Preventing childhood obesity through a family-based mindfulness intervention

描述(申请人提供)：儿童肥胖是一个严重的公共卫生问题。儿童肥胖与成年肥胖和增加糖尿病、心脏病和某些癌症的风险有关。值得注意的是，肥胖在低收入少数民族儿童和父母肥胖的儿童中尤其普遍。学龄前儿童(2-5岁)刚刚开始形成饮食和体力活动(PA)偏好的模式，因此这是预防计划的理想目标年龄，特别是可以改善家庭儿童在家中提供的食物和活动选择的家庭计划。重要的基础研究表明，父母的压力是儿童肥胖的一个风险因素。这种风险在面临多种慢性压力的低收入家庭中可能会加剧。基于正念的压力减轻(MBSR)是一种经验性的治疗方法，可以减轻成年人的压力。然而，MBSR对父母压力和儿童肥胖的潜在影响尚未得到测试。这项拟议的研究的目标是测试以育儿为重点的MBSR版本加上营养和体力活动咨询的初步可行性和效果大小，以减轻来自低收入城市家庭的高危2-5岁儿童的父母压力并预防肥胖。我们假设，在高压力低收入肥胖父母的子女中，MBSR加营养和PA咨询(MBSR N)将减轻父母的压力，改善育儿方式，增加健康饮食和PA，并预防肥胖。这项拟议的研究汇集了儿童发展、肥胖行为干预、儿童内分泌学、营养学和运动生理学等多学科的专家团队，以在城市社区诊所试行MBSR N的可行性和初步效果。将从一家服务于低收入城市社区的儿童指导诊所招募60名超重的2-5岁儿童父母，他们表示压力很大。父母将被随机分配接受为期8周的MBSR N干预(基于由Sinha博士共同开发的针对成年人的MBSR加营养和PA干预)或接触对照组N组。在干预前和干预后，在6个月和1年的随访中，我们将收集问卷、临床访谈和生物学指标 父母和孩子的压力(包括皮质醇对实验室应激源的反应)，父母教养，父母和孩子的饮食行为和PA，以及儿童BMI百分位数得分。我们还将收集有关父母BMI和代谢变量(如葡萄糖)的数据。我们将评估MBSR N的可行性和可接受性，并将测试最初的干预效果并确定效果大小，以计划进行MBSR N的充足动力的长期疗效试验。这项研究将提供：1.MBSR N的初步疗效数据，2.R01提案的试点数据，以进行MBSR N的大型长期试验，3.MBSR N在现实世界社区诊所环境中可接受的证据，以及4.高危儿童肥胖发展的纵向数据。如果有效，MBSR N可能是一种新的策略，可以减少高危成年人的压力和肥胖，同时防止他们年幼儿童的超重/肥胖。

DESCRIPTION (provided by applicant): Childhood obesity is a serious public health problem. Childhood obesity is associated with obesity in adulthood and increased risk for diabetes, heart disease, and some cancers. Notably, obesity is particularly common in low-income ethnic minority children and children of obese parents. Preschool-aged children (aged 2-5 years) are just beginning to form patterns of eating and physical activity (PA) preferences and so this is an ideal age to target in prevention programs, particularly family-based programs which can improve food and activity choices offered to young children at home. Significant basic research indicates parent stress as a risk factor for child obesity. This risk may be exacerbated in low-income families who face multiple chronic stressors. Mindfulness-based stress reduction (MBSR) is an empirically-supported treatment that reduces stress in adults. However, the potential effects of MBSR on parent stress and child obesity have not been tested. The goal of the proposed study is to test initial feasibility and obtain effect sizes for a parenting-focused version of MBSR plus nutrition and physical activity counseling to reduce parent stress and prevent obesity in at-risk 2-5 year olds from low-income urban families. We hypothesize that MBSR plus nutrition and PA counseling (MBSR+N) for parents will decrease parent stress, improve parenting, increase healthy eating and PA, and prevent obesity in children of highly stressed low-income obese parents. The proposed study brings together a multidisciplinary team of experts in child development, behavioral interventions for obesity, pediatric endocrinology, nutrition, and exercise physiology to pilot test the feasibility and initial efficac of MBSR+N in an urban community-based clinic. 60 overweight parents of 2-5 year olds reporting high stress levels will be recruited from a child guidance clinic serving a low-income urban community. Parents will be randomly assigned to receive either an 8 week MBSR+N intervention (based on the MBSR plus nutrition and PA intervention for adults developed by Dr. Sinha, co-PI) or to a contact control+N group. At pre- and post-intervention and at a 6 month and 1 year follow-up, we will collect questionnaire, clinical interview, and biological measures of parent and child stress (including cortisol response to a laboratory stressor), parenting, parent and child eating behavior and PA, and child BMI percentile scores. We will also collect data on parent BMI and metabolic variables (e.g., glucose). We will assess feasibility and acceptability of MBSR+N and will test initial intervention effects and determine effect sizes to plan for an adequately- powered long-term efficacy trial of MBSR+N. The study will provide: 1. Initial efficacy data for MBSR+N, 2. Pilot data for a R01 proposal to conduct a large long-term trial of MBSR+N, 3. Evidence of acceptability of MBSR+N in a real-world community clinic setting, and 4. Longitudinal data on the development of obesity in at-risk children. If effective, MBSR+N could be a novel strategy to reduce stress and obesity in high risk adults and simultaneously prevent overweight/obesity in their young children.