Analysis of Behavioral Interventions for Pediatric Obesity

项目摘要/摘要 儿童肥胖是一种公共健康危机，正在戏剧性地损害我们国家的健康和资源。 儿童肥胖的黄金标准治疗是基于家庭的行为减肥治疗(FBT)。然而， 考虑到美国肥胖人群中大量不健康的提示，FBT后体重恢复是很常见的 环境。美国国立卫生研究院呼吁设计和测试干预措施，以实现并保持健康的 重量。为此，Wilfley及其同事对两种减肥维持干预措施进行了评估 在一项针对超重或肥胖青年及其父母的随机对照试验中(NICHDR01HD036904； Wilfley等人，2007年)。结果表明，在FBT之后，社会促进了减肥的维持 行为技能干预(SFM)和行为技能减肥维持干预(BSM)产生的效果更好 保持减肥效果优于对照条件，且SFM优于BSM。关键的下一个问题是 检查哪种干预策略提供的价值最大。因此，这项提案的总体目标是 是评估SFM、BSM和儿童控制条件的比较成本-效果 和父母对BMI单位的变化在两年内减少(目标1)，抑郁症状和狂欢 饮食行为在两年内减少(目标2)，以及与肥胖有关的健康益处和健康 护理费用超过10年(目标3)。微观模拟成本效益模型将基于一个新的 发表的方法来自对儿童肥胖干预的最大经济评估。对该计划的评估 包括抑郁症和暴饮暴食的每种变化的成本，因为治疗带来的心理社会变化 在先前的儿童肥胖干预的成本-效果分析中被忽视，尽管 抑郁和暴食对肥胖青年的体重状况、残疾和生活质量的影响。建议数 学习和培训计划加强了我的研究计划(A)评估行为的有效性 对肥胖和体重相关问题的干预，以及(B)调查影响收养的因素和 将循证行为干预落实到常规实践中。富有的教育者 芝加哥大学的环境将使我具有很强的理论和方法论 在成本效益分析方面的基础，以进行这个翻译研究项目，并将扩大我的 综合评估行为干预措施的能力。导师团队的专业知识确保了这一点 项目一定会成功的。这项工作的目标是提供关于收养家庭的有意义的决定- 基于减肥策略的肥胖症的治疗，这有可能推进 肥胖护理的可持续解决方案。通过这样做，我们促进了确保所有个人健康生活和 富有成效的生活。总而言之，NRSA将为有指导的博士后培训提供受保护的时间-- 有效性分析，这对于实现我成为一名专注于 测试、实施和增加对肥胖和体重相关问题的干预提供。

PROJECT SUMMARY/ABSTRACT Pediatric obesity is a public health crisis that is taking a dramatic toll on our nation's health and resources. Gold-standard treatment for pediatric obesity is family-based behavioral weight loss treatment (FBT). However, weight regain following FBT is common given the abundance of unhealthy prompts in the US obesogenic environment. The NIH has called for designing and testing interventions to achieve and maintain a healthy weight. Toward this end, two weight loss maintenance interventions were evaluated by Wilfley and colleagues in a randomized controlled trial of youth with overweight or obesity and their parents (NICHD R01 HD036904; Wilfley et al., 2007). Results showed that, following FBT, a social facilitation weight loss maintenance intervention (SFM) and a behavioral skills weight loss maintenance intervention (BSM) produced greater weight loss maintenance than a control condition, and SFM was superior to BSM. The critical next question is to examine which intervention strategy offers the greatest value. Thus, the overarching aim of this proposal is to evaluate the comparative cost-effectiveness of SFM, BSM, and the control condition for children and parents on changes in BMI units reduced over two years (Aim 1), depressive symptoms and binge eating behaviors reduced over two years (Aim 2), and on obesity-related health benefits and health care costs over 10 years (Aim 3). The microsimulation cost-effectiveness model will be based on a newly published approach from the largest economic evaluation of pediatric obesity interventions. Evaluation of the cost per changes in depression and binge eating is included because psychosocial changes from treatment have been neglected in prior cost-effectiveness analyses of pediatric obesity intervention, despite the impact of depression and binge eating on weight status, disability, and quality of life in youth with obesity. The proposed study and training plan enhances my program of research (a) evaluating the efficacy of behavioral interventions for obesity and weight-related issues, and (b) investigating factors that impact adoption and implementation of evidence-based behavioral interventions into routine practice. The rich educational environment of The University of Chicago will equip me with a strong theoretical and methodological foundation in cost-effectiveness analysis to conduct this translational research project and will expand my capacity to comprehensively evaluate behavioral interventions. Expertise of the mentorship team ensures this project will be successful. The goal of this work is to inform meaningful decisions regarding adoption of family- based weight loss maintenance strategies for the treatment of obesity, which has the potential to advance sustainable solutions for obesity care. In doing so, we facilitate efforts to ensure all individuals live healthy and productive lives. In summary, this NRSA would afford protected time for mentored postdoctoral training in cost- effectiveness analysis, which is critical for achieving my goal of being an independent investigator focused on testing, implementing, and increasing access to intervention delivery for obesity and weight-related issues.