Defining behaviors and the stress response among positive deviants for childhood obesity

项目摘要 这个R 03奖旨在确定现有的成功战略，以解决儿童肥胖的低 社会经济地位的人群。一小部分（10-15%）儿童在幼儿期患有肥胖症 在青春期达到健康的体重。整个项目的目标是确定这些行为 被称为积极异常者的儿童及其家庭已经有效地实施了这一措施。通过学习 从已经在持续肥胖高风险社区中发挥作用的措施来看， 对肥胖儿童的家庭来说更相关和更有效。缺乏干预措施 对社会经济地位低的家庭有效， 人口问题突出表明需要确定有效的战略。 目标1将使用现有的医疗记录数据来检查从青春期前，学龄 儿童和分类儿童谁有负的BMI斜率向健康的体重（积极的 偏差者）和BMI斜率平坦或增加的儿童（对照）。家庭被招募参加一个 病例对照研究使用混合方法来定义用于解决孩子体重的技能和行为。 在目标2中，我们使用皮质醇、白细胞介素-6和C反应蛋白来检查对应激的生物反应， 比较积极的偏差和控制，以检验假设，积极的偏差，尽管经历 相似的压力源，对压力的生物反应与对照组不同。这些目标的实现将 直接通知设计一个以肥胖为重点的临床试验，测试积极偏差的有效性- 衍生策略与旨在减轻压力的干预措施配对，使用生物标记物来个性化 干预措施。 该项目将在特殊的研究环境中进行，以利用俄勒冈州临床研究中心的资源。 和转化研究所（OCTRI）协助从大型病历中提取数据， 生成数据集。福斯特博士（PI）最近在K23奖期间完成了一个类似的项目， 该项目旨在借鉴K23期间吸取的经验教训，并在战略上扩大，作为实现 R 01应用程序，用于测试使用此方法设计的干预措施的有效性。

PROJECT SUMMARY This R03 award seeks to identify existing successful strategies to address childhood obesity in low socioeconomic status populations. A small proportion (10-15%) of children with obesity in early childhood achieve a healthy weight by adolescence. The goal of the overall project is to identify what behaviors these children and their families, termed positive deviants, have implemented that has been effective. By learning from what is already working among communities at high risk of continued obesity, interventions can be adapted to be more relevant and effective for families of children with obesity. The paucity of interventions shown to be effective for low socioeconomic status families and the increasing disparities in obesity for this population underscore the need to identify effective strategies. Aim 1 will use existing medical record data to examine weight trajectories from pre-adolescent, school aged children and categorize children into those who have a negative BMI slope towards a healthy weight (positive deviants) and children with a flat or increasing BMI slope (controls). Families are recruited to participate in a case-control study using mixed methods to define the skills and behaviors used to address their child's weight. In aim 2, we examine the biologic response to stress using cortisol, interleukin-6 and C-reactive protein, comparing positive deviants and controls to test the hypothesis that positive deviants, despite experiencing similar stressors, have a different biologic response to stress than controls. The completion of these aims will directly inform the design of an obesity-focused clinical trial testing the effectiveness of positive deviance- derived strategies paired with interventions designed to mitigate stress using biologic markers to personalize interventions. The project will occur in an exceptional research environment for using the resources of the Oregon Clinical and Translational Research Institute (OCTRI) to assist with data abstraction from a large medical record to generate the dataset. Dr. Foster (PI) has recently completed a similar project during his K23 award, with this project designed to build on the lessons learned during the K23 and strategically expand as a step towards an R01 application for testing the effectiveness of interventions designed using this approach.