Defining behaviors and the stress response among positive deviants for childhood obesity

项目总结 此R03奖项旨在确定解决低收入地区儿童肥胖问题的现有成功策略 社会经济地位人口。儿童早期肥胖的儿童比例很小(10%-15%) 在青春期达到健康的体重。整个项目的目标是确定这些行为 儿童及其家庭被称为积极的离经叛道者，已经实施了这一有效的措施。通过学习 从持续肥胖的高风险社区中已经起作用的情况来看，干预措施可以 适应于对肥胖儿童的家庭更相关和更有效。干预措施的匮乏 对于社会经济地位低的家庭和日益扩大的肥胖症差距来说，这是有效的 人口问题强调需要确定有效的战略。 目标1将使用现有的医疗记录数据来检查青春期前、学龄儿童的体重轨迹 并将儿童归类为BMI负斜率接近健康体重(正体重)的儿童 以及体重指数斜率平缓或增大的儿童(对照组)。家庭被招募参加一项 使用混合方法的病例对照研究，以确定用于解决孩子体重问题的技能和行为。 在目标2中，我们使用皮质醇、白介素6和C反应蛋白来检测应激的生物反应， 比较积极的偏差和对照，以检验积极偏差的假设，尽管经历了 类似的压力源，与对照组相比，对压力有不同的生物反应。这些目标的实现将 直接为以肥胖为重点的临床试验的设计提供信息，以测试正偏差的有效性- 衍生策略与旨在缓解压力的干预措施相结合，使用生物标记物进行个性化 干预措施。 该项目将在使用俄勒冈临床医院资源的特殊研究环境中进行 和翻译研究所(OCTRI)帮助从大型医疗记录中提取数据，以 生成数据集。福斯特博士最近在他的K23奖项中完成了一个类似的项目， 旨在以K23期间吸取的经验教训为基础的项目，并从战略上扩展，以此作为迈向 R01应用程序，用于测试使用该方法设计的干预措施的有效性。

PROJECT SUMMARY This R03 award seeks to identify existing successful strategies to address childhood obesity in low socioeconomic status populations. A small proportion (10-15%) of children with obesity in early childhood achieve a healthy weight by adolescence. The goal of the overall project is to identify what behaviors these children and their families, termed positive deviants, have implemented that has been effective. By learning from what is already working among communities at high risk of continued obesity, interventions can be adapted to be more relevant and effective for families of children with obesity. The paucity of interventions shown to be effective for low socioeconomic status families and the increasing disparities in obesity for this population underscore the need to identify effective strategies. Aim 1 will use existing medical record data to examine weight trajectories from pre-adolescent, school aged children and categorize children into those who have a negative BMI slope towards a healthy weight (positive deviants) and children with a flat or increasing BMI slope (controls). Families are recruited to participate in a case-control study using mixed methods to define the skills and behaviors used to address their child's weight. In aim 2, we examine the biologic response to stress using cortisol, interleukin-6 and C-reactive protein, comparing positive deviants and controls to test the hypothesis that positive deviants, despite experiencing similar stressors, have a different biologic response to stress than controls. The completion of these aims will directly inform the design of an obesity-focused clinical trial testing the effectiveness of positive deviance- derived strategies paired with interventions designed to mitigate stress using biologic markers to personalize interventions. The project will occur in an exceptional research environment for using the resources of the Oregon Clinical and Translational Research Institute (OCTRI) to assist with data abstraction from a large medical record to generate the dataset. Dr. Foster (PI) has recently completed a similar project during his K23 award, with this project designed to build on the lessons learned during the K23 and strategically expand as a step towards an R01 application for testing the effectiveness of interventions designed using this approach.