The Bariatric Experience Long Term (BELONG) II for Racial and Ethnic Minority Patients

针对少数族裔患者的长期（BELONG）减肥体验 II

基本信息

批准号：
10210238
负责人：
Karen Jacqueline Coleman
金额：
$ 70.38万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-23 至 2023-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10210238
关键词：
Address Anxiety Area Back Bariatrics Behavioral Body Image Body Weight decreased Body mass index Caring Central obesity Chronic stress Clinical Crime Data Development Disease Eating Behavior Environmental Risk Factor Ethnic Origin Ethnography Failure Food Gastric Bypass Health Status Healthcare Systems Hispanics Hydrocortisone Individual Literature Measures Mediating Mental Depression Methods Morbid Obesity Neighborhoods Not Hispanic or Latino Obesity Operative Surgical Procedures Outcome Outcome Study Participant Patient Self-Report Patients Population Postoperative Care Poverty Predictive Factor Prevalence Procedures Qualitative Methods Race Research Sample Size Socioeconomic Status Stomach Stress Testing Weight Work bariatric surgery black patient black women care systems comorbidity coping critical period cultural values design diet and exercise effective therapy ethnic difference ethnic minority population evidence base experience follow-up health disparity innovation lifestyle intervention low socioeconomic status middle age patient oriented programs psychosocial racial and ethnic racial and ethnic disparities racial discrimination racial minority racism response social treatment choice vigilance

项目摘要

Effective treatments for severe obesity are particularly needed in racial/ethnic minority populations. Rates of severe obesity are as high as 36% for middle-aged non-Hispanic black women compared to 16% for their white counterparts in the U.S. Even with multi-component lifestyle interventions, only 50% of studies show 5% weight loss (considered clinically meaningful), and most participants gain back at least half of this lost weight over 18–30 months. These outcomes have led to the development of surgical treatments for severe obesity. When compared to diet and exercise, bariatric surgery results in much higher weight loss over a period of 24 months (75% vs. 11%). Research on bariatric weight loss outcomes among racial/ethnic minorities is limited. What evidence does exist suggests that black patients consistently lose less weight than whites over 2–3 years of follow-up. The evidence for differences between Hispanic and white or black bariatric patients is equivocal. Hispanic patients have been shown to lose more, less, or the same amount of weight as non-Hispanic black and white patients. Across studies, the disparities in % total weight loss vary from less than 2% to 10%. This variability is twice as much as the amount of weight loss considered clinically meaningful. We propose to address evidence gaps in the literature by extending the work done by our team during the Bariatric Experience Long-Term (BELONG) study which addressed how self-reported behavioral, psychosocial, and perceived environmental factors predicted weight loss over 3 years following gastric bypass and sleeve. Patients (n = 1,975) were 41% Hispanic, 17% non-Hispanic black, and 37% non-Hispanic white. The proposed study will expand the work of BELONG by incorporating: 1) A focus on weight regain during 3-5 years after surgery; 2) measures shown to contribute to health disparities in severe obesity (vigilant coping style and internalized racism); and 3) innovative qualitative methods (photo-elicitation and ethnography) to understand the patient experience. IMPACT: Results will help design patient-centered, culturally appropriate post- operative care programs so that all patients achieve the maximum benefits from this highly effective treatment. We propose the following study aims: AIM 1: Determine how environmental (social, physical); healthcare system; and patient psychosocial and behavioral factors, and health status contribute to racial/ethnic disparities in bariatric weight loss and regain after 5 years. AIM 2: Gain a deeper understanding of weight loss and regain for different races/ethnicities 5 years after surgery using qualitative methods. EXPLORATORY AIM: Explore the interaction of race/ethnicity and bariatric procedure type on weight loss and regain after 5 years.

少数种族/族裔人群尤其需要有效治疗严重肥胖症。非西班牙裔黑人中年女性的严重肥胖率高达 36%，而美国黑人女性的严重肥胖率为 16% 美国的白臂即使采取多种生活方式干预措施，也只有 50% 的研究显示 5% 体重减轻（被认为具有临床意义），并且大多数参与者至少恢复了减重的一半超过 18-30 个月的结果导致了严重肥胖症手术治疗的发展。与节食和运动相比，减肥手术在 24 年内的减重效果要高得多几个月（75% vs. 11%）。关于少数族裔/族裔减肥效果的研究有限。现有证据表明，在 2-3 年内，黑人患者的体重减轻始终低于白人患者西班牙裔和白人或黑人肥胖患者之间差异的证据是模棱两可的。研究表明，西班牙裔患者与非西班牙裔黑人相比，体重减轻更多、更少或相同各项研究中，总体重减轻百分比的差异从 2% 到 10% 不等。我们建议，变异性是临床上有意义的体重减轻量的两倍。通过扩展我们团队在减肥期间所做的工作来解决文献中的证据差距体验长期（BELONG）研究探讨了自我报告的行为、心理社会和感知的环境因素预测胃绕道手术和袖状胃绕道手术后三年内体重减轻。患者 (n = 1,975) 中 41% 是西班牙裔，17% 是非西班牙裔黑人，37% 是非西班牙裔白人。研究将通过纳入以下内容来扩展 BELONG 的工作： 1) 关注术后 3-5 年内的体重反弹手术；2）已证明会导致严重肥胖的健康差异的措施（警惕的应对方式和内在的种族主义）；3）创新的定性方法（照片启发和民族志）来理解影响：结果将有助于设计以患者为中心、适合文化的术后治疗。手术护理计划，使所有患者从这种高效的治疗中获得最大的益处。我们提出以下研究目标：目标 1：确定环境（社会、身体）保健；系统；患者心理社会和行为因素以及健康状况影响种族/民族 5 年后减肥体重减轻和恢复的差异目标 2：更深入地了解使用定性方法计算手术后 5 年不同种族/民族的体重减轻和恢复情况。探索性目标：探索种族/民族与减肥手术类型对体重的相互作用 5年后的损失和恢复。