Weight Loss and Maintenance for Individuals with IDD

IDD 患者的减肥和维持

• 批准号: 8139141
• 负责人: Joseph E. Donnelly
• 金额: $ 56.33万
• 依托单位: UNIVERSITY OF KANSAS MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-15 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8139141
• 关键词: Adherence; Adult; Advocacy; Affect; American; American Dietetic Association; Area; Behavior; Behavioral; Blood Pressure; Body Weight Changes; Body Weight decreased; Cardiovascular Diseases; Cardiovascular system; Caregivers; Caring; Chronic Disease; Consumption; Data; Decision Making; Developmental Disabilities; Diabetes Mellitus; Diet; Dietary intake; Disabled Persons; Eating; Energy Intake; Energy Metabolism; Environment; Equation; Evaluation; Fatty acid glycerol esters; Food; Fostering; Funding; General Population; Glucose; Government; Group Homes; Health; Health Promotion; Healthy People 2010; High Density Lipoprotein Cholesterol; Home environment; Hypertension; Individual; Insulin; Intellectual functioning disability; Intervention; Investigation; LDL Cholesterol Lipoproteins; Laboratories; Lead; Learning; Life; Life Style; Light; Literature; Living Arrangement; Logistics; Maintenance; Malignant Neoplasms; Measurement; Mediation; Mediator of activation protein; Mental Retardation; Metabolic; Monitor; Movement; Obesity; Overweight; Parents; Participant; Patient Self-Report; Pattern; Persons; Physical activity; Pilot Projects; Policies; Population; Positioning Attribute; Preparation; Prevalence; Prevention; Process; Provider; Psychosocial Factor; Publishing; Quality of life; Reporting; Research; Risk; Risk Factors; Sampling; Schedule; Schools; Self Determination; Self Efficacy; Side; Sports Medicine; Stress; System; Time; Training; Translations; Transportation; Triglycerides; Weight; Work; clinically relevant; college; comparison group; design; diabetes prevention program; disorder risk; drinking; empowered; energy balance; fitness; follow-up; fruits and vegetables; good diet; improved; nutrition; obesity treatment; patient home care; peer; portion control; pressure; programs; public health relevance; randomized trial; social cognitive theory; treatment strategy; weight maintenance

DESCRIPTION (provided by applicant): Individuals with IDD have obesity rates that exceed those in the general population, consume energy dense diets, and perform very little physical activity (PA). Overweight and obesity are independent risk factors for chronic disease such as cancer, diabetes, hypertension, and cardiovascular disease in both the general population and those with IDD. However to date, limited research on weight management for individuals with IDD has been completed. We have recently initiated a 6 month pilot investigation on weight loss in 73 individuals with IDD and 66 completed the 6 months. We modified the Stop Light Diet (SLDm) to include reduced energy pre-packaged meals (PM) to reduce energy and fat content, and encouraged consumption of low energy shakes and 35 fruits and vegetables (F/V) per week. SLDm resulted in an average 6.1 percent reduction in weight at 6 months and increased F/V consumption. We continue to follow the 66 participants for an additional 6 months and weight loss at 9 and 12 months is 8.2 percent and 9.1 percent from baseline. Although our pilot results are encouraging, this study was conducted in a small sample with no comparison group, and funding only allowed for measurement of weight during follow up. Therefore, we propose to conduct an adequately powered randomized trial to evaluate weight loss and weight maintenance. Social Cognitive Theory (SCT) guides the interventions using both sides of the energy balance equation (i.e. energy intake and energy expenditure) in overweight and obese individuals with IDD. We will compare participants who use the SLDm with participants who use a recommended care diet (RC). Following a 6 month period of reduced energy intake (weight loss), both groups will be placed on a diet with sufficient energy to maintain weight (i.e. weight maintenance) for and additional 12 months. Both groups will participate in a PA program that has been shown to improve metabolic risk factors such as blood pressure, triglycerides, and cardiovascular fitness, and has provided modest weight loss in gymnasium and laboratory settings. In the current proposal the PA program will be modified for home use and conducted for the entire 18 month trial. We expect the SLDm group to have greater weight loss at 6 months and less weight regain from 6 to 18 months compared to RC. We have proposed mediation analysis for components of SCT for both participant and care givers to discover what components of the intervention affected weight change. We will conduct extensive process evaluation will collect quantitative and qualitative data to assess how well the programs were implemented and accepted by participants. PUBLIC HEALTH RELEVANCE: Narrative. There are few efficacious treatment options for individuals with IDD who wish to lose weight and reduce health risk. Both SLDm and RC diets combined with PA may provide weight loss and reduction of health risk, although we expect greater and clinically meaningful weight loss and maintenance with SLDm compared to RC. Translation of the 2 approaches to weight loss can be accomplished through the existing IDD agencies and care providers with modest training.

描述（由申请人提供）：IDD 患者的肥胖率超过一般人群，饮食能量密集，体力活动 (PA) 很少。超重和肥胖是普通人群和 IDD 患者患癌症、糖尿病、高血压和心血管疾病等慢性疾病的独立危险因素。然而迄今为止，针对 IDD 患者的体重管理的研究还很有限。我们最近对 73 名 IDD 患者进行了为期 6 个月的减肥试点调查，其中 66 人完成了这 6 个月的调查。我们修改了 Stop Light Diet (SLDm)，纳入低能量预包装餐 (PM)，以减少能量和脂肪含量，并鼓励每周食用低能量奶昔和 35 种水果和蔬菜 (F/V)。 SLDm 使 6 个月时体重平均减轻 6.1%，并增加 F/V 消耗。我们继续对 66 名参与者进行额外 6 个月的跟踪，第 9 个月和第 12 个月的体重较基线分别减少了 8.2% 和 9.1%。尽管我们的试点结果令人鼓舞，但这项研究是在小样本中进行的，没有对照组，而且资金只允许在随访期间测量体重。因此，我们建议进行一项充分有力的随机试验来评估体重减轻和体重维持。社会认知理论 (SCT) 指导使用能量平衡方程两边（即能量摄入和能量消耗）对超重和肥胖 IDD 患者进行干预。我们将比较使用 SLDm 的参与者与使用推荐护理饮食 (RC) 的参与者。经过 6 个月的能量摄入减少（减肥）后，两组均将在接下来的 12 个月内采用能量充足的饮食来维持体重（即体重维持）。两组都将参加 PA 计划，该计划已被证明可以改善血压、甘油三酯和心血管健康等代谢危险因素，并在体育馆和实验室环境中提供适度的减肥效果。在当前的提案中，PA 程序将被修改为适合家庭使用，并在整个 18 个月的试验中进行。我们预计，与 RC 相比，SLDm 组在 6 个月时体重减轻较多，而 6 至 18 个月时体重反弹较少。我们为参与者和护理人员提出了对 SCT 组成部分的中介分析，以发现干预措施的哪些组成部分影响了体重变化。我们将进行广泛的过程评估，收集定量和定性数据，以评估计划的实施情况和参与者的接受程度。 公共卫生相关性：叙述。对于希望减肥和降低健康风险的 IDD 患者来说，有效的治疗选择很少。 SLDm 和 RC 饮食与 PA 相结合都可以减轻体重并降低健康风险，尽管我们预计与 RC 相比，SLDm 可以实现更大且具有临床意义的体重减轻和维持。这两种减肥方法的转化可以通过现有的 IDD 机构和经过适当培训的护理提供者来完成。