Parental Involvement as a Strategy to Enhance Adolescent Weight Control

描述（由申请人提供）：儿童和青少年超重的患病率继续增加。最新的国家健康和营养检查调查（NHANES）数据显示，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超重进入成年至关重要。虽然已经给予相当大的关注，以解决儿童肥胖症的综合行为干预，有较少的经验证据表明，这种干预措施与青少年的疗效。本研究的目的是检验一种父母参与的新模式，以加强超重青少年的体重控制。该干预措施通过两种机制将标准化的认知行为青少年体重管理治疗与增加父母参与相结合：健康体重控制策略的父母建模和增强与饮食，体育活动和体重相关的父母-青少年沟通。研究目的是：1）评估干预的可行性; 2）比较加强干预与标准青少年体重控制治疗在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，以检验参与加强干预是否会导致BMI更大程度下降的假设。共有48名年龄在13至17岁之间，超重30%和90%的青少年将被随机分配到两个基于组的治疗条件之一：青少年体重控制，包括标准的认知行为干预结合最低限度的父母参与（CBT+MPC）或加强父母支持条件，重点是健康的父母体重控制实践和改善沟通（CBT+ EPS）。在基线和16周干预结束时，将获得体重、身高、健康父母体重控制策略和亲子沟通的测量结果。我们将通过收集每周出勤率、青少年和家长完成饮食和体力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加强干预的可行性。青少年与父母的沟通将通过问卷调查以及与饮食、体重和体育活动相关的家长互动录像编码进行评估。将使用单独的多变量方差分析（MANOVA）来评估父母的健康体重策略，并结合问卷和父母与青少年沟通的录像数据。将对从基线至治疗结束的变化评分进行方差分析（ANOVA），以评价治疗条件对青少年BMI和z-BMI的影响。鉴于这是一项探索性的初步研究，我们希望获得BMI效应量的估计值。这项研究的下一个目标是进行一项全面的临床试验，以评估加强父母参与青少年体重控制的有效性。 公共卫生相关性：在美国，儿童和青少年超重的患病率继续增加，大约37%的儿童和34%的青少年被定义为超重（BMI大于85%且<94%）或肥胖（BMI大于95%）。在青春期减少超重的干预措施对于防止超重进入成年至关重要。拟议的研究将测试一种新的方法的可行性，家长参与，包括注重健康的父母体重的做法和改善沟通，在加强青少年体重控制。

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.