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，肥胖在低收入的少数民族儿童和肥胖父母的孩子中尤为普遍。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一个危险因素。在面临多重慢性压力源的低收入家庭中，这种风险可能会加剧。正念减压（MBSR）是一种经验支持的治疗方法，可以减轻成人的压力。然而，正念减压对父母压力和儿童肥胖的潜在影响尚未得到测试。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正念减压加上营养和体育活动咨询的效果大小，以减轻父母的压力，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辅导（MBSR+N）可以减轻父母压力，改善养育方式，增加健康饮食和PA，并预防高压力低收入肥胖父母的孩子肥胖。该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等多学科专家团队，在城市社区诊所试点测试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2-5岁儿童的超重父母，他们报告压力水平高。父母将被随机分配接受8周的正念减压+N干预（基于Sinha博士为成人开发的正念减压+营养和PA干预）或接触控制+N组。在干预前和干预后以及6个月和1年的随访中，我们将收集问卷、临床访谈和生物学测量

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.