Food Insecurity and Family-based Treatment for Pediatric Obesity

项目总结/摘要 儿童肥胖症使儿童面临长期、负面的健康后果，包括心血管疾病， 高血压和斯托克，对低收入家庭儿童的影响尤为严重。低收入 家庭面临粮食无保障的风险也在增加。与贫困的“稀缺心态”理论相一致， 粮食不安全与延迟奖励折扣增加和当前偏见增加有关。是 也与增加食物强化和减少膳食计划的可能性有关。这些因素 反过来又会增加肥胖的风险。尽管这个问题很严重，但很少有研究表明， 研究了食物不安全及其心理相关因素在儿童行为治疗中的作用， 肥胖儿童肥胖的家庭治疗（FBT）是儿童肥胖的有效治疗方法， 目标是父母-孩子的二元关系，并通过行为改变实现儿童持久的体重变化 技术，如强化，刺激控制，预先计划和育儿技巧。然而，低收入 家庭在类似的行为肥胖治疗中表现出降低的治疗反应， 治疗退出的风险增加。这项拟议中的研究将调查208对父母-子女的粮食不安全状况 参加了CDC资助的一项试点研究，该研究旨在为低收入家庭调整FBT， 强调预算和膳食计划，这已被证明可以预测更大的减肥在以前的 肥胖症治疗研究，以及将家庭与健康的社会决定因素联系起来的转诊制度 （SDOH）的需求，如粮食不安全，资源。拟议的研究将1）描述父母的特征， 在没有粮食不安全的情况下，使用基于体重和健康状况的基线数据，人口统计学（SES，种族， 种族）、健康需求的其他社会决定因素（如住房、公用事业、交通）、稀缺心态 （延迟折扣，食物的相对强化功效，财务规划视野，感知生活概率 到75岁），家庭营养和身体活动，以及膳食计划行为; 2）确定 食物不安全和稀缺心态（父母）治疗3个月和6个月后体重发生中度变化， 参加FBT的父母和儿童;以及3）确定是否增加膳食计划和SDOH服务 收入缓和粮食不安全和/或稀缺心态与体重变化之间的关系。通过 描述FBT中食物不安全和体重结果之间的关联，这项研究将有助于指导 为低收入家庭调整家庭基本治疗方法， 肥胖的风险不成比例。

Project Summary/Abstract Pediatric obesity puts children at risk for long-term, negative health outcomes including cardiovascular disease, high blood pressure, and stoke, and disproportionately impacts children from low-income families. Low-income families are also at increased risk for food insecurity. Consistent with the “scarcity mindset” theory of poverty, food insecurity is associated with increased discounting of delayed rewards and increased present bias. It is also associated with increased food reinforcement, and decreased likelihood of meal planning. These factors are in turn associated with increased risk for obesity. Despite the seriousness of this issue, little research has examined the role food insecurity and its psychological correlates play in behavioral treatments for pediatric obesity. Family-based treatment (FBT) for pediatric obesity is an effective treatment for childhood obesity that targets parent-child dyads and achieves long-lasting weight change in children through behavior change techniques such as reinforcement, stimulus control, preplanning, and parenting skills. However, low-income households have shown reduced treatment response in similar behavioral obesity treatments and are at elevated risk for treatment drop-out. The proposed study will examine food insecurity in 208 parent-child dyads enrolled in a CDC-funded pilot study seeking to adapt FBT for low-income families that will include a unique emphasis on budgeting and meal planning, which has been shown to predict greater weight loss in previous studies of obesity treatment, as well as a referral system to link families with social determinants of health (SDOH) needs, such as food insecurity, to resources. The proposed study will 1) characterize parents with and without food insecurity using baseline data based on weight and health status, demographics (SES, race, ethnicity), other social determinants of health needs (e.g. housing, utilities, transportation), scarcity mindset (delay discounting, relative reinforcing efficacy of food, financial planning horizon, perceived probability of living to age 75), family nutrition and physical activity, and meal planning behavior; 2) determine the degree to which food insecurity and scarcity mindset (in parents) moderate weight change after 3 and 6 months of treatment for parents and children enrolled in FBT; and 3) determine whether increased meal planning and SDOH service receipt moderate the relationship between food insecurity and/or scarcity mindset, and weight change. By characterizing the association between food insecurity and weight outcomes in FBT, this study will help guide the adaptation of FBT for low-income families and improve treatment for a subset of children at disproportionate risk for obesity.