Preventing childhood obesity through a family-based mindfulness intervention

描述（由申请人提供）：儿童肥胖是一个严重的公共卫生问题。儿童期肥胖与成年期肥胖有关，并增加患糖尿病、心脏病和某些癌症的风险。值得注意的是，肥胖在低收入少数民族儿童和肥胖父母的儿童中特别常见。学龄前儿童（2-5岁）刚刚开始形成饮食和体育活动（PA）偏好的模式，因此这是预防计划的理想目标年龄，特别是以家庭为基础的计划，可以改善家庭为幼儿提供的食物和活动选择。重要的基础研究表明，父母压力是儿童肥胖的危险因素。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。基于正念的减压（MBSR）是一种治疗支持的治疗方法，可以减轻成年人的压力。然而，正念减压疗法对父母压力和儿童肥胖的潜在影响尚未得到验证。这项研究的目的是测试最初的可行性，并获得以父母为中心的MBSR版本加上营养和身体活动咨询的效果大小，以减少父母的压力，并预防来自低收入城市家庭的2-5岁高危儿童肥胖。我们假设，MBSR加营养和PA咨询（MBSR+N）的父母将减少父母的压力，改善养育，增加健康的饮食和PA，并防止高度紧张的低收入肥胖父母的孩子肥胖。 这项拟议的研究汇集了儿童发育、肥胖行为干预、儿科内分泌学、营养学和运动生理学方面的多学科专家团队，以在城市社区诊所中对MBSR+N的可行性和初步疗效进行试点测试。60名2-5奥尔兹的超重父母将从一个为低收入城市社区服务的儿童指导诊所招募。父母将被随机分配接受为期8周的MBSR+N干预（基于Sinha博士开发的成人MBSR+营养和PA干预）或接触对照+N组。在干预前后以及6个月和1年的随访时，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（包括对实验室压力源的皮质醇反应），父母养育，父母和孩子的饮食行为和PA，以及孩子BMI百分位数。我们还将收集有关父母BMI和代谢变量的数据（例如，葡萄糖）。我们将评估MBSR+N的可行性和可接受性，并将测试初始干预效果，确定效果大小，以计划进行一项具有充分把握度的MBSR+N长期疗效试验。该研究将提供：1。MBSR+N的初始疗效数据，2. R 01建议进行MBSR+N的大型长期试验的试点数据，3。MBSR+N在真实社区诊所环境中可接受性的证据; 4.高危儿童肥胖发展的纵向数据。如果有效的话，MBSR+N可能是一种新的策略，可以减少高风险成人的压力和肥胖，同时防止他们年幼的孩子超重/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.