Suzanne E. Mazzeo - US grants

DESCRIPTION (provided by applicant): This K01 Mentored Research Scientist Development Award proposal describes a rigorous five year training program in genetic epidemiology with an emphasis on eating disorders. Eating disorders are often chronic, and have severe medical, psychological, and financial consequences for patients and their families. However, many questions about their etiology remain. Recently, investigators have begun to examine the role of genetics in the development of eating disorders. Yet, the relative contributions of genetic and environmental factors to eating disordered behaviors require further investigation in order to enhance prevention and treatment efforts. This application outlines a training program that will enable Dr. Mazzeo to combine her previous experience in eating disorders research, and her strong background in psychometrics,with skills in genetics, epidemiology, and biostatistics. These skills will be applied in a series of population based twin studies examining the role of both genes and environment in the development and maintenance of the full range of eating problems. The general goals of this research program are to increase our understanding of the heritabUity of specific disordered eating behaviors, and to enhance knowledge of environmental factors that lead to gene expression among individuals biologically predisposed to eating problems. Specific research objectives include: a) conducting a meta-analysis of previous investigations of the heritability of bulimia nervosa and associated symptomatology in twins; b) examining the influence of genetic and environmental factors on dietary restraint, disinhibition, and susceptibility to hunger; c) testing the validity of the equal environment assumption in both U.S. and Norwegian twin samples using contextual variables that are particularly relevant to the development of eating pathology; d) evaluating the role of constitutional thinness as a protection against the development of eating disorders in men, e) testing explanatory models of the comorbidity of eating and alcohol use disorders, and eating and mood disorders in a population-based twin sample of men; and f) evaluating models of the comorbidity of eating and anxiety disorders, and eating and alcohol use disorders in a population-based twin sample of women. Completion of this training program will enable Dr. Mazzeo and her sponsors to elucidate genetic and environmental risk factors for eating disorders. It will also provide Dr. Mazzeo with the requisite training to become an independent investigator in the genetic epidemiology of eating disorders.

[unreadable] DESCRIPTION (provided by applicant): Rates of pediatric overweight represent a public health crisis which shows no signs of abating [5-6]. Pediatric overweight is associated with numerous physical and psychological health risks, and overweight children are at significant risk for obesity in adulthood [15]. Thus, treatment of pediatric overweight is an important step in the prevention of adult obesity. African-American children are at particularly high risk for overweight and its related health complications [6-9]. However, this ethnic group has traditionally had limited access to obesity treatment [78] and relatively few studies have included sufficient numbers of lower-SES, African American participants. Further, although parental involvement in treatment for pediatric overweight has been found to be beneficial [17-20], few studies have examined the efficacy of offering treatment exclusively to parents, a potentially cost-effective approach which could benefit the entire family [72]. This R03 project will evaluate the efficacy of an intensive parenting intervention, (NOURISH), targeting ethnically diverse parents of overweight children (ages 6-11). In contrast to previous research in the field, NOURISH addresses several urgent research priorities by targeting the underserved and addressing the significant disparity in obesity treatment services. Parents meeting study criteria (having a child between the ages of 6 and 11 with a BMI greater than the 85th percentile) will be offered participation in the randomized trial comparing NOURISH with a placebo control group. We hypothesize that children whose parents participate in NOURISH will manifest greater decreases in BMI, and greater improvements in dietary intake and quality of life compared to children whose parents do not participate. This study is designed explicitly to gather preliminary data to inform sample size and power calculations for a subsequent larger randomized controlled trial. Project Narrative: The percentage of overweight children between the ages of 6 and 11 has nearly tripled in the last three decades, and rates are even higher among African Americans. Overweight children are at-risk for numerous health problems, thus effective treatments are urgently needed. This study will evaluate an innovative intervention for ethnically diverse parents (NOURISH), which focuses on helping parents role model and teach their children healthy behaviors. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): Binge and loss of control (LOC) eating affect a significant number of adolescents of all ethnicities and are associated with numerous psychological problems, including depression, anxiety, low self-esteem, body dissatisfaction, and weight concerns. African American women appear to be particularly vulnerable to binge eating disorder, and LOC and binge eating are prevalent among African American girls. However, empirically validated culturally sensitive treatments for these disordered eating behaviors are not available. Thus, this R34 application aims to develop a manualized and culturally sensitive intervention (LIBER8-Linking Individuals Being Emotionally Real) for African American and White adolescent girls targeting binge and LOC eating. We will target the intervention to adolescents with either or both behaviors. This intervention will integrate components of dialectical behavior therapy tailored to adolescents who engage in binge and LOC eating, such as mindfulness and distress tolerance skills training, with a core of cognitive-behavioral therapy (CBT). We will seamlessly integrate a key adolescent communication strategy, namely text-messaging, into therapeutic self-monitoring. We will evaluate the feasibility and acceptability of the intervention in a controlled pilot trial. This study is designed explicitly to gather preliminary data to inform a subsequent larger randomized controlled trial. We hypothesize that this intervention will serve to reduce binge and LOC eating, as well as improve psychosocial functioning as evidenced by decreased depression, anxiety, eating disorder cognitions, and impulsivity, and improved quality of life. PUBLIC HEALTH RELEVANCE: Many adolescents struggle with overeating (binge-eating). Adolescents with these eating problems are more likely than their peers to be depressed, anxious, and feel badly about their appearance. African American girls are especially at-risk for these eating problems. Effective treatments are urgently needed. This study will develop and evaluate an innovative intervention (LIBER8-Linking Individuals Being Emotionally Real) for ethnically diverse adolescent girls. This intervention will focus on teaching girls skills that help them reduce their problematic eating behaviors and improve their overall well-being.

