Development of an Early Intervention for the Prevention of Childhood Obesity

描述（由申请人提供）：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，超重的增加对儿童健康的影响已经很明显，包括高血压、胰岛素血症、2型糖尿病和胆固醇水平，而且毫无疑问，随着时间的推移，这种影响会越来越大。根据最近完成的一项前瞻性风险因素研究的结果，拟议的项目测试了一种早期预防儿童超重的创新方法。该研究的结果表明，如果一个或两个超重/肥胖父母的孩子具有高度反应性的气质，那么孩子的风险将增加一倍以上。这一群体在童年时期变得超重的风险最高，占父母超重的人的42%，是本研究的重点。核心假设是，面对这种性格的孩子所带来的行为问题，父母往往会过度控制孩子的行为，包括喂食。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的自我调节能力不足，从而使他们面临超重的风险。本研究的具体目的是在2-3岁的儿童中开发并测试一种干预措施，以在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调查和通过来自高风险和低风险儿童家庭的焦点小组收集数据，从而制定一项干预措施，以减少父母对儿童喂养的过度控制。第二阶段将包括对100个有高危儿童的家庭进行随机对照研究，将干预与标准体重控制/健康生活计划进行比较。如果干预成功，下一步将是在一个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减少儿童后期超重的患病率，并探索干预的作用机制。儿童超重的流行率在过去10年里翻了一番，对国家的健康构成了重大威胁，并增加了卫生服务的成本，因为这些儿童中的许多人成为肥胖的成年人，并出现了相关的健康问题。这些变化对公共卫生构成重大挑战。预防肥胖是一项多层次的任务，没有一种方法可能会成功。因此，预防方案可能包括监管变化，例如，影响食品的营养标签和广告；以人口为基础的信息和教育计划；教育和行为改变项目针对不同年龄段的群体，如学校和个人，包括高危人群，并试图改变易导致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发现，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.