Acceptance-based Group Intervention for Binge Eating

基于接受的暴食团体干预

• 批准号: 8277551
• 负责人: Niloofar Afari
• 金额: --
• 依托单位: VA SAN DIEGO HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-10-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8277551
• 关键词: Address; Adult; Affect; Anxiety; Behavioral; Binge Eating; Body Weight decreased; Body mass index; Caring; Clinical; Comorbidity; Complement; Control Groups; Coronary heart disease; Degenerative polyarthritis; Diabetes Mellitus; Diet; Distress; Eating; Eating Behavior; Eating Disorders; Emotional; Emotions; Epidemic; Food; Frequencies; Health; Health Care Costs; Healthcare Systems; Hour; Hunger; Hyperphagia; Impairment; Individual; Intake; Intervention; Letters; Link; Maintenance; Measures; Mediating; Mental Depression; Mental Health; Nutrient; Obesity; Outcome; Overweight; Patient Care; Patients; Physical activity; Problem behavior; Quality of life; Randomized; Risk; Role; Sampling; Severities; Stress; Symptoms; Testing; Therapeutic Intervention; Veterans; Weight; Weight maintenance regimen; active control; bariatric surgery; base; brief intervention; clinical practice; craving; depressive symptoms; deprivation; distress tolerance; efficacy testing; emotional distress; emotional eating; evidence base; experience; group intervention; health administration; improved; improved functioning; indexing; interest; meetings; mortality; obesity treatment; physical conditioning; primary outcome; programs; psychologic; psychological distress; respiratory; response; treatment response; weight loss intervention; weight maintenance

DESCRIPTION (provided by applicant): Approximately two-thirds of all adults and close to 75% of Veterans are overweight or obese, making obesity a national epidemic with significant impairments in physical and psychological functioning, increasing healthcare costs, and high mortality rates. A significant proportion of overweight and obese individuals binge eat in response to stress or negative emotions, further contributing to obesity. Obesity and binge eating are independently related to a number of physical and mental health co-morbidities such as diabetes, coronary heart disease, osteoarthritis, respiratory symptoms, depression, and anxiety. Although behavioral weight loss interventions have been partially effective, few show long-term maintenance of weight loss, especially for patients with binge eating behavior. Thus, a stepped-care approach that provides more intensive treatment to specifically address the emotional and behavioral factors associated with problematic eating and obesity may be necessary. Acceptance and Commitment Therapy (ACT), an empirically-supported intervention that is being rolled out nationally by the VA, has been effective in reducing distress, increasing quality of life, and improving other indices of health in a wide range of conditions from depression to diabetes. Our preliminary findings suggest that a brief ACT-based group intervention for patients with overweight or obesity can substantially reduce binge eating and distress, and improve functioning. In this study, we propose to test the efficacy of an ACT intervention for binge eating in conjunction with a standard behavioral weight loss intervention, Managing Overweight and/or Obesity for Veterans Everywhere (MOVE!), at the VA San Diego Healthcare System (VASDHS). Patients (N = 154) who are overweight or obese (body mass index > 25 kg/m2) and meet the clinical criteria for binge eating will be randomized to receive either four 2-hour weekly ACT intervention groups or brief MOVE-II active control groups after their participation in MOVE!. We hypothesize that: 1) patients in the ACT intervention will experience significantly greater reductions in binge eating severity than patients in the brief MOVE-II active control group (primary outcome); 2) patients in the ACT intervention will experience significantly greater improvements in physical and mental health functioning, obesity-related quality of life, physical activity levels, caloric and nutrient intake, emotional distress symptoms, binge frequency, and other forms of emotional eating than patients in the brief MOVE-II active control group; 3) gains associated with the ACT intervention will be maintained longer than gains associated with the brief MOVE-II active control group; 4) at 3-month and 6-month follow-ups, patients in the ACT intervention will have greater decreases in body mass index compared to patients in the brief MOVE-II active control group; and 5) measures of acceptance and action will mediate treatment response in the ACT intervention on outcomes of interest. Given the significant physical and psychological sequelae of binge eating and obesity, a brief intervention that can reduce disordered eating, enhance the maintenance of weight loss, and improve functioning among patients who suffer from binge eating, could be critical in the comprehensive approach to patient care at the VA. PUBLIC HEALTH RELEVANCE: Overweight and obesity are serious, disabling, and costly problems among Veterans. Binge eating is a behavioral problem that can interfere with attempts to lose weight. Although behavioral weight loss interventions are partly effective, few show long-term maintenance of weight loss, especially for patients who binge eat, overeat, or eat unhealthy foods in response to stress or negative emotions. Acceptance and Commitment Therapy (ACT) is an empirically-supported intervention, that can reduce binge eating severity and distress, and improve functioning. We propose to compare a brief ACT group intervention to an active control group in a sample of 154 overweight or obese binge eating veterans who have completed the VA's national behavioral weight management program (MOVE!). We anticipate that the ACT intervention will reduce binge eating and distress while improving functioning and maintenance of weight loss.

