The Effect of Behavioral and Physiological Factors on Obesity Risk in Children

描述（由申请人提供）：Dorsey博士是一名专注于预防儿童肥胖的独立研究员。1998年至2001年，多尔西博士在纽约儿童医院（Children’s Hospital of New York）担任儿科住院医师，她意识到自己在营养、体育活动和其他决定体重增加的生理过程方面的知识有限，这让她在帮助超重患者方面准备不足。同样令人不安的是，缺乏能够指导临床实践的研究，以及缺乏预防肥胖的有效干预措施。这种临床需求激发了她对开展研究的兴趣，以提高临床医生处理导致肥胖的行为、生理和环境因素的能力，并改善儿童肥胖预防工作。2001年至2006年，Dorsey博士在Robert Wood Johnson临床学者项目和调查医学项目（耶鲁大学医学院的博士项目）的培训和研究经历为她在研究方法方面奠定了坚实的基础。作为研究员，她接受了研究设计和生物统计学方面的正规教育，并有在临床人群中进行研究的经验，使用带有加速度计的直接运动监测来评估超重和非超重儿童的身体活动行为。该奖项的支持将使Dorsey博士能够通过课程、指导和研究进行额外的培训，以了解体育活动和身体健康与儿童肥胖的关系。Drs。多尔西和克鲁姆霍尔兹召集了一群不同的导师和顾问，帮助她进行培训、拟议的研究项目，并指导她的职业发展。这个指导团队分为发起人和顾问监督委员会。这些人都有与Dorsey博士的短期和长期职业目标相关的专业知识。拟议的项目将在纽约纽约大学和纽黑文耶鲁大学医学院两个校区进行。多西博士将在每个站点有一位共同导师、顾问和合作者。自2006年以来，她一直成功地在两个校区工作。多西博士住在纽约市，乘坐通勤火车往返于纽约和纽黑文之间，他定期与导师会面，并在两地开展研究活动。这种成功将在本应用程序所建议的培训期间持续下去。拟议研究的总体目标是确定运动测试和身体活动监测的潜在效用，以支持临床环境中的肥胖预防。这项工作将确定身体活动监测和运动测试是否可以在儿科诊所环境中实施，以及这些工具是否可以帮助临床医生确定哪些儿童在他们的实践中有最大的肥胖风险。通过横断面分析，Dorsey博士将展示运动测试中的表现如何与直接测量的身体活动水平和身体成分的临床测量相关联。她将使用纵向分析来确定运动测试的表现和/或直接测量的身体活动水平是否可以预测1年内腰围或BMI SD值的变化。研究参与者将是非肥胖的7 - 9岁儿童，其体重指数在年龄和性别的第50百分位数以上，以确定儿童肥胖风险增加的早期临床指标。这项研究的重点是生活在城市中心的拉丁裔和非裔美国儿童的临床人群，在这些城市中心，肥胖和相关的合并症（如糖尿病）最为普遍。迫切需要解决这些人群中肥胖的高发问题，并有机会在这些因素尚未得到很好描述的儿童中增加有关体育活动和健康的知识。在未来，这些结果将用于设计干预措施，以改善少数民族人群和儿科保健机构的肥胖预防。拟议中的项目将建立在多西博士之前的研究基础上，该研究涉及使用直接运动监测，在该研究中，她开发了一种分析8-10岁儿童运动数据的新方法。这种新方法确定了剧烈运动的次数，并描述了儿童运动的次数、时长（分钟）和平均运动强度（计数）。多尔西博士还研究了这些模式与儿童肥胖的关系。该奖项的支持将使Dorsey博士能够将他的研究经验与运动生理学、身体成分评估、社会和心理流行病学、理解健康差异、医疗保健环境中的表现改善以及应用新医疗技术和治疗策略的成本效益分析等方面的新培训结合起来。最终，她将把这些方法和工具转化为临床应用，以改善初级保健和社区环境中儿童的预防策略。在五年内，Dorsey博士将成为一名独立研究员，在评估促进肥胖的生理和行为因素以及这些因素如何在不同方式和不同程度上影响儿童的发展过程中具有丰富的专业知识。她在未来五到十年完成的研究将为临床环境和与更大的公共政策倡议合作的干预措施的设计和评估提供信息，以减少儿童肥胖的流行。

DESCRIPTION (provided by applicant): Dr. Dorsey is pursuing a career as an independent researcher focused on the prevention of obesity in children. As a pediatric resident at the Children's Hospital of New York, from 1998 to 2001, Dr. Dorsey realized that her limited knowledge of nutrition, physical activity, and other physiological processes that determine weight gain left her ill prepared to help her overweight patients. Equally troubling were the paucity of research that could guide clinical practice and the absence of effective interventions for the prevention of obesity. This clinical need sparked her interest in conducting research to improve the clinician's ability to address the behavioral, physiological, and environmental factors that lead to obesity, and improve efforts at obesity prevention in children. Dr. Dorsey's training and research experiences in the Robert Wood Johnson Clinical Scholars Program and the Investigative Medicine Program (a doctoral program at Yale School of Medicine) from 2001 to 2006 provided her with a strong foundation in research methodology. As a fellow she received formal education in research study design and biostatistics as well as experience conducting research in clinical populations using direct motion monitoring with accelerometers to assess physical activity behaviors in overweight and non-overweight children. Support from this award will allow Dr. Dorsey to pursue additional training through coursework, mentorship, and research to understand how physical activity and physical fitness relate to adiposity in children. Drs. Dorsey and Krumholz have assembled a group of diverse mentors and advisors to assist her with training, the proposed research projects, and guide her career development. This mentorship team is divided into Sponsors and an Oversight Committee of advisors. Each of these individuals has expertise related to Dr. Dorsey's short-term and long-term career goals. The proposed project will be conducted across two campuses, NYORC in New York and Yale School of Medicine in New Haven. Dr. Dorsey will have a co mentor, advisors and collaborators at each site. She has been successfully working across the two campuses since 2006. Dr. Dorsey lives in New York City and travels between New York and New Haven with ease using the commuter train, meeting regularly