Binge Eating as a Mechanism Underlying the Food Insecurity-Obesity Paradox in Adolescents

项目摘要/摘要 在美国，食物不安全与青少年肥胖症风险升高之间存在矛盾的联系。这个 这种额外风险背后的机制还不是很清楚，而这种知识对于提供信息是必不可少的。 为资源不足的青少年提供预防肥胖的努力。因此，与需求保持一致 由美国国立卫生研究院肥胖研究战略计划强调，以确定导致风险增加的原因 对于经济边缘人群中的肥胖症，迫切需要研究来阐明可修改的 有针对性地在食物缺乏保障的青少年中预防肥胖的机制。在拟议的项目中， 哈扎德博士是一名注册营养师和公共卫生研究员，他将研究暴饮暴食是否可能 解释食物不安全和青少年肥胖风险增加之间的联系的机制。与 她组建的卓越的指导团队以及通过加州大学为她提供的资源 明尼苏达州，这个独立之路奖将支持哈扎德博士填补关键的培训空白，并 进行必要的研究，以开启她作为独立调查员进行干预的职业生涯 努力在经历食物不安全的青少年中促进食物安全和健康体重。做好准备 对于这一角色，提出了包括课程作业、指导和研究在内的多方面培训计划：(1) 定性和混合方法，(2)高级统计方法，重点是机器学习和因果关系 调解分析，以及(3)干预设计、开发和传播，重点是人-- 以设计为中心。哈扎德博士通过这一培训计划发展起来的专业知识对于 建议的研究。在指导K99阶段，她将阐明暴饮暴食的病因。 采用混合方法处理青春期的食物不安全问题，包括：(A) 对报告暴饮暴食的食物不安全青少年进行定性访谈，以及(B)利用来自 由美国国立卫生研究院资助的使用基于树的机器学习技术的观察队列(目标1)。在 在独立R00阶段，哈扎德博士将招募175名青少年加入新的独立队列 追踪18个月，量化暴饮暴食在多大程度上调节了两个人之间的纵向联系 青春期的食物不安全和体重增加(目标2)。最后，使用以人为中心的设计方法， 她将制作小插曲，描述潜在的以学校为基础的干预措施，以改善粮食安全和预防 食物不安全青少年的超重增加，并评估对潜在体重增加的感知可接受性 在对经历过食物的青少年进行半结构化访谈中使用这些小插曲进行干预 不安全(目标3)。该项目的调查结果将为开发和实施 以学校为基础的干预措施，以促进青少年的食物安全和健康体重 不安全感，进而促进了哈扎德博士成功地过渡到独立的研究生涯。 1

PROJECT SUMMARY/ABSTRACT Food insecurity is paradoxically associated with elevated risk of adolescent obesity in the United States. The mechanisms underlying this excess risk are not well understood, and such knowledge is essential for informing obesity prevention efforts for adolescents from under-resourced backgrounds. Thus, aligned with the need emphasized by the Strategic Plan for NIH Obesity Research to identify the reasons contributing to increased risk for obesity among economically marginalized populations, research is critically needed to elucidate modifiable mechanisms to target in obesity prevention efforts among food-insecure adolescents. In the proposed project, Dr. Hazzard, a registered dietitian and public health researcher, will examine binge eating as a potential mechanism to explain the association between food insecurity and elevated risk for adolescent obesity. With the exceptional mentorship team she has assembled and the resources available to her through the University of Minnesota, this Pathway to Independence Award will support Dr. Hazzard in filling critical training gaps and conducting the research necessary to launch her career as an independent investigator conducting intervention work to promote food security and healthy weight among adolescents experiencing food insecurity. To prepare her for this role, a multifaceted training plan including coursework, mentorship, and research is proposed in: (1) qualitative and mixed methods, (2) advanced statistical methods, with a focus on machine learning and causal mediation analysis, and (3) intervention design, development, and dissemination, with an emphasis on human- centered design. The expertise Dr. Hazzard develops through this training plan will be essential for conducting the proposed research. During the mentored K99 phase, she will elucidate the etiology of binge eating in the context of food insecurity during adolescence using a mixed-methods approach that involves (a) conducting qualitative interviews in food-insecure adolescents who report binge eating and (b) leveraging existing data from an NIH-funded observational cohort to employ tree-based machine learning techniques (Aim 1). In the independent R00 phase, Dr. Hazzard will recruit 175 adolescents into a new, independent cohort that she will follow for 18 months to quantify the extent to which binge eating mediates the longitudinal association between food insecurity and weight gain during adolescence (Aim 2). Finally, using a human-centered design approach, she will develop vignettes describing potential school-based interventions to improve food security and prevent excess weight gain among food-insecure adolescents and assess perceived acceptability of the potential interventions using these vignettes in semi-structured interviews with adolescents who have experienced food insecurity (Aim 3). Findings from this project will lay the groundwork for the development and implementation of a school-based intervention to promote food security and healthy weight among adolescents experiencing food insecurity and, in turn, promote Dr. Hazzard’s successful transition to an independent research career. 1