body Weight decreased; Caregivers; Child; Child Rearing; Clinical; Data; Development; Diet; Dietary intake; Educational process of instructing; Enrollment; Environment; Exercise; Familial disease; Family; Family member; Feeding behaviors; Female; Food; Frequencies; Future; Gold; Guidelines; Home; Home environment; Household; Individual; Intervention; Lead; Maintenance; Measures; Mediator of activation protein; Modeling; Obesity; Outcome; Overweight; Parents; Participant; Patient Self-Report; Randomized; Randomized Clinical Trials; Research; Siblings; Teenagers; Weight; Weight maintenance regimen; arm; base; clinically significant; digital imaging; experience; feeding; food environment; group intervention; improved; improved outcome; lifestyle intervention; novel; obesity treatment; obesogenic; primary endpoint; programs; sex; skills training; social; success; therapy design; treatment arm; treatment group; treatment response; weight loss intervention; weight maintenance

PROJECT SUMMARY Family-based lifestyle intervention (FBLI) is the gold standard for treating adolescent obesity, which emphasizes the importance of making family-wide changes to the shared home environment. Yet, program assessments overwhelmingly focus on the individual adolescent. Understanding the impact of FBLIs beyond the identified adolescent is important, given that obesity is a familial disease and there are likely bidirectional relations between an adolescent’s treatment success and broader changes in their household. It is unknown if family-wide changes are made within FBLI, or if non-targeted family members experience weight-related benefits. These data are critical, given that weight losses observed in adolescent obesity treatments are generally modest, with no clear guidance regarding the optimal family-based treatment approach during this distinct developmental period. Towards that end, we propose to leverage our ongoing randomized clinical trial (RCT) of TEENS+, a FBLI for adolescents with obesity, to determine: 1) if family-wide changes to the shared home environment are implemented, 2) if ripple effects to untreated family members are observed, and 3) whether these changes are predictive of adolescents’ weight management success. Via R01HD095910, we are evaluating two approaches to involving parents in FBLI to treat adolescent obesity. In this RCT, all adolescents participate in TEENS+, our 4m behavioral weight loss (BWL) treatment. Parents are randomized to either 1) parent skills training based on authoritative parenting (Parents as Coaches; PAC) or 2) concurrent parent BWL (Parent Weight Loss; PWL). TEENS+ was informed by our pilot (HD084930), which included 82 adolescent (M age=13.7±1.2yrs; 52% Black)/parent dyads. We demonstrated that both parent treatments yielded adolescent weight loss at the end of the 4m treatment. Further, improvements to the obesogenic home food environment were observed in both groups; yet a more comprehensive assessment of the shared home environment is needed to determine if broader family-wide changes, including weight changes of non-targeted family members, are executed, and if these changes predict adolescent weight loss. To that end, adolescent/parent dyads will be randomized to TEENS+PAC or TEENS+PWL via our ongoing R01 trial. This ancillary R21 will expand trial assessments and conduct a comprehensive assessment of the shared home feeding and weight environment of the target adolescents. Specifically, we will enroll non-targeted children (8- 17yrs) and caregivers living in the same household as the target parent/adolescent dyad (N=60 families; 30 per treatment group). At 0, 2, 4 (primary endpoint), and 8m, the target parent/adolescent dyad and non- targeted children (n=~80) and caregivers (n=~60), will complete anthropometric assessments. Measures of the shared home feeding and weight environment will also be conducted. Results will determine the familial reach of TEENS+ and reveal potential mediators of treatment response to target directly in future iterations of FBLI to optimize adolescent outcomes.

项目总结 基于家庭的生活方式干预(FBLI)是治疗青少年肥胖的黄金标准， 强调在家庭范围内改变共享家庭环境的重要性。然而，程序 评估压倒性地侧重于青少年个体。了解FBLIS的影响 考虑到肥胖是一种家族性疾病，而且肥胖可能是双向的，确定青少年是很重要的 青少年的治疗成功与其家庭中更广泛的变化之间的关系。目前还不清楚是否 在FBLI中进行家庭范围的更改，或者如果非目标家庭成员经历与体重相关的更改 福利。这些数据至关重要，因为在青少年肥胖治疗中观察到的体重下降是 总体上是温和的，在此期间没有关于最佳家庭治疗方法的明确指导 明显的发育期。为此，我们建议利用我们正在进行的随机临床试验 (RCT)，肥胖青少年的FBLI，以确定：1)家庭范围内是否对共享的 实施家庭环境，2)如果观察到对未治疗的家庭成员的连锁反应，以及3) 这些变化是否预示着青少年体重管理的成功。通过R01HD095910，我们 正在评估两种让父母参与FBLI治疗青少年肥胖的方法。在本RCT中，所有 青少年参与Teens+，我们的4M行为减肥(BWL)治疗。父母是随机的 1)基于权威育儿的家长技能培训(家长作为教练；PAC)或2)同时进行 父母体重下降(父母体重减轻；PWL)。青少年+是由我们的飞行员(HD084930)通知的，其中包括82 青少年(男性=13.7±1.2岁；黑人占52%)/父母二人组。我们证明了两种亲本疗法 在4M治疗结束时，青少年的体重减轻了。此外，对肥胖之家的改善 两组都观察了食物环境；但对共享家庭的评估更全面 需要环境来确定是否有更广泛的家庭范围的变化，包括非针对性的体重变化 如果这些变化预示着青少年体重的下降。为此， 青少年/父母二人组将通过我们正在进行的R01试验随机分为Teens+PAC或Teens+PWL。这 辅助R21将扩大试行评估，对共享家园进行全面评估 目标青少年的饮食和体重环境。具体地说，我们将招收非目标儿童(8- 17岁)和与目标父母/青少年二人组住在同一家庭的照顾者(N=60个家庭；30个 每个治疗组)。在0、2、4(主要终点)和8M处，目标父母/青少年二联体和非 目标儿童(n=~80)和照顾者(n=~60)将完成人体测量评估。三项措施 还将进行共享家庭喂养和体重环境。结果将决定家庭的范围 并在FBLI的未来迭代中直接揭示治疗反应的潜在介体 优化青春期结局。