with mentors and conducts research activities at both sites. This success will continue over the training period proposed in this application. The overall goal of the proposed research is to determine the potential utility of exercise testing and physical activity monitoring to support obesity prevention in clinical settings. This work will establish whether physical activity monitoring and exercise testing can be administered in a pediatric clinic setting and whether these tools can help clinicians identify which children in their practices are at greatest risk of obesity. Using a cross-sectional analysis, Dr. Dorsey will demonstrate how performance on exercise tests relates to directly measured physical activity levels and to clinical measures of body composition. She will use a longitudinal analysis to determine whether performance on exercise tests and/or directly measured physical activity levels predict changes in waist circumference or BMI SD values over 1-year. Study participants will be non-obese 7 - to 9- year old children with a body mass index above the 50th percentile for age and gender in order to identify early clinical indicators of increased risk of obesity in children. This research will be focused on clinical populations of Latino and African-American children living in urban centers where obesity and related co-morbid diseases such as diabetes mellitus are most prevalent. There is an urgent need to address the high prevalence of obesity in these populations, and an opportunity to increase knowledge regarding physical activity and fitness among children in whom these factors have not been well described. In the future, these results will be used to design interventions that improve obesity prevention in minority populations and in pediatric healthcare settings. The proposed project will build on Dr. Dorsey's previous research involving the use of direct motion monitoring in which she developed a novel method for analyzing motion data in 8-10-year old children. This new approach identifies bouts of vigorous physical activity, and characterizes the number of bouts children perform, their length (minutes), and their average motion intensity (counts). Dr. Dorsey also examined how these patterns relate to obesity in children. Support from this award will allow Dr. Dorsey to combine this research experience with new training in exercise physiology, assessment of body composition, social and psychological epidemiology, understanding health disparities, performance improvement in healthcare settings, and cost benefit analysis for the application of new medical technologies and treatment strategies. Ultimately she will translate these methods and tools for clinical application to improve prevention strategies for children in primary care and community settings. In five years Dr. Dorsey will be an independent researcher with substantial expertise in the assessment of the physiological and behavioral factors that promote obesity and how these factors affect children in different ways and to different degrees during their development. The research she completes in the next five to ten years will inform the design and evaluation of interventions both within clinical settings and in collaboration with larger public policy initiatives to reduce the prevalence of obesity in children. PUBLIC HEALTH RELEVANCE: Objective assessment of factors that influence energy expenditure, specifically physical activity and physical fitness, are measures that can potentially be used by clinicians to explain variations in body fatness and predict weight gain in children. Dr. Dorsey will use the knowledge gained from this work to develop new applications for available tools that will improve clinical decision making and elucidate more effective strategies for obesity prevention. Her future work will focus on translating these findings into action on the community level with a focus on Latino and African-American children living in urban, low-income communities.