Behavioral Skill Adherence in Pediatric Obesity Treatment

描述（由申请人提供）：儿童肥胖症是一个非常普遍的问题，需要治疗和预防努力，以减少受影响儿童和儿童人群的心血管疾病风险和代谢后果。以家庭为基础的儿童肥胖症行为治疗的疗效可能会受到父母和儿童对食物和活动监测、应急管理和环境控制等行为技能的非最佳使用的影响。参与者行为技能使用（BSU）是成人肥胖治疗结果最有效的相关因素之一。然而，在儿童肥胖治疗试验中，BSU评估并不常见，进行时通常仅通过父母报告回顾性回顾，可靠性未知，并且不完整，大多仅评估食物监测的质量。不良和不完整的BSU测量妨碍改善儿童肥胖的行为干预。此外，帮助家庭在治疗期间和治疗后启动和维持BSU的不同方法尚未得到测试。本R21发展/探索性提案响应PA-06-298 -了解儿童和青少年健康风险行为变化的机制，旨在研究1）治疗期间和治疗后测量的BSU与儿童体重状态、体力活动和饮食变化之间的前瞻性关系，2）治疗期间和治疗后不同实施方法（处方与自我指导）之间BSU轨迹的差异。82对父母-孩子将被随机分配接受以家庭为基础的儿童行为肥胖治疗的处方或自我指导的实施方法。将在基线、第5、10和15次治疗、治疗后以及3个月和6个月随访时评估父母和干预者对家庭使用每种行为技能（监测、应急管理、环境控制）的报告。还将在这些时间点对每项技能的使用进行补充评估。将检查在治疗过程中和整个随访期间，由多个受试者/格式多次测量的BSU与儿童体重状态（z-BMI）和体重相关行为（饮食、体力活动）变化之间的前瞻性关联。该提案将提供有关BSU类型及其与短期和长期治疗疗效最相关的测量的重要信息，并提供关于不同实施方法的相对疗效的试点数据，以启动和维持儿童肥胖干预中的BSU。 在美国，儿童肥胖症是一个日益严重的公共卫生问题，对个人和人群具有负面的健康、心理社会和经济后果。该提案探讨了改善儿童超重干预措施的核心机制和战略。

DESCRIPTION (provided by applicant): Pediatric obesity is a highly prevalent problem, requiring both treatment and prevention efforts to reduce cardiovascular disease risk and metabolic consequences among affected children and the child population. The efficacy of family-based behavioral pediatric obesity treatment is likely compromised by non-optimal parent and child use of the behavioral skills of food and activity monitoring, contingency management, and environmental control. Participant behavioral skills use (BSU) is among the most potent correlates of adult obesity treatment outcome. However, in pediatric obesity treatment trials, BSU assessment is infrequent, when conducted is often only retrospectively recalled by parent report, has unknown reliability, and is incomplete, mostly assessing only the quality of food monitoring. Poor and incomplete BSU measurement precludes improving behavioral interventions for pediatric obesity. Furthermore, different approaches to help families initiate and sustain BSU during and following treatment have not been tested. This R21 developmental/exploratory proposal, in response to PA-06-298 - Understanding Mechanisms of Health Risk Behavior Change in Children and Adolescents-, aims to investigate 1) prospective relations between BSU measured during and following treatment and change in child weight status, physical activity, and diet, and 2) differences in BSU trajectory between different implementation approaches (prescriptive versus self-directed) during and following treatment. Eighty-two parent-child pairs will be randomly assigned to receive either a prescriptive or self-directed implementation approach to family-based behavioral pediatric obesity treatment. Parent- and interventionist-report of the family's use of each behavioral skill (monitoring, contingency management, environmental control) will be assessed at baseline, at the 5th, 10th, and 15th treatment sessions, at post-treatment and at the 3-month and 6-month follow-ups. A supplemental assessment of use of each skill will also be conducted at these time points. Prospective associations between BSU, measured multiple times and by multiple informant/formats, and change in child weight status (z-BMI) and weight-related behaviors (diet, physical activity) over the course of treatment and throughout follow-up will be examined. This proposal will provide important information about the type of BSU and its measurement that is most related to short- and long-term treatment efficacy, and provide pilot data on the relative efficacy of different implementation approaches to initiate and sustain BSU in pediatric obesity intervention. Pediatric obesity is a growing public health problem in the United States and has negative health, psychosocial, and economic consequences for individuals and the population. This proposal investigates core mechanisms and strategies for improving interventions for childhood overweight.