FOOD SUBSTITUTION FOR CHILD NUTRITION/OBESITY PREVENTION

描述（由申请人提供）：儿童肥胖症在全国范围内不断增加，与严重的健康并发症有关，并会持续到成年期。然而，控制性肥胖预防研究仍然很少。行为经济学理论为概念化和设计此类干预措施提供了一个新颖的框架。为此，我们提出了一项随机对照试验，测试“以家庭为基础的食物替代品”干预措施（有或没有家庭食品供应成分）对有肥胖风险的儿童的长期体重变化的影响。根据行为经济学理论，我们预测增加水果和蔬菜的摄入量将取代非针对性的能量密集型食物的摄入，从而减少有肥胖风险的儿童的体重增加。预计家庭提供目标水果和蔬菜后，这种效果将会增强。参与者将是180个不同种族背景的家庭，目标儿童是4至6岁且有肥胖“风险”的儿童。家庭将被随机分配到以下三个治疗组之一： (1) 最小干预对照； (2) 以家庭为基础的食物替代品（FBFS）； (3) 带有家庭食品的 FBFS。每个条件将有 60 个家庭。分配到对照组的家庭将接受营养教育。分配到 FBFS 组的人员将接受旨在增加儿童水果和蔬菜摄入量的行为策略培训（例如，针对父母的角色建模和应急管理培训）。分配到 FBFS with Home-Food-Provisions 小组的家庭将收到上述包裹以及目标水果和蔬菜的供应，以增强他们的家庭可达性。 主要结果指标是儿童身体成分的短期和两年变化。次要结果将包括饮食摄入量、父母食物准备技能以及水果和蔬菜可及性的测量。中介分析将阐明干预对身体成分变化产生影响的机制。这项研究旨在为环境操纵提供新的见解，从而诱导与预防肥胖相容的食物替代品，同时推进行为经济学理论。

DESCRIPTION (provided by applicant): Childhood obesity is increasing nationwide, is associated with serious health complications, and tracks into adulthood. However, controlled obesity prevention studies remain scarce. Behavioral-economics theory offers a novel framework for conceptualizing and designing such interventions. To this end, we propose a randomized controlled trial that tests the effects of a "Family-Based Food Substitutions" intervention - with and without a Home-Food-Provisions component - on long-term weight change in children at risk for obesity. Based on behavioral-economics theory, we predict that increasing fruit and vegetable intake will substitute for the intake of untargeted energy dense foods and thereby reduce weight gain in children at-risk for obesity. This effect is predicted to be enhanced among families provided home provisions of targeted fruits and vegetables. Participants will be 180 families of diverse ethnic background, with the target child being 4 to 6 years old and "at-risk" for obesity. Families will be randomized to one of the following three treatment groups: (1) Minimal Intervention Control; (2) Family-Based Food Substitutions (FBFS); or (3) FBFS with Home-Food Provisions. There will be 60 families per condition. Families assigned to the control group will receive nutrition education. Those assigned to the FBFS group will be trained in behavioral strategies that target increased child fruit and vegetable intake (e.g., role modeling and contingency management training for parents). Families assigned to the FBFS with Home-Food-Provisions group will receive the aforementioned package plus supplies of targeted fruits and vegetables to enhance their home accessibility. The primary outcome measure will be short-term and 2-year changes in the children's body composition. Secondary outcomes will include measures of dietary intake, parental food preparation skills, and fruit and vegetable accessibility. Mediator analyses will elucidate the mechanisms by which the intervention exerts its effect on changes in body composition. This investigation is designed to provide new insights into environmental manipulations that will induce food substitutions compatible with obesity prevention, while advancing behavioral-economics theory.