2012 Annual Report
1a.Objectives (from AD-416):
Objective 1: Investigate the effectiveness of community-based intervention strategies to prevent childhood obesity and its associated health risks in 8- to 12-y-old Hispanic children with BMI >/= 85th percentile.
Sub-objective 1.A. Test the effectiveness of diet behavior modification, structured aerobic exercise, or diet behavior modification plus structured aerobic exercise for obesity prevention and improvement in fitness, health risks, and psychological state in at-risk Hispanic children, ages 8-12 y, assigned to one of three treatment groups or control in a 12-month family-based RCT.
Sub-objective 1.B. Evaluate the role of genetic variation in response to strategies aimed at diet and PA.
Sub-objective 1.C. Model energy balance in growing children to predict the obligatory changes in energy intake and/or energy expenditure and PAL required for obesity prevention.
Objective 2: Develop and evaluate family-centered intervention strategies for the pediatric primary care setting to prevent childhood obesity.
Sub-objective 2.A. Develop a conceptual model and perform formative work to evaluate the model for a pediatric obesity prevention program for primary care clinics.
Sub-objective 2.B. Develop and pilot test a parent-targeted obesity prevention program for pediatric primary care clinics.
Sub-objective 2.C. Evaluate the parent-targeted prevention program for effectiveness in pediatric primary care clinics.
1b.Approach (from AD-416):
The long-term objective of this project is to increase our understanding of how to prevent childhood obesity through targeted community interventions. A multifactorial theoretical approach based on Social Cognitive Theory (SCT) and parenting theory will be taken to address the built environment as well as family dynamics and child behavior at the community and primary care level. A 12-month family-based randomized controlled trial (RCT) will be conducted to test the effectiveness of diet behavior modification, structured aerobic exercise, or diet behavior modification plus structured aerobic exercise for obesity prevention and improvement in fitness, health risks, and psychological state in at-risk Hispanic children (Objective 1). The role of genetic variation in response to strategies aimed at diet and physical activity (PA) will be evaluated and a model developed to predict the obligatory changes in energy intake and physical activity level (PAL) required for obesity prevention. Family-centered intervention strategies will be developed and evaluated for the pediatric primary care setting to prevent childhood obesity (Objective 2). A conceptual model will be developed and formative work performed to evaluate the model for obesity prevention program for primary care clinics. A parent-targeted obesity prevention program will be developed and a pilot study conducted in pediatric primary care clinics. A RCT will be conducted to evaluate the parent-targeted prevention program for effectiveness in pediatric primary care clinics. Together, these strategies form a new paradigm that integrates community resources and pediatric primary care in support of the child and the family in the prevention and management of childhood obesity.
For sub-objective 1A we are attempting to investigate the effectiveness of community-based intervention strategies to prevent childhood obesity and its associated health risks in at-risk children. A 12-mo family-based child obesity intervention called MEND (Mind Exercise Nutrition Do It) is being conducted at local YMCAs in underserved communities. MEND is a healthy lifestyle program involving a 10-week intensive phase of twice-weekly MEND sessions for parents. For the second hour of the 2-hour session, the children participate in exercise classes while the parents receive information and counseling from trained health educators. The follow-up phase of MEND entails exercise classes, YMCA Youth Sports, and parental support groups. To date, 74 families have been enrolled into this 12-mo program. Data collection will be completed in September. In sub-objective 2B we are evaluating the role of genetic variation in response to strategies aimed at diet and physical activity. To explore the effect of genetic variation on behaviors related to diet and physical activity, we have completed a genome-wide association study (GWAS) that involved measuring 1.1 million genetic markers in 815 children. Our findings corroborated genes implicated in other studies, identified novel genes in biological pathways, and revealed novel genes of unknown function. In addition, we sequenced a gene called insulin receptor substrate 2 (IRS2) that is important in the regulation of insulin signaling. We found a total of 140 genetic variants, some of which were common and others rare in Hispanic children. One rare variant in particular was related to body mass index, fat mass, and waist circumference in Hispanic children. We concluded that rare but not common IRS2 variants may play a role in the regulation of body weight in Hispanic children. Understanding the genetics underlying obesity is of great interest to the biomedical community. In sub-objective 1C we are continuing our data collection. In sub-objective 2B we were able to develop a manuscript describing the feasibility study, and it has been accepted at Child: Care, Health & Development and is currently e-published ahead of print. To evaluate the parent-targeted prevention program in pediatric primary care clinics (Sub-objective 2C), as proposed in the project plan, external funds were sought and an R01 application to NIH- NIDDK was resubmitted, but funding has not been obtained. Thus the expected progress was not achieved through month 36 for sub-objective 2C. As described in the contingency plan of the objective, the study design and approach have been redesigned with continued collaboration with Texas Children's Health Plan and Texas Children's Pediatric Associates. The objective has been redesigned to develop Helping HAND (the parent-targeted obesity prevention program for pediatric primary care clinics) into a program that can be delivered via mobile technologies. Additional external funding have again been sought (application submitted to NIH-NICHD) to achieve this aim and test the resulting program in a feasibility study. Qualitative studies to inform the development of the Mobile Health program are currently planned as part of the OSQR project in continued collaboration with the Texas Children’s Health Plan.