Behavioral Skill Adherence in Pediatric Obesity Treatment

描述(申请人提供)：儿童肥胖是一个非常普遍的问题，需要治疗和预防努力，以减少受影响儿童和儿童群体的心血管疾病风险和代谢后果。以家庭为基础的儿童行为肥胖治疗的有效性可能会受到父母和孩子对食物和活动监测、应急管理和环境控制等行为技能的非最佳使用的影响。参与者行为技能使用(BSU)是影响成人肥胖治疗结果的最重要因素之一。然而，在儿童肥胖治疗试验中，BSU评估并不频繁，进行时往往只被父母的报告回顾，可靠性未知，而且是不完整的，大多只评估食物监测的质量。较差和不完整的BSU测量排除了改善儿童肥胖的行为干预。此外，在治疗期间和之后帮助家庭启动和维持BSU的不同方法尚未得到测试。针对PA-06-298-《儿童和青少年健康危险行为改变的机制理解》，本R21发展/探索性建议旨在调查1)治疗期间和治疗后测量的BSU与儿童体重状况、体力活动和饮食变化之间的预期关系，以及2)不同实施方法(处方和自我指导)在治疗期间和治疗后BSU轨迹的差异。82对父母-孩子将被随机分配，接受基于家庭的儿童行为肥胖治疗的处方或自我指导的实施方法。家长和干预者将在基线、第5次、第10次和第15次治疗时、治疗后以及3个月和6个月的随访中评估家庭使用每项行为技能(监测、应急管理、环境控制)的情况。在这些时间点，还将对每种技能的使用情况进行补充评估。在治疗过程中和整个随访过程中，将研究BSU和儿童体重状况(z-BMI)和与体重相关的行为(饮食、体力活动)的变化之间的前瞻性关联。这项建议将提供与短期和长期治疗效果最相关的BSU类型及其测量的重要信息，并为启动和维持BSU在儿童肥胖干预中的不同实施方法的相对有效性提供试点数据。在美国，儿童肥胖是一个日益严重的公共卫生问题，对个人和人群的健康、心理社会和经济影响都是负面的。该提案调查了改善儿童超重干预的核心机制和战略。

DESCRIPTION (provided by applicant): Pediatric obesity is a highly prevalent problem, requiring both treatment and prevention efforts to reduce cardiovascular disease risk and metabolic consequences among affected children and the child population. The efficacy of family-based behavioral pediatric obesity treatment is likely compromised by non-optimal parent and child use of the behavioral skills of food and activity monitoring, contingency management, and environmental control. Participant behavioral skills use (BSU) is among the most potent correlates of adult obesity treatment outcome. However, in pediatric obesity treatment trials, BSU assessment is infrequent, when conducted is often only retrospectively recalled by parent report, has unknown reliability, and is incomplete, mostly assessing only the quality of food monitoring. Poor and incomplete BSU measurement precludes improving behavioral interventions for pediatric obesity. Furthermore, different approaches to help families initiate and sustain BSU during and following treatment have not been tested. This R21 developmental/exploratory proposal, in response to PA-06-298 - Understanding Mechanisms of Health Risk Behavior Change in Children and Adolescents-, aims to investigate 1) prospective relations between BSU measured during and following treatment and change in child weight status, physical activity, and diet, and 2) differences in BSU trajectory between different implementation approaches (prescriptive versus self-directed) during and following treatment. Eighty-two parent-child pairs will be randomly assigned to receive either a prescriptive or self-directed implementation approach to family-based behavioral pediatric obesity treatment. Parent- and interventionist-report of the family's use of each behavioral skill (monitoring, contingency management, environmental control) will be assessed at baseline, at the 5th, 10th, and 15th treatment sessions, at post-treatment and at the 3-month and 6-month follow-ups. A supplemental assessment of use of each skill will also be conducted at these time points. Prospective associations between BSU, measured multiple times and by multiple informant/formats, and change in child weight status (z-BMI) and weight-related behaviors (diet, physical activity) over the course of treatment and throughout follow-up will be examined. This proposal will provide important information about the type of BSU and its measurement that is most related to short- and long-term treatment efficacy, and provide pilot data on the relative efficacy of different implementation approaches to initiate and sustain BSU in pediatric obesity intervention. Pediatric obesity is a growing public health problem in the United States and has negative health, psychosocial, and economic consequences for individuals and the population. This proposal investigates core mechanisms and strategies for improving interventions for childhood overweight.