描述（由申请人提供）： 所有成年人中约有三分之二和接近75％的退伍军人超重或肥胖，使肥胖症成为全国流行病，其身体和心理功能受到重大损害，医疗保健成本的增加以及高死亡率。超重和肥胖的个体在应对压力或负面情绪的反应中饮食中很大一部分，进一步促进了肥胖症。肥胖和暴饮暴食与许多身体和心理健康的合并症，例如糖尿病，冠心病，骨关节炎，呼吸道症状，抑郁和焦虑。尽管行为减肥干预措施已部分有效，但很少有长期维持体重减轻，尤其是对于暴饮暴食行为的患者。因此，可能需要采用更深入的治疗方法来专门解决与有问题的饮食和肥胖有关的情绪和行为因素。接受和承诺疗法（ACT）是一种由VA在全国范围内推出的经验支持的干预措施，在降低困扰，提高生活质量并改善了从抑郁症到糖尿病的各种疾病中有效。我们的初步发现表明，对超重或肥胖症患者进行简短的基于ACT的小组干预可以大大减少暴饮暴食和困扰，并改善功能。在这项研究中，我们建议在VA San Diego Healthcare System（VASDHS）上测试与标准的行为减肥干预措施一起测试ACT干预措施对暴饮暴食的功效，该行为减肥干预措施，管理各地的退伍军人（移动！）的超重和/或肥胖。超重或肥胖的患者（n = 154）（体重指数> 25 kg/m2）并符合暴饮暴食的临床标准，将随机分配以接受四个2小时的每周2小时的ACT干预组，或者在参加移动后的短暂移动II主动对照组！我们假设：1）ACT干预中的患者在短暂的II主动对照组（主要结果）中，暴饮暴食严重程度的降低将明显更大。 2）ACT干预中的患者将在身心健康功能，与肥胖相关的生活质量，体育锻炼水平，热量和营养方面的改善显着改善 与短暂的II主动对照组相比，摄入量，情绪困扰症状，暴饮暴食频率和其他形式的情绪饮食； 3）与ACT干预相关的收益将比与短暂的II主动对照组相关的收益更长； 4）在3个月和6个月的随访中，与简短的II主动对照组相比，该ACT干预中的患者体重指数将更大。 5）接受和行动的措施将调解对感兴趣结果的ACT干预中的治疗反应。鉴于暴饮暴食和肥胖的重大身体和心理后遗症，短暂的干预措施可以减少无序的饮食，增强体重减轻的维持，并改善患有暴饮暴食的患者的功能，对于在VA的全面患者护理方法中至关重要。 公共卫生相关性： 超重和肥胖是严重的，残疾和代价高昂的问题。暴饮暴食是一个行为问题，可能会干扰减肥的尝试。尽管行为减肥干预措施部分有效，但很少有长期维护体重减轻，尤其是对于那些因压力或负面情绪而暴饮暴食，吃饱或吃不健康食物的患者。接受和承诺疗法（ACT）是一种经济上支持的干预措施，可以减少暴饮暴食的严重程度和困扰，并改善功能。我们建议将简短的ACT小组干预与一个活跃的对照组进行比较，以154个超重或肥胖的暴饮暴食，他们完成了VA的国家行为体重管理计划（Move！）。我们预计该行为干预将减少暴饮暴食和困扰，同时改善功能和维持体重减轻。