Parental Involvement as a Strategy to Enhance Adolescent Weight Control

描述（由申请人提供）：儿童和青少年中超重的患病率持续增加。来自最新的国家健康和营养调查（NHANES）的数据表明，大约37%的儿童和34%的青少年超重或肥胖（BMI大于85%）。治疗目前超重的儿童和青少年的干预措施对于预防成年后超重至关重要。虽然对解决儿童肥胖问题的综合行为干预给予了相当大的关注，但证明此类干预对青少年有效的经验证据较少。本研究的目的是测试一种新的父母参与模式，以加强超重青少年的体重控制。干预结合了标准化的青少年体重管理认知行为治疗和增加父母的参与，通过两种机制：父母对健康体重控制策略的建模和加强与饮食、身体活动和体重相关的父母-青少年沟通。研究目的是：1)评估干预措施的可行性；2)比较强化干预与标准青少年体重控制治疗在青少年与父母沟通和父母健康体重实践方面的变化；3)获得初步数据，以检验参与强化干预是否能更大程度地降低BMI的假设。共有48名年龄在13岁至17岁之间，体重超重30%至90%的青少年将被随机分配到两种基于小组的治疗条件之一：青少年体重控制包括标准的认知行为干预，结合最小的父母参与（CBT+MPC）或加强父母支持，重点是健康的父母体重控制实践和改善沟通（CBT+ EPS）。将在基线和16周干预结束时获得体重、身高、健康父母体重控制策略和青少年与父母沟通的测量数据。我们将通过收集每周出勤率、青少年和家长完成饮食和身体活动监测日志以及青少年和家长对治疗可接受性的评分来评估强化干预的可行性。青少年与父母之间的交流将通过问卷测量和青少年与父母在饮食、体重和体育活动方面的互动录像进行编码来评估。采用单因素方差分析（MANOVA）评价家长健康体重策略，并结合问卷调查和亲子沟通录像资料。采用方差分析（ANOVA）对基线至治疗结束的变化评分进行方差分析，评估治疗状况对青少年BMI和z-BMI的影响。鉴于这是一项探索性的初步研究，我们期望获得BMI的效应大小的估计。这项研究的下一个目标是进行全面的临床试验，以评估父母参与青少年体重控制的效果。

DESCRIPTION (provided by applicant): The prevalence of overweight among children and adolescents continues to increase. Data from the most recent National Health and Nutrition Examination Survey (NHANES) indicate that approximately 37 percent of children and 34 percent of adolescents are either overweight or obese (BMI greater than 85th percent). Interventions to treat currently overweight children and adolescents are critical for prevention of overweight into adulthood. While considerable attention has been given to comprehensive behavioral interventions to address obesity in children, there is less empirical evidence demonstrating efficacy of such interventions with adolescents. The purpose of the proposed study is to test a novel model of parental involvement for enhancing weight control among overweight adolescents. The intervention combines standardized cognitive behavioral adolescent weight management treatment with increased parental involvement through two mechanisms: parental modeling of healthy weight control strategies and enhanced parent-adolescent communication related to diet, physical activity, and weight. Study objectives are to: 1) evaluate the feasibility of the intervention; 2) compare the enhanced intervention to standard adolescent weight control treatment with regard to changes in adolescent-parent communication and parent healthy weight practices, and 3) obtain preliminary data to test the hypothesis of whether participation in the enhanced intervention results in greater decrease in BMI. A total of 48 adolescents between the ages of 13 and 17 years and 30 percent and 90 percent overweight will be randomized to one of two group-based treatment conditions: adolescent weight control that includes standard cognitive-behavioral intervention combined with minimal parent involvement (CBT+MPC) or an enhanced parental support condition focused on healthy parent weight control practices and improved communication (CBT+ EPS). Measures of weight, height, healthy parent weight control strategies, and adolescent-parent communication will be obtained at baseline and at the end of the 16-week intervention. We will evaluate feasibility of the enhanced intervention by collecting measures of weekly attendance, adolescent and parent completion of diet and physical activity monitoring logs, and adolescent and parent ratings of treatment acceptability. Adolescent-parent communication will be evaluated through questionnaire measures as well as coding of adolescent-parent videotaped interactions related to diet, weight, and physical activity. Separate multivariate analysis of variance (MANOVA) will be used to evaluate parent healthy weight strategies and combined questionnaire and videotaped data of parent-adolescent communication. Analysis of variance (ANOVA) will be conducted on the change scores from baseline to end of treatment to evaluate the effects of treatment condition on adolescent BMI and z-BMI. Given that this is an exploratory pilot study, we expect to obtain estimates of effect size for BMI. The next objective in this line of research is to conduct a full-scale clinical trial to evaluate the efficacy of enhanced parent involvement for adolescent weight control. PUBLIC HEALTH RELEVANCE: The prevalence of overweight in children and adolescents in the United States continues to increase, with approximately 37 percent of children and 34 percent of adolescents defined as either overweight (BMI greater than 85th percent and < 94th percent) or obese (BMI greater than 95th percent). Interventions to decrease overweight during adolescence are critical for prevention of overweight into adulthood. The proposed study will test the feasibility of a novel approach for parental involvement, including focus on healthy parent weight practices and improved communication, in enhancing adolescent weight control.