DESCRIPTION (provided by applicant): Pediatric overweight is a national public health concern. The percentage of overweight children in the U.S. between the ages of 6 and 11 has nearly tripled in the last 3 decades and African Americans are particularly at risk. Moreover, pediatric overweight is associated with numerous physical and psychological health problems and overweight children are at significant risk for obesity in adulthood. Despite the urgent need for pediatric overweight interventions, outcomes of some of the most rigorous treatments are, at best, mixed. Although research has found that including parents in interventions for pediatric overweight has positive effects on outcomes, relatively few studies have included sufficient numbers of lower-SES, African American participants, a group at increased risk for pediatric overweight and associated complications. Further, although parental involvement in treatment for pediatric overweight is beneficial, few studies have examined the efficacy of offering treatment exclusively to parents, a potentially cost- effective approach which could benefit the entire family This study will evaluate the efficacy of an intensive intervention targeting ethnically diverse parents of overweight (BMI >85th percentile) children ages 5-11. This intervention has been implemented in a small pilot trial (R03 HD056050, NOURISH-Nourishing Our Understanding of Role modeling to Improve Support and Health), and yielded significant reductions in child BMI percentile. In this R01 application, we propose a larger RCT of NOURISH (NOURISH+), which will build upon the strengths of our pilot work and integrate more hands-on experiences for parents to optimize the intervention's efficacy. Parents meeting study criteria will be offered participation in the randomized trial comparing NOURISH+ with a control group. We hypothesize that children whose parents participate in NOURISH+ will manifest greater decreases in BMI percentile, and greater improvements in dietary intake, physical activity, and quality of life compared to children whose parents are in the control group. Results have significant potential to inform future translational studies involving NOURISH+. PUBLIC HEALTH RELEVANCE: The percentage of overweight children ages 6 to 11 has nearly tripled in the last three decades, and rates are even higher among African Americans. Overweight children are at-risk for numerous physical and mental health problems, thus effective treatments are urgently needed. This study will evaluate an innovative, intervention for ethnically diverse parents (NOURISH+), which focuses on helping parents role model and teach their children healthy behaviors.

DESCRIPTION (provided by applicant): Dietary quality is associated with children's academic performance, and physical and emotional well-being. Poor dietary habits increase risk for many chronic diseases, even among individuals who are not overweight, suggesting that improving children's eating behaviors is an extremely important target of public health efforts. Yet, individual or group programming targeting dietary quality and obesity prevention is time and resource- intensive, and not universally available, limiting its impact on some of the groups most vulnerable to obesity, especially lower income and minority children. Enhancing food quality in elementary schools is associated with reductions in obesity. Consistent with this research, the National School Lunch Program (NSLP) was recently revised to require students to select fruits and vegetables (F&Vs). This change has generated significant concerns from school districts about plate waste (and very vocal complaints from students about the palatability of the foods offered). This policy uses a serve model to expose students to healthier nutritional options. However, this approach poses challenges, as research suggests that increasing (not forcing) dietary choices is associated with greater F&V consumption. This application, submitted in response to PA-13-099 (School Nutrition and Physical Activity Policies, Obesogenic Behaviors & Weight Outcomes) will make a significant contribution to pediatric obesity policy research by investigating the impact of the revised NSLP mandate aimed at increasing F&V consumption. In this application, we partner with Title I schools (85%+ ethnic/racial minority students) to assess the impact of the serve model on F&V consumption during school breakfast and lunch in 1st-3rd grade students. We will also investigate whether a brief intervention in which students' tasting of these foods is reinforced increases their consumption and perceived palatability. This project will provide important data regarding the extent of plate waste in Title I schools under the revised NSLP. In addition, we hypothesize that F&V consumption and liking of these foods will significantly increase at the intervention school, compared with the control school, and changes will persist at 6-week follow-up. Finally, we will conduct qualitative interviews with relevant stakeholders, including cafeteria staff, school administrators, teachers, and parents/caregivers. Interviews will address the perceived feasibility and acceptability of school food policies, and elicit suggestions for additional policy endeavors. Findings will inform future iterations of this (and related) school food policy. This is especially important given that many policies are mandated in the absence of data indicating whether they will have the desired effects, and if they might yield any unintended consequences. This multidisciplinary, multi-method application is highly consistent with the specific research objectives of this PA, which prioritizes investigations focused on: 1) the influence of school policies on nutritional behaviors, 2) the implementation of these policies, 3) understanding conditions that enhance the feasibility and success of school nutritional policies, and 4) increasing connections between the school and home nutritional environment.