Changing Health And Lifestyle Behaviors of Offspring Following Maternal Bariatric Surgery

母亲减肥手术后改变后代的健康和生活方式行为

• 批准号: 10666635
• 负责人: MARGARET H ZELLER
• 金额: $ 28万
• 依托单位: CINCINNATI CHILDRENS HOSP MED CTR
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-23 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10666635
• 关键词: Academy; Address; Adult; Aftercare; Age; Age Years; American; Behavior; Behavior Therapy; Behavioral; Behavioral Sciences; Body Weight decreased; Body mass index; Caring; Categories; Child; Child Rearing; Child Support; Childhood; Chronic; Clinical Trials; Creativeness; Data; Development; Dietary intake; Disease; E-learning; Eating; Eating Behavior; Educational process of instructing; Emotional; Enrollment; Environmental Risk Factor; Epidemic; Family; Female; Food; Gatekeeping; Genetic; Guidelines; Health; Home; Hour; Household; Intake; Intervention; Knowledge; Learning; Life Style; Link; Literature; Metabolic; Mission; Modeling; Monitor; Morbid Obesity; Mothers; National Institute of Diabetes and Digestive and Kidney Diseases; Nature; Nutrient; Obesity; Outcome; Overweight; Parents; Participant; Pathway interactions; Patients; Pediatrics; Persons; Phase; Physical activity; Physiological; Population; Prevention; Prevention Guidelines; Proteins; Randomized; Readiness; Recommendation; Research Personnel; Risk; Seminal; Severities; Shapes; Social Sciences; Testing; Thinness; Visit; Weight; Weight Gain; Woman; Work; Youth; adult obesity; age group; arm; bariatric surgery; behavior change; design; digital technology; effective therapy; efficacy evaluation; evidence base; excessive weight gain; experience; family support; feeding; follow-up; food environment; fruits and vegetables; high risk; implementation evaluation; implementation research; improved; innovation; insight; intergenerational; intervention delivery; maternal obesity; moderate-to-vigorous physical activity; next generation; novel; obesity development; obesity in children; obesity prevention; obesity risk; obesity treatment; obesogenic; offspring; parental influence; pressure; process evaluation; randomized, clinical trials; satisfaction; secondary outcome; skills; standard of care; successful intervention; sugar; sweetened beverage; synergism; telehealth; theories; trend; tv watching

ABSTRACT/PROJECT SUMMARY Overweight/obesity rates continue to surge, with severity of weight increasing and no age group spared. Fueling this epidemic are intergenerational links reflecting an interplay of genetic, physiological, behavioral and environmental factors. Parental obesity, particularly maternal severe obesity, is a potent predictor of obesity in child offspring. Parents are the primary influence on the development of pediatric lifestyle behaviors, acting as gatekeepers of the home food environment (HFE) and shaping eating behaviors via parenting practices and modelling, all key drivers in childhood obesity prevention and development. For millions of families, the cycle of obesity will continue without new discoveries and innovative solutions targeting youth at highest risk to slow these intergenerational trends. Metabolic and bariatric surgery (MBS) is the most effective treatment for severe obesity, with most patients female and approximately 40 years of age, many of whom are mothers with dependent children who already have overweight/obesity. These mothers may experience impressive weight loss and make their own significant lifestyle changes following MBS yet may not be changing the obesogenic nature of the household and diminishing the known risk to offspring. Maternal MBS may be a uniquely powerful (yet currently missed) intergenerational opportunity to effectively intervene. The present investigators are engaged in the iterative development of HALO (Health And Lifestyle Behaviors In Offspring), a parent-led behavioral intervention targeting a high-risk pediatric population (i.e., residing offspring ages 6-12; body mass index [BMI] > the 70th and < 120% of the 95th percentiles of mothers with severe obesity) that is uniquely well- timed, when mothers are highly engaged in behavior change and losing weight during the first post-MBS year. The current application is the Phase 2 pilot and feasibility randomized clinical trial of HALO relative to enhanced standard of care with 50 mother/child dyads (randomized n = 25 per arm). In addition to examining HALO feasibility, acceptability, and maternal satisfaction, we will examine efficacy of HALO on the prevention of child excess weight gain. We will also assess change in secondary outcomes including factors thought to be mechanisms for change in child zBMI (e.g., child daily intake of total kcals), changes in the HFE (e.g., presence per person of total kcals), and parenting behaviors related to child feeding (e.g., restriction, monitoring). Demonstration of HALO’s feasibility and initial efficacy will serve as the groundwork for a Phase 3 R01 application to test for sustained healthier child weight outcomes in the context of maternal MBS. HALO has the potential to revolutionize care pathways by creating a synergy of partnerships between pediatric and adult care to address a chronic intergenerational disease.

摘要/项目摘要 超重/肥胖率继续飙升，体重严重程度不断增加，所有年龄段的人都未能幸免。 推动这一流行病的是代际联系，反映了遗传、生理、行为和 环境因素。父母肥胖，尤其是母亲严重肥胖，是肥胖的有效预测因素。 孩子的后代。父母是影响儿童生活方式行为发展的主要影响者， 家庭食物环境（HFE）的看门人，并通过养育方式塑造饮食行为 建模，都是儿童肥胖预防和发展的关键驱动因素。对于数以百万计的家庭来说，循环 如果没有针对高风险青少年的新发现和创新解决方案，肥胖症将继续存在 这些代际趋势。代谢和减肥手术（MBS）是重度肥胖症最有效的治疗方法 肥胖，大多数患者为女性，年龄约 40 岁，其中许多是患有肥胖症的母亲 已经超重/肥胖的受抚养子女。这些母亲可能会经历令人印象深刻的体重 MBS 后，他们会失去并做出重大的生活方式改变，但可能不会改变肥胖的原因 家庭的性质并减少对后代的已知风险。母体 MBS 可能是一种独特的强大力量 （但目前错过了）有效干预的代际机会。目前的调查人员是 参与HALO（后代健康和生活方式行为）的迭代开发，这是一个由家长主导的项目 针对高危儿科人群（即 6-12 岁的居住后代；体重 指数 [BMI] > 重度肥胖母亲第 95 个百分位数的 70% 且 < 120%），这是唯一良好的 时机，当母亲在 MBS 后的第一年高度参与行为改变和减肥时。 目前申请的是HALO相对于2期先导及可行性随机临床试验 通过 50 名母亲/儿童二人组（随机 n = 每臂 25 名）提高护理标准。除了检查之外 HALO的可行性、可接受性和产妇满意度，我们将考察HALO对于预防的效果 儿童体重增加过多。我们还将评估次要结果的变化，包括被认为是 儿童 zBMI 变化的机制（例如，儿童每日摄入的总千卡热量）、HFE 的变化（例如， 每人的总千卡热量）以及与儿童喂养相关的养育行为（例如限制、 监控）。 HALO 的可行性和初步功效的展示将作为第三阶段的基础 R01 应用程序用于测试母亲 MBS 背景下持续健康的儿童体重结果。光环 通过在儿科和儿童之间建立伙伴关系的协同作用，有可能彻底改变护理途径 成人护理以解决慢性代际疾病。