Improving Adolescent Obesity Treatment: Exploring the Role of Parents

 描述(由申请人提供)：迫切需要创新的肥胖预防和治疗方法，特别是在非裔美国人(AA)中，这是一个肥胖风险及其相关发病率和死亡率增加的人群。研究和临床实践指南一直建议父母应该包括在孩子的肥胖症治疗中，但让父母参与青少年肥胖症治疗的最有效战略尚不清楚。青春期对以家庭为基础的护理提出了重大挑战，因为青少年对独立和自主的渴望增加，助长了对权威人物的抵制；然而，他们仍然依赖父母满足许多需求。考虑到这些挑战，调查青少年肥胖治疗中父母参与的特定临床范例的研究不一致也就不足为奇了。为此，目前的应用程序尝试了两种不同的方法，让父母参与青少年肥胖症的治疗。青少年(教学，鼓励，锻炼，营养，支持)是一个以家庭为基础的，多学科的行为治疗计划，主要针对AA，肥胖青少年。这个调查小组先前证明，参与青少年干预与6个月后体重指数(BMI)的显著下降有关。在青少年时期，父母被包括在每月小组中，以支持青少年的体重管理。虽然父母体重不是目标，但父母和青少年的BMI变化之间存在显著的相关性。这些发现突显了父母参与的重要性，并表明父母体重管理可能是一个重要的干预目标。事实上，在青少年治疗中直接针对父母减肥可能与青少年体重指数的更大降低有关，因为同时进行体重管理的父母可能会对共享的环境做出更大的改变，并发挥强大的榜样作用，因为他们有共同的目标。为此，在我们之前工作的基础上，我们开发了Teens+，一种基于家庭的青少年肥胖干预措施。本申请提出了一项随机对照试验，以确定在96名超重或肥胖青少年(体重指数第85百分位数)和父母(S)(体重指数25公斤/平方米)中，父母治疗青少年+的可行性和初步疗效。家庭将随机接受两种为期4个月的治疗之一：1)青少年+父母作为教练(PAC)，聘请父母作为帮助他们孩子体重管理的人；或2)青少年+父母减肥(PWL)，让父母参与他们自己的体重管理。所有青少年都将参加青少年+计划，其中包括饮食目标的营养教育、有监督的体力活动和行为支持，并整合动机访谈以提高治疗参与度。评估将在0个月、4个月和7个月完成。这项调查的结果将为随后的一项更大规模的试验提供信息，该试验调查父母在青少年肥胖治疗中的作用，目标主要是非裔美国家庭。

 DESCRIPTION (provided by applicant): There is an urgent need for innovative approaches to obesity prevention and treatment, particularly among African Americans (AA), a population at increased risk of obesity and its associated morbidity and mortality. Research and clinical practice guidelines consistently recommend that parents should be included in their children's obesity treatment, yet the most effective strategy to engage parents in adolescent obesity treatment is unclear. The adolescent period presents substantial challenges to family-based care, as youth experience increased desire for independence and autonomy, contributing to resistance to authority figures; yet they still rely on parents for many needs. Given these challenges, it is not surprising that research investigating specific clinical paradigms for involvng parents in adolescent obesity treatments is inconsistent. To that end, the current application pilots two distinct approaches for involving parents in their adolescents' obesity treatment. TEENS (Teaching, Encouragement, Exercise, Nutrition, Support) is a family-based, multidisciplinary behavioral treatment program targeting primarily AA, obese adolescents. This investigative team previously demonstrated that participation in the TEENS intervention is associated with significant reductions in body mass index (BMI) at 6 months. In TEENS, parents were included in monthly groups to support their adolescent's weight management. Although parent weight was not targeted, a significant correlation between parent and adolescent BMI change was found. These findings highlight the importance of parental involvement and suggest that parent weight management might be an important intervention target. Indeed, directly targeting parent weight loss within adolescent treatment might be associated with even greater adolescent BMI reductions, as parents engaged in concurrent weight management might make greater changes to the shared environment and serve as powerful role models, given their common goals. Towards that end and building on our previous work, we developed TEENS+, a family-based adolescent obesity intervention. This application proposes a randomized controlled pilot to determine the feasibility and preliminary efficacy of two parent treatments within TEENS+ among 96 overweight or obese adolescents (BMI>85th percentile) and parent(s) (BMI>25 kg/m2). Families will be randomized to one of two 4-month treatments: 1) TEENS+Parents as Coaches (PAC), engaging parents as helpers in their child's weight management, or 2) TEENS+Parent Weight Loss (PWL), engaging parents in their own weight management. All adolescents will participate in the TEENS+ protocol, which includes nutrition education with dietary goals, supervised physical activity, and behavioral support, and integrates motivational interviewing to enhance treatment engagement. Assessments will be completed at 0, 4, and 7 months. Results of this investigation will inform a subsequent larger trial investigating the role of parents in adolescent obesity treatment, targeting predominately African American families.