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.

项目摘要 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， 强调对共享家庭环境进行家庭更改的重要性。但是，程序 评估绝大多数集中在个人青少年上。了解FBLI的影响超越 鉴于肥胖是一种家族疾病，并且可能存在双向 青少年的治疗成功与家庭的更大变化之间的关系。未知是否 家庭范围的变化是在FBLI内进行的，或者如果不靶向的家庭成员会经历与体重有关的 好处。鉴于在青少年肥胖治疗中观察到的体重减轻是至关重要的 在此期间，通常没有关于最佳家庭治疗方法的明确指导 独特的发展时期。为此，我们建议利用我们正在进行的随机临床试验 （RCT）青少年+，肥胖青少年的FBLI，以确定：1）如果家庭范围对共享的变化 实施家庭环境，2）如果观察到未经处理的家庭成员的连锁反应，3） 这些变化是否可以预测青少年的体重管理成功。通过R01HD095910，我们 正在评估使父母参与FBLI治疗青少年肥胖的两种方法。在这个RCT中，所有人 青少年参与青少年+，我们的4M行为减肥（BWL）治疗。父母是随机的 1）基于权威育儿的父母技能培训（父母作为教练； PAC）或2）并发 父bwl（父重量减轻； PWL）。青少年+由我们的飞行员（HD084930）告知，其中包括82 青少年（M年龄= 13.7±1.2yrs; 52％黑色）/父二元组。我们证明了两个父母治疗 在4M处理结束时产生青少年体重减轻。此外，改善了肥胖的家园 两组都观察到食物环境。然而，对共享房屋进行了更全面的评估 需要环境来确定更广泛的家庭范围的变化，包括不靶向的重量变化 家庭成员将被执行，如果这些变化可以预测青少年的体重减轻。为此， 青少年/父二聚体将通过我们正在进行的R01试验随机分为青少年+PAC或青少年+PWL。这 辅助R21将扩大试验评估，并对共享房屋进行全面评估 目标青少年的喂养和体重环境。具体而言，我们将招募非目标儿童（8-- 17岁）和与目标父母/青少年二元组在同一家庭中的护理人员（n = 60个家庭； 30 每个治疗组）。在0、2、4（主要终点）和8M时，目标母体/青少年二元组和非 - 有针对性的儿童（n = 〜80）和护理人员（n = 〜60）将完成人体测定评估。措施 还将进行共同的家庭喂养和体重环境。结果将确定家庭到达 青少年+，并揭示了在FBLI将来直接迭代对靶标的治疗反应的潜在介体 优化青少年结果。