Binge Eating as a Mechanism Underlying the Food Insecurity-Obesity Paradox in Adolescents

项目总结/摘要 在美国，食品不安全与青少年肥胖风险的增加相关联。的 这种过度风险背后的机制还没有得到很好的理解，而这些知识对于提供信息至关重要。 为来自资源不足背景的青少年开展肥胖预防工作。因此，根据需要， 美国国立卫生研究院肥胖研究战略计划强调， 对于经济边缘化人群中的肥胖，迫切需要研究来阐明可改变的 在食物不安全的青少年中开展肥胖预防工作的目标机制。在拟议的项目中， 博士哈扎德是一名注册营养师和公共卫生研究员，他将把暴饮暴食作为一种潜在的 这一机制解释了粮食不安全与青少年肥胖风险升高之间的关联。与 她组建了一支出色的导师团队，并通过大学为她提供了资源。 明尼苏达州，这个独立之路奖将支持博士Hazzard在填补关键的培训差距， 进行必要的研究，以开始她作为独立调查员进行干预的职业生涯 努力促进粮食无保障的青少年的粮食安全和健康体重。准备 针对这一角色，提出了包括课程、导师制和研究在内的多方面培训计划：（1） 定性和混合方法，（2）先进的统计方法，重点是机器学习和因果关系 调解分析，以及（3）干预措施的设计，开发和传播，重点是人类- 中心设计Hazzard博士通过该培训计划开发的专业知识对于开展 建议的研究。在指导K99阶段，她将阐明暴食的病因， 在青少年时期粮食不安全的背景下，采用混合方法，包括：（a）开展 对报告暴饮暴食的食物不安全青少年进行定性访谈，（B）利用来自 NIH资助的观察队列采用基于树的机器学习技术（目标1）。在 在独立R 00阶段，Hazzard博士将招募175名青少年进入一个新的独立队列，她将 跟踪18个月，以量化暴饮暴食在多大程度上介导了 青春期的粮食不安全和体重增加（目标2）。最后，采用以人为本的设计方法， 她将开发小插图，描述潜在的以学校为基础的干预措施，以提高粮食安全和预防 食物不安全的青少年体重过度增加，并评估潜在的 在与经历过食物的青少年的半结构化访谈中使用这些小插曲进行干预 不安全（目标3）。该项目的研究结果将为制定和实施 一项以学校为基础的干预措施，以促进经历食物的青少年的食物安全和健康体重 不安全感，反过来，促进博士Hazzard的成功过渡到一个独立的研究生涯。 1

PROJECT SUMMARY/ABSTRACT Food insecurity is paradoxically associated with elevated risk of adolescent obesity in the United States. The mechanisms underlying this excess risk are not well understood, and such knowledge is essential for informing obesity prevention efforts for adolescents from under-resourced backgrounds. Thus, aligned with the need emphasized by the Strategic Plan for NIH Obesity Research to identify the reasons contributing to increased risk for obesity among economically marginalized populations, research is critically needed to elucidate modifiable mechanisms to target in obesity prevention efforts among food-insecure adolescents. In the proposed project, Dr. Hazzard, a registered dietitian and public health researcher, will examine binge eating as a potential mechanism to explain the association between food insecurity and elevated risk for adolescent obesity. With the exceptional mentorship team she has assembled and the resources available to her through the University of Minnesota, this Pathway to Independence Award will support Dr. Hazzard in filling critical training gaps and conducting the research necessary to launch her career as an independent investigator conducting intervention work to promote food security and healthy weight among adolescents experiencing food insecurity. To prepare her for this role, a multifaceted training plan including coursework, mentorship, and research is proposed in: (1) qualitative and mixed methods, (2) advanced statistical methods, with a focus on machine learning and causal mediation analysis, and (3) intervention design, development, and dissemination, with an emphasis on human- centered design. The expertise Dr. Hazzard develops through this training plan will be essential for conducting the proposed research. During the mentored K99 phase, she will elucidate the etiology of binge eating in the context of food insecurity during adolescence using a mixed-methods approach that involves (a) conducting qualitative interviews in food-insecure adolescents who report binge eating and (b) leveraging existing data from an NIH-funded observational cohort to employ tree-based machine learning techniques (Aim 1). In the independent R00 phase, Dr. Hazzard will recruit 175 adolescents into a new, independent cohort that she will follow for 18 months to quantify the extent to which binge eating mediates the longitudinal association between food insecurity and weight gain during adolescence (Aim 2). Finally, using a human-centered design approach, she will develop vignettes describing potential school-based interventions to improve food security and prevent excess weight gain among food-insecure adolescents and assess perceived acceptability of the potential interventions using these vignettes in semi-structured interviews with adolescents who have experienced food insecurity (Aim 3). Findings from this project will lay the groundwork for the development and implementation of a school-based intervention to promote food security and healthy weight among adolescents experiencing food insecurity and, in turn, promote Dr. Hazzard’s successful transition to an independent research career. 1