Binge Eating as a Mechanism Underlying the Food Insecurity-Obesity Paradox in Adolescents - 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. The K99 phase of this Pathway to Independence Award supported 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. Through coursework, mentorship, and research, Dr. Hazzard gained expertise 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. During the mentored K99 phase, she worked to elucidate the etiology of binge eating in the context of food insecurity during adolescence using a mixed-methods approach that involved (a) conducting qualitative interviews in foodinsecure adolescents who report binge eating and (b) leveraging existing data from an NIH-funded observational cohort to employ tree-based machine learning techniques. 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 1 of the R00 phase). Finally, using a human-centered design approach, she will develop vignettes describing potential interventions in community settings 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 2 of the R00 phase). Findings from this project will lay the groundwork for the development and implementation of an intervention in a community setting 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.
