A Naturalistic Examination of Dietary Lapses in Low-Income, Treatment-Seeking Families with Obesity

项目总结/摘要 儿童肥胖是一个严重的公共卫生问题，对低收入青年的影响尤为严重。虽然 以家庭为基础的行为肥胖治疗（FBT）是一种有效的干预措施， 与治疗依从性差和次优反应相关。阐明可改变的风险因素， 造成低收入家庭的治疗差异，对于最大限度地提高治疗反应至关重要， 预防高危青年中与体重相关的慢性合并症。一个重要的可改变的风险因素是， 遵守饮食建议（即，饮食失误），一个强有力的预测肥胖治疗非- 反应根据自我调节的目标冲突理论，饮食失误的发生是由于未能抑制 对瞬间的自我的反应（例如，负面情绪）和社会环境（例如，存在 不健康食品）的线索，破坏核心自我调节过程涉及饮食相关的自我调节。 父母是儿童饮食自我调节的主要支持者，他们通过塑造健康的饮食习惯和构建 家庭饮食环境。因此，这是合理的，失败的尝试，由父母自我调节自己的饮食 这种行为可能会引发父母的饮食失误，继而导致孩子的体重增加 随着时间重要的是，低收入家庭可能会增加饮食失误的风险， 在他们的自然环境中的内在和社会环境线索，阻碍自我调节的尝试 饮食行为。数据显示，父母报告的短暂抑郁情绪和压力预示着不健康的 低收入家庭的喂养方式。此外，社会环境因素，如存在和 不健康食品的可获得性和低资源社区健康食品的高昂成本可能会使 对父母代表孩子选择健康食品的能力提出了额外的要求。到目前为止，没有任何研究 调查这些瞬间的线索是否或如何导致父母的饮食失误和随后的儿童饮食 低收入家庭的饮食失误，也没有研究饮食失误对父母和孩子体重变化的影响。 生态瞬时评估，一种收集真实的重复测量行为数据的评估工具 在自然环境中的时间，是一个理想的方法来表征饮食失误，因为他们的敏感性， 上下文触发器此外，EMA方法可以提供比传统自我报告方法更高的有效性， 依赖于对饮食依从性的有偏见的回顾性回忆。因此，在48个父母-子女二元组（子女）的样本中， 年龄5-12岁）从正在进行的低收入家庭FBT试验中招募，拟议的研究将采用EMA， 描述父母饮食失误的频率、性质和瞬间背景，并检查其影响 在随后的儿童饮食失误和父母-孩子的体重变化在整个3个月的FBT。结果 拟议的研究有可能通过以下方式为开发新的儿童肥胖干预措施提供信息： 揭示了支持家庭饮食行为自我调节的精确时刻。

Project Summary/Abstract Childhood obesity is a serious public health concern that disproportionately affects low-income youth. Although family-based behavioral obesity treatment (FBT) is an efficacious intervention, low socioeconomic status is associated with poor treatment adherence and suboptimal response. Elucidation of modifiable risk factors that contribute to these treatment disparities in low-income families is crucial to maximize treatment response and prevent chronic weight-related comorbidities in high-risk youth. One important modifiable risk factor is non- adherence to dietary recommendations (i.e., dietary lapses), a strong predictor of obesity treatment non- response. According to goal-conflict theory of self-regulation, dietary lapses occur due to failure to inhibit responsiveness to momentary intrapersonal (e.g., negative emotions) and socioenvironmental (e.g., presence of unhealthy foods) cues that undermine core self-regulatory processes involved in eating-related self-regulation. Parents are key supporters of child eating self-regulation by modeling healthy eating habits and structuring the family food environment. As such, it is plausible that failed attempts by the parent to self-regulate their own eating behavior could trigger a dietary lapse in the parent and subsequently in the child, which may lead to weight gain over time. Importantly, low-income families may be at increased risk for dietary lapses due to the salience of intrapersonal and socioenvironmental cues in their natural environment that thwart attempts to self-regulate eating behavior. Data show that parent-reported momentary depressed mood and stress predict unhealthy parent feeding practices in low-income families. Further, socioenvironmental factors such as the presence and availability of unhealthy foods and prohibitive cost of healthy foods in low-resource neighborhoods may place additional demands on parents’ ability to select healthy foods on behalf of their child. To date, no studies have investigated whether or how these momentary cues lead to parent dietary lapses and subsequent child dietary lapses in low-income families, nor examined the impact of dietary lapses on parent and child weight change. Ecological momentary assessment, an assessment tool that collects repeated measures behavioral data in real time in the natural environment, is an ideal methodology to characterize dietary lapses given their sensitivity to contextual triggers. Further, EMA methods may offer incremental validity over traditional self-report methods that rely on biased retrospective recall of dietary adherence. Therefore, in a sample of 48 parent-child dyads (children aged 5-12) recruited from an ongoing FBT trial in low-income families, the proposed study will employ EMA to characterize the frequency, nature, and momentary context of parent dietary lapses, and examine their effects on subsequent child dietary lapses and parent-child weight change throughout 3-month FBT. Results from the proposed study have the potential to inform the development of novel childhood obesity interventions by revealing precise moments to support family eating-behavior self-regulation.