FOOD SUBSTITUTION FOR CHILD NUTRITION/OBESITY PREVENTION

描述（由申请人提供）：儿童肥胖在全国范围内呈上升趋势，与严重的健康并发症有关，并可追踪到成年期。然而，控制肥胖预防的研究仍然很少。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”干预——有或没有家庭食物供应的成分——对有肥胖风险的儿童的长期体重变化的影响。基于行为经济学理论，我们预测增加水果和蔬菜的摄入量将取代非目标能量密集食物的摄入，从而减少肥胖风险儿童的体重增加。预计在家庭中提供目标水果和蔬菜的家庭中，这种效果会得到加强。参与者将是180个不同种族背景的家庭，目标儿童为4至6岁，有肥胖“风险”。家庭将被随机分为以下三个治疗组：(1)最小干预控制；(2)基于家庭的食物替代（FBFS）；或(3)提供家庭食品的FBFS。每个项目将有60个家庭参加。被分配到对照组的家庭将接受营养教育。那些被分配到FBFS组的人将接受行为策略方面的培训，以增加儿童水果和蔬菜摄入量为目标（例如，为父母提供角色示范和应急管理培训）。被分配到家庭食品供应小组的家庭将获得上述包裹和目标水果和蔬菜供应，以提高他们的家庭可及性。主要的结果测量将是儿童身体组成的短期和2年内的变化。次要结果将包括膳食摄入量、父母食物制备技能以及水果和蔬菜的可及性。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，这些操纵将诱导与肥胖预防相容的食物替代，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.