Randomized Trial of a Healthy Weight Intervention for Youth with Serious Emotional Disturbance

摘要 患有严重情绪障碍(SED)的青少年超重和肥胖的患病率超过 儿童超重和肥胖在普通人群中的流行水平。相关心血管疾病 心血管疾病(CVD)的危险因素，如糖耐量异常、高血压和血脂异常，在 肥胖的孩子。因此，关注患有SED的青少年超重/肥胖是预防他们早产的关键 心血管疾病。2015年，美国心脏协会呼吁关注年轻人的精神疾病是重要风险 为早期心血管疾病创造条件，并宣布需要在筛查和管理方面进行变革性改变 超重和肥胖。尽管如此，对患有SED的青少年进行健康体重干预的研究是值得注意的 如果没有，干预措施可能需要为这些经常冲动的人群量身定做， 敌对行为和/或情绪症状。在普通人群中，成功的干预措施针对 青少年肥胖症通常包括父母的积极参与。服务青少年的社区心理健康计划 通常将父母作为常规治疗的一部分，因此提供了一种未被赏识但潜在的 解决超重和肥胖问题的重要机会。此R01应用程序的目标是设计和 在患有自闭症的青少年中严格测试一种创新的、可扩展的健康体重干预措施，其中包括父母 接洽和提供商支持。我们的研究团队在儿童心理健康方面拥有丰富的经验， 青少年体重管理和体力活动干预，成人严重精神疾病和 普通民众。我们建议冠军试验，一项与社区心理合作的双臂试验 马里兰州的卫生组织。我们将进行以人群为基础的筛查，以识别超重的青少年 和肥胖，招募120名8-18岁的SED患者，BMI在85%或以上。我们会 按性别和地点分层，随机分配参与者接受a)常规护理和教育材料 健康体重，或b)为期12个月的冠军干预1)健康教练，训练有素的心理健康 提供健康生活方式咨询和体重管理支持的计划员工，健康的 饮食和更多的体力活动，包括让年轻人和父母都参与的技术；以及2) 来自健康提供者的支持，他们将提供基本的体重管理信息和鼓励 行为改变。干预的前6个月将包括频繁接触，然后是6个月 维护阶段。12个月时，与对照组相比，主要结果是BMI z评分降低； 次要结果包括腰围、血压、血糖、血脂水平、生活质量和 6个月和12个月出现精神症状。心血管疾病的先证者在年轻时就开始了，而患有SED的人在 风险特别高。要打破这一连串导致过早心血管疾病的风险因素，需要充分利用 干预患有自发性精神障碍的青少年超重和肥胖的机会之窗。冠军选拔赛将 测试一种创新而又实用的方法，这种方法可以很容易地纳入对患有自发性精神障碍的青少年的全面护理。

ABSTRACT The prevalence of overweight and obesity in youth with serious emotional disturbance (SED) exceeds the epidemic levels of overweight and obesity for children in the general population. Associated cardiovascular (CVD) risk factors such as glucose intolerance, hypertension and lipid abnormalities frequently already exist in obese children. Thus, focusing on overweight/obesity in youth with SED is critical to prevent their premature CVD. In 2015 the American Heart Association called attention to mental illnesses in youth as important risk conditions for early CVD and declared the need for transformational change in screening and management of overweight and obesity. Despite this, studies of healthy weight interventions in youth with SED are noticeably absent, and interventions will likely need to be tailored for this population who frequently have impulsivity, oppositional behavior and/or mood symptoms. In the general population, successful interventions targeting youth obesity often include active parental participation. Community mental health programs serving youth typically engage parents as part of routine treatment and therefore provide an unappreciated but potentially important opportunity to address overweight and obesity. The objective of this R01 application is to design and rigorously test an innovative, scalable healthy weight intervention in youth with SED that incorporates parental engagement and provider support. Our research team has extensive experience spanning child mental health, weight management and physical activity interventions in youth, and in adults with serious mental illness and in the general population. We propose the CHAMPION Trial, a two-arm trial partnering with community mental health organizations in Maryland. We will perform population-based screening to identify youth with overweight and obesity, and recruit and enroll 120 ages 8-18 years with SED with a BMI at or above the 85th%tile. We will stratify by sex and site and randomly assign participants to receive a) usual care plus educational materials on healthy weight, or b) the 12-month CHAMPION intervention with 1) a health coach, a trained mental health program employee, who provides healthy lifestyle counseling and support for weight management, a healthy diet and increased physical activity incorporating techniques to engage both the youth and parents; and 2) support from health providers who will provide basic weight management messages and encouragement for behavior change. The intervention's first 6 months will include frequent contacts, followed by a 6-month maintenance phase. The primary outcome will be decreased BMI z-score compared to control at 12 months; secondary outcomes include waist circumference, blood pressure, glucose, lipid levels, quality of life, and psychiatric symptoms at 6 and 12 mo. Antecedents of CVD begin early in youth, and those with SED are at particularly high risk. Breaking this cascade of risk factors leading to premature CVD will require capitalizing on the window of opportunity to intervene on overweight and obesity in youth with SED. The CHAMPION Trial will test an innovative, yet practical approach that could be readily incorporated into overall care of youth with SED.