Creating effective childhood obesity interventions through the study of positive outliers

通过研究正异常值制定有效的儿童肥胖干预措施

• 批准号: 9980929
• 负责人: Lauren Gehler Fiechtner
• 金额: $ 17.39万
• 依托单位: MASSACHUSETTS GENERAL HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-08-01 至 2022-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980929
• 关键词: 19 year old; Address; Adult; Advisory Committees; Behavior; Behavior Therapy; Behavioral; Biometry; Biostatistical Methods; Body mass index; Characteristics; Child; Childhood; Clinical; Data; Data Collection; Diet; Ensure; Epidemiology; Family; Food; Foundations; Funding; Future; Gastroenterology; General Hospitals; Goals; Health; Health Care Costs; Healthcare; High Prevalence; Individual; Institutes; Intervention; Interview; K-Series Research Career Programs; Lead; Learning; Low income; Massachusetts; Measurable; Mentorship; Mission; Morbidity - disease rate; National Institute of Child Health and Human Development; Neighborhoods; Obesity; Outcome; Parents; Participant; Patients; Physical activity; Physicians; Pilot Projects; Positioning Attribute; Preventive service; Productivity; Protocols documentation; Qualitative Methods; Randomized Controlled Trials; Research; Resources; Risk; Running; Savings; Scientist; Sleep; Statistical Methods; System; Time; Time Series Analysis; Training; United States National Institutes of Health; Weight maintenance regimen; adult obesity; adverse outcome; base; behavior change; cardiometabolic risk; cardiometabolism; career; design; effective intervention; efficacy trial; ethnic minority population; group intervention; healthy weight; high risk; high risk population; implementation science; improved; nutrition; obesity in children; obesity treatment; prevent; prospective; prospective test; psychosocial; racial and ethnic; recruit; skills; success; theories; wasting

Project Summary Obesity in childhood is associated with adverse cardio-metabolic outcomes as well as near-term adverse outcomes, including both physical and psychosocial morbidities. Evidence has shown that improving a child's body mass index (BMI) can lead to a more favorable cardio-metabolic risk profile and prevent adult obesity. However, many clinically-based randomized controlled trials (RCT) to improve a child's BMI have had limited success. Previous trials have used multiple concurrent components to achieve improved BMI status, making it difficult to know which components were effective. Identifying the most effective components of an intervention has been recognized by the USPSTF as a major gap in current research. One underused strategy to improve interventions is to study children in obesity RCTs who have succeeded in decreasing their BMI z-score by ≥0.2 units, hereafter referred to as “positive outliers.” During this 4 year K23 career development award, Dr. Fiechtner will leverage data from two randomized controlled trials for childhood obesity (STAR N=549 and Connect for Health = 721) to 1) identify which components of a childhood obesity intervention are most effective (Aim 1) 2) qualitatively engage parent stakeholders to examine in a detailed manner how their children achieved success or did not respond and how these lessons may be applied to others in similar neighborhood contexts (Aim 2); and 3) conduct a pilot study to prospectively test the identified effective components and strategies in a high-risk population tailoring the intervention to their neighborhood (Aim 3). Through this training plan she will expand upon a foundation of pediatric gastroenterology, nutrition, epidemiology and basic biostatistics to develop expertise in 1) advanced biostatics 2) qualitative methods 3) time series analysis 4) improvement/implementation science and 5) the practical skills necessary to lead a research team. She will leverage the wealth of resources of Massachusetts General Hospital, Harvard and the Institute for Healthcare Improvement to conduct the proposed analyses. These studies and trainings will lay the necessary scientific framework to launch her career as an independent physician scientist with the long-term goal of creating targeted effective interventions for particularly high-risk groups who are unable to get to a healthier weight, i.e. those where the “deck is stacked” against them because of cultural or environmental barriers. This proposal addresses NICHD's mission to ensure all children have the chance to achieve their full potential for healthy and productive lives.

项目摘要 儿童期肥胖与不良的心脏代谢结果以及近期不良的 结果，包括身体和心理社会发病率。有证据表明，改善儿童的 身体质量指数（BMI）可以导致更有利的心脏代谢风险状况，并防止成人肥胖。 然而，许多以临床为基础的随机对照试验（RCT），以改善儿童的BMI有限， 成功以前的试验使用多个并发组件来改善BMI状态， 很难知道哪些成分有效。确定干预措施的最有效组成部分 USPSTF认为这是目前研究中的一个主要空白。一个未充分利用的改进策略 干预措施是研究在肥胖RCT中成功降低BMI z评分≥0.2的儿童 单位，下文称为“阳性离群值”。在这4年的K23职业发展奖，博士。 Fiechtner将利用两项儿童肥胖症随机对照试验的数据（星星N=549和 连接健康= 721）到1）确定儿童肥胖干预的哪些组成部分最重要 有效（目标1）2）让家长利益相关者从质量上参与进来，详细审查他们的 孩子们取得了成功或没有回应，以及如何将这些教训应用于其他类似的 邻里环境（目标2）;和3）进行试点研究，以前瞻性地测试所确定的有效 高危人群的组成部分和策略，根据他们的社区定制干预措施（目标3）。 通过这个培训计划，她将扩大基础的儿科胃肠病学，营养， 流行病学和基础生物统计学，以发展1）高级生物统计学2）定性方法3） 时间序列分析4）改进/实施科学和5）领导一个 研究团队。她将利用马萨诸塞州总医院、哈佛和 医疗保健改善研究所进行拟议的分析。这些研究和培训将奠定 必要的科学框架，以启动她的职业生涯作为一个独立的医生科学家与长期 目标是为无法获得医疗服务的特别高风险群体制定有针对性的有效干预措施， 更健康的体重，即那些由于文化或环境原因而对他们“甲板堆叠”的人 隔栏.该提案涉及NICHD的使命，即确保所有儿童都有机会实现其全面发展。 健康和富有成效的生活的潜力。