Exploring the Familial Reach of Adolescent Obesity Treatment

探索青少年肥胖治疗的家庭影响力

• 批准号: 10589875
• 负责人: Melanie K Bean
• 金额: $ 21.05万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-03-10 至 2025-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10589875
• 关键词: Adolescence; Adolescent; Adolescent obesity; Adult; Age; Behavioral; Black race; Body Weight Changes; Body Weight decreased; Caregivers; Child; Child Rearing; Clinical; Data; Development; Diet; Dietary intake; Educational process of instructing; Electronics; Enrollment; Environment; Exercise; Familial disease; Family; Family member; Feeding behaviors; Female; Food; Frequencies; Future; Guidelines; Home; Home environment; Household; Individual; Intervention; Measures; Mediator; Modeling; Obesity; Outcome; Overweight; Parents; Participant; Patient Self-Report; Randomized; Recommendation; Research; Siblings; Weight; Weight maintenance regimen; arm; clinically significant; digital imaging; experience; feeding; food environment; group intervention; improved; improved outcome; lifestyle intervention; novel; obesity treatment; obesogenic; primary endpoint; programs; randomized, clinical trials; sex; skills training; social; success; therapy design; treatment arm; treatment group; treatment response; weight loss intervention; weight maintenance

PROJECT SUMMARY Family-based lifestyle intervention (FBLI) is the gold standard for treating adolescent obesity, which emphasizes the importance of making family-wide changes to the shared home environment. Yet, program assessments overwhelmingly focus on the individual adolescent. Understanding the impact of FBLIs beyond the identified adolescent is important, given that obesity is a familial disease and there are likely bidirectional relations between an adolescent’s treatment success and broader changes in their household. It is unknown if family-wide changes are made within FBLI, or if non-targeted family members experience weight-related benefits. These data are critical, given that weight losses observed in adolescent obesity treatments are generally modest, with no clear guidance regarding the optimal family-based treatment approach during this distinct developmental period. Towards that end, we propose to leverage our ongoing randomized clinical trial (RCT) of TEENS+, a FBLI for adolescents with obesity, to determine: 1) if family-wide changes to the shared home environment are implemented, 2) if ripple effects to untreated family members are observed, and 3) whether these changes are predictive of adolescents’ weight management success. Via R01HD095910, we are evaluating two approaches to involving parents in FBLI to treat adolescent obesity. In this RCT, all adolescents participate in TEENS+, our 4m behavioral weight loss (BWL) treatment. Parents are randomized to either 1) parent skills training based on authoritative parenting (Parents as Coaches; PAC) or 2) concurrent parent BWL (Parent Weight Loss; PWL). TEENS+ was informed by our pilot (HD084930), which included 82 adolescent (M age=13.7±1.2yrs; 52% Black)/parent dyads. We demonstrated that both parent treatments yielded adolescent weight loss at the end of the 4m treatment. Further, improvements to the obesogenic home food environment were observed in both groups; yet a more comprehensive assessment of the shared home environment is needed to determine if broader family-wide changes, including weight changes of non-targeted family members, are executed, and if these changes predict adolescent weight loss. To that end, adolescent/parent dyads will be randomized to TEENS+PAC or TEENS+PWL via our ongoing R01 trial. This ancillary R21 will expand trial assessments and conduct a comprehensive assessment of the shared home feeding and weight environment of the target adolescents. Specifically, we will enroll non-targeted children (8- 17yrs) and caregivers living in the same household as the target parent/adolescent dyad (N=60 families; 30 per treatment group). At 0, 2, 4 (primary endpoint), and 8m, the target parent/adolescent dyad and non- targeted children (n=~80) and caregivers (n=~60), will complete anthropometric assessments. Measures of the shared home feeding and weight environment will also be conducted. Results will determine the familial reach of TEENS+ and reveal potential mediators of treatment response to target directly in future iterations of FBLI to optimize adolescent outcomes.

项目摘要 以家庭为基础的生活方式干预（FBLI）是治疗青少年肥胖的金标准， 强调在整个家庭范围内改变共同的家庭环境的重要性。然而，方案 评估绝大多数集中在青少年个人。了解FBLI的影响， 由于肥胖是一种家族性疾病， 青少年的治疗成功与其家庭更广泛的变化之间的关系。不清楚是否 在FBLI内进行家庭范围的变化，或者如果非目标家庭成员经历体重相关的变化， 效益这些数据是至关重要的，因为在青少年肥胖治疗中观察到的体重减轻是 一般适度，在此期间没有关于最佳家庭治疗方法的明确指导 不同的发展时期。为此，我们建议利用我们正在进行的随机临床试验 (RCT)的TEENS+，肥胖青少年的FBLI，以确定：1）如果家庭范围内的变化，以共享 家庭环境，2）如果观察到未治疗家庭成员的涟漪反应，以及3） 这些变化是否预示着青少年的体重管理成功。通过R 01 HD 095910，我们 正在评估两种让父母参与FBLI治疗青少年肥胖的方法。在本RCT中，所有 青少年参与TEENS+，我们的4米行为减肥（BWL）治疗。父母是随机的 1）基于权威育儿的父母技能培训（父母作为教练; PAC）或2）同时 父母体重减轻（Parent Weight Loss; PWL）TEENS+是由我们的飞行员（HD 084930）告知的，其中包括82名 青少年（男性年龄=13.7± 1.2岁; 52%为黑人）/父母二人组。我们证明了两种母体治疗 在4个月的治疗结束时，青少年体重减轻。此外，改善肥胖家庭 两组都观察到了食物环境;然而，对共同家庭的更全面评估 需要环境来确定是否有更广泛的家庭范围的变化，包括非靶向的体重变化 家庭成员，被处决，如果这些变化预测青少年体重减轻。为此， 通过我们正在进行的R 01试验，将青少年/父母配对随机分配至TEENS+PAC或TEENS+PWL。这 辅助R21将扩大试验评估，并对共享房屋进行全面评估 目标青少年的喂养和体重环境。具体而言，我们将招收非目标儿童（8- 17岁）和与目标父母/青少年二元组生活在同一家庭的照顾者（N=60个家庭; 30 每个治疗组）。在0、2、4（主要终点）和8个月时，目标父母/青少年二元组和非 目标儿童（n=~80）和护理人员（n=~60）将完成人体测量评估。措施 还将进行共享家庭喂养和体重环境。结果将决定家庭范围 并揭示了在FBLI的未来迭代中直接对靶点产生治疗反应的潜在介质， 优化青少年的成果。