Development of an Early Intervention for the Prevention of Childhood Obesity

描述(申请人提供)：该项目的长期目标是开发一种有效的方法来预防儿童超重，从而帮助减轻与儿童、青少年和成人超重和肥胖相关的健康负担。在过去的20年里，超重增加对儿童健康的影响已经很明显，而且随着时间的推移，这种影响无疑会增加。拟议的项目根据最近完成的一项前瞻性风险因素研究的结果，测试了一种早期预防儿童超重的创新方法。这项研究的结果表明，如果孩子有一个或两个超重/肥胖的父母，如果孩子具有高度反应性的气质，风险会增加一倍以上。这一群体是儿童时期超重风险最高的群体，占父母超重的42%，也是这项研究的重点。中心假设是，面对这种气质的孩子带来的行为问题，父母往往会过度控制孩子的行为，包括进食。实验室研究表明，这种过度控制可能会导致儿童对食物摄入量的自我调节不足，使他们面临超重的风险。这项研究的具体目的是开发并测试对2-3岁儿童的干预，以在一项对照研究中确定父母对孩子饮食行为的过度控制是否可以改变。研究的第一阶段将包括通过问卷和通过焦点小组从高风险和低风险儿童的家庭收集数据，从而制定干预措施，以减少父母对其子女喂养的过度控制。第二阶段将包括一项随机对照研究，对象是100个有高危儿童的家庭，将干预措施与标准体重控制/健康生活计划进行比较。如果这项干预被发现是成功的，那么下一步将在一项更大的长期对照研究中进行测试，以确定父母对饮食控制的改变是否会降低儿童后期超重的患病率，并探索干预起作用的机制。在过去的10年里，儿童超重的流行率翻了一番，对国家的健康构成了重大威胁，并增加了医疗服务的成本，因为这些儿童中的许多人成为肥胖的成年人，并伴随着相关的健康问题。这些变化构成了一个重大的公共卫生挑战。预防肥胖是一项多层次的任务，没有一种方法可能取得成功。因此，预防计划可能包括监管变化，例如，影响食品的营养标签和广告；基于人口的信息和教育计划；针对群体(如学校)和不同年龄段的个人(包括高危群体)的教育和行为改变计划：以及试图改变容易超重和肥胖的家庭环境。这项研究试图转化实验室和风险因素研究的基本结果，旨在改变家庭环境的一个特定方面。

DESCRIPTION (provided by applicant): The long-term aim of this project is to develop an effective method to prevent childhood overweight thus helping to reduce the health burden associated with overweight and obesity in children, adolescents, and adults. The effects of the increase in overweight over the past 20 years on children's health in terms of higher blood pressure, insulinemia, Type 2 diabetes, and cholesterol levels are already evident, and will undoubtedly grow over time. The proposed project tests an innovative approach to the early prevention of childhood overweight based on the results of a recently completed prospective risk factor study. The findings from that study suggested that the risk for children with one or two overweight/obese parents was more than doubled if the child had a highly reactive temperament. This group, at the highest risk of becoming overweight in childhood, comprised 42 percent of those with an overweight parent or parents, and is the focus of this study. The central hypothesis is that parents faced with the behavior problems posed by a child with this temperament tend to over-control the child's behavior, including feeding. Laboratory studies have shown that such over-control may lead to the child developing inadequate self-regulation of food intake putting them at risk for the development of overweight. The specific aims of this study are to develop and then test an intervention in children aged 2-3 years to ascertain in a controlled study whether parental over-control of their child's eating behavior can be modified. The first phase of the study will involve data collection both by questionnaire and through focus groups from families of high and low- risk children, leading to the development of an intervention to reduce parental over- control of their children's feeding. The second phase will consist of a randomized controlled study with 100 families with a high-risk child, comparing the intervention with a standard weight control/healthy living program. If the intervention is found successful then the next step would be test it in a larger longer-term controlled study to ascertain whether change in parental control over eating reduces the prevalence of overweight in later childhood, and to explore the mechanism through which the intervention works. The prevalence of childhood overweight has doubled over the past 10-years posing a major threat to the nation's health, and additional costs to health services, as many of these children become obese adults with the associated health problems. These changes present a major public health challenge. Prevention of obesity is a multi-level task with no one approach likely to produce success. Hence, prevention programs may include regulatory changes, e.g., affecting nutritional labeling and advertising of food products; population based information and education programs; educational and behavior change programs aimed at groups e.g., schools, and individuals across the age span, including high-risk groups: and attempts to modify family environments that predispose to overweight and obesity. This study attempts to translate basic findings from laboratory and risk factor studies and is aimed at modifying a specific aspect of the family environment.