Partnering lifestyle intervention with bariatric surgery to maximize health outcomes in adolescents

将生活方式干预与减肥手术结合起来，最大限度地提高青少年的健康结果

• 批准号: 10586038
• 负责人: Sarah Elizabeth Messiah
• 金额: $ 18.43万
• 依托单位: UNIVERSITY OF TEXAS HLTH SCI CTR HOUSTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-07 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10586038
• 关键词: 19 year old; Academy; Address; Adolescent; Adolescent obesity; Adult; Adult asthma; Affect; Age; American; Arthritis; Attention; Basic Behavioral Science; Behavior Therapy; Behavioral; Black Populations; Black race; Body Weight decreased; Body mass index; Caring; Child; Childhood; Chronic Disease; Clinical; Data; Development; Disparity; Educational process of instructing; Effectiveness; Epidemic; Equity; Family; Focus Groups; Future; Goals; Health; Hispanic; Hispanic Populations; Inpatients; Intervention; Intervention Trial; Interview; Kidney Diseases; Life Expectancy; Life Style; Liver diseases; Medical; Mental Health; Metabolic; Methods; Modification; Morbid Obesity; National Health and Nutrition Examination Survey; Not Hispanic or Latino; Obesity; Obesity Epidemic; Operative Surgical Procedures; Outcome; Parents; Participant; Patients; Pediatrics; Pharmacotherapy; Phase; Population; Populations at Risk; Postoperative Period; Press Releases; Prevalence; Qualifying; Quality of life; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Research; Research Design; Research Personnel; Resolution; Risk; Science; Standardization; Subcategory; Target Populations; Teenagers; Testing; Translating; United States; Youth; adolescent health outcomes; adolescent patient; bariatric surgery; cardiometabolism; clinically significant; comorbidity; design; ethnic diversity; ethnic minority; ethnic minority population; evidence base; healthy lifestyle; implementation outcomes; improved; informant; lifestyle intervention; member; multi-site trial; obesity management; patient population; pilot test; prevent; programs; psychologic; public health relevance; sex; sleep quality; standard of care; therapy development; treatment program; trend

PROJECT SUMMARY Severe obesity, defined as ≥ 120% of the 95th percentile of body mass index (BMI) adjusted for age and sex or a BMI >35 kg/m2 is the fastest growing subcategory of obesity in the United States (US) pediatric population. Approximately 9% of 12-19 year-olds have severe obesity, triple the prevalence in 1988-1994. Even more concerning, almost 12% of Non-Hispanic Black and 9% of Hispanic adolescents ages 12-19 have severe obesity compared to 7% of their non-Hispanic white counterparts. Metabolic and bariatric surgery (MBS) is shown to be safe and efficacious in treating adolescents (defined as ages 13-18 for this application) with severe obesity. Yet national adolescent MBS rates have not increased at the same rate of that of the severe obesity epidemic, and short-and long-term attrition (those who qualify but do not follow through with MBS and those who do not return for care after MBS) remains a significant challenge in this patient population. Alternatively, weight-loss behavioral/lifestyle and pharmacotherapy treatment programs in inpatient and ambulatory settings have not reported similar sustained weight loss trajectories, particularly in the long-term. Behavioral/lifestyle programs teach the necessary modifications to sustain successful weight loss, but there is no standardized pre-and post- operative lifestyle intervention that is offered to adolescent MBS patients to support these behavioral changes. As such, we propose the following mixed methods specific aims: AIM 1. Generate qualitative data necessary to adapt an existing evidence-based healthy lifestyle behavioral intervention’s content, strategies and delivery methods to explicitly support pre- and post-MBS, ethnically diverse (non-Hispanic white and black; Hispanic, other), adolescent patients and their families. This formative research will include focus groups, and key informant interviews with adolescents, parents, and clinical team members. AIM 2. Adapt the healthy lifestyle behavioral intervention (referenced in AIM 1), as informed by AIM 1 data (and analyses), to support pre-and post-MBS among ethnically diverse adolescent patients and their families. AIM 3. Conduct a proof-of-concept study to assess feasibility, acceptability and effectiveness of an MBS-supported healthy lifestyle behavioral intervention (adapted in AIM 2) among adolescent patients, their families, and their clinical team. We will iteratively analyze the AIM 1 qualitative data until no new concepts emerge from later interviews/discussions, and the resulting themes are considered “saturated” by the data analysts. Results from this study will inform the development of a future randomized controlled trial to test the MBS-lifestyle intervention(s) versus standard of care.

项目摘要 重度肥胖，定义为经年龄和性别校正的体重指数（BMI）第95百分位数的≥ 120%，或 a BMI >35 kg/m2是美国（US）儿科人群中增长最快的肥胖亚类。 大约9%的12-19岁的人患有严重肥胖症，是1988-1994年流行率的三倍。更 令人担忧的是，近12%的非西班牙裔黑人和9%的12-19岁的西班牙裔青少年患有严重肥胖症。 而非西班牙裔白色人的这一比例为7%。代谢和减肥手术（MBS）被证明是 在治疗患有严重肥胖症的青少年（对于本申请，定义为13-18岁）中安全有效。然而 全国青少年MBS率没有以与严重肥胖流行相同的速度增长， 短期和长期流失（符合条件但未完成MBS的人员和未返回的人员 对于MBS后的护理）仍然是该患者群体中的重大挑战。或者，减肥 在住院和门诊环境中的行为/生活方式和药物治疗方案尚未 报告了类似的持续减肥轨迹，特别是在长期。行为/生活方式方案 教必要的修改，以维持成功的减肥，但没有标准化的前和后， 为青少年MBS患者提供有效的生活方式干预，以支持这些行为改变。 因此，我们提出以下混合方法的具体目标：目的1.生成必要的定性数据， 调整现有循证健康生活方式行为干预的内容、策略和实施方式 明确支持MBS前和MBS后的方法，种族多样性（非西班牙裔白色和黑人;西班牙裔， 青少年患者及其家属。这种形成性的研究将包括焦点小组，和关键 与青少年、父母和临床团队成员进行的知情人访谈。AIM 2.适应健康的生活方式 行为干预（在AIM 1中引用），根据AIM 1数据（和分析），以支持术前和术后 不同种族的青少年患者及其家庭中的MBS后。AIM 3.进行概念验证 一项评估MBS支持的健康生活方式行为的可行性、可接受性和有效性的研究 在青少年患者、他们的家庭和他们的临床团队中进行干预（适应AIM 2）。我们将 反复分析AIM 1定性数据，直到在以后的访谈/讨论中没有新的概念出现， 并且所得到的主题被数据分析师认为是“饱和的”。这项研究的结果将告知 未来将开展一项随机对照试验，以测试MBS-生活方式干预与标准 在乎