Creating effective childhood obesity interventions through the study ofpositive outliers

项目摘要 儿童期肥胖与心脏代谢不良结果以及近期不良反应有关 结果，包括身体和心理社会疾病。有证据表明，提高孩子的 身体质量指数(BMI)可以导致更有利的心脏代谢风险概况，并防止成人肥胖。 然而，许多基于临床的随机对照试验(RCT)改善儿童BMI的效果有限 成功。之前的试验使用了多个并发组件来改善BMI状态，使其 很难知道哪些成分是有效的。确定干预措施的最有效组成部分 已经被USPSTF认为是当前研究中的一个主要差距。一个未得到充分利用的改进策略 干预措施是研究肥胖儿童的随机对照试验，这些儿童成功地将BMIz得分降低了≥0.2% 单位，以下简称“正异常值”。在4年的K23职业发展奖期间，Dr。 Fiechtner将利用来自两个针对儿童肥胖的随机对照试验的数据(STAR N=549和 联系健康=721)确定儿童肥胖干预的哪些组成部分最多 有效(目标1)2)定性地让母公司利益相关者详细审查他们的 孩子们是否取得了成功或没有反应，以及这些教训如何应用于其他类似的人 邻里环境(目标2)；以及3)进行试点研究，以前瞻性地测试已确定的有效 高危人群中的组成部分和策略，使干预措施适合他们的社区(目标3)。 通过这个培训计划，她将在儿科胃肠病学、营养学、 流行病学和基础生物统计学，以发展1)高级生物统计学的专业知识2)定性方法3) 时间序列分析4)改进/实施科学和5)领导 研究团队。她将利用马萨诸塞州综合医院、哈佛大学和 医疗保健改进研究所进行拟议的分析。这些研究和培训将为 必要的科学框架，启动她的职业生涯，作为一名独立的内科科学家 为无法获得治疗的高危人群创建有针对性的有效干预措施的目标 更健康的体重，即那些因文化或环境原因而处于不利地位的体重 障碍。这项提案符合NICHD的使命，即确保所有儿童都有机会充分发挥他们的 为健康和富有成效的生活创造潜力。

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.