An innovative, physical activity-focused approach to weight loss maintenance

一种以身体活动为重点的创新维持减肥方法

• 批准号: 8759928
• 负责人: Meghan Butryn
• 金额: $ 60.55万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8759928
• 关键词: Address; Adherence; Adult; Aftercare; Behavior Therapy; Behavioral; Body Weight decreased; Communities; Decision Making; Diet; Eating Behavior; Educational process of instructing; Effectiveness; Energy Metabolism; Epidemic; Exercise; Health; Health Benefit; Impaired health; Individual; Intervention; Link; Maintenance; Mediating; Mediator of activation protein; Motivation; Obesity; Obesity associated disease; Outcome; Participant; Phase; Physical activity; Prevention; Quality of life; Recruitment Activity; Research; Testing; Time; Weight; Weight maintenance regimen; Work; base; behavior change; clinically significant; design; disorder risk; distress tolerance; disturbance in affect; follow-up; group intervention; improved; innovation; intervention effect; novel; programs; psychologic; public health relevance; skills; theories

DESCRIPTION (provided by applicant): Obesity is causally linked with numerous health problems. State-of-the-art behavioral interventions for obesity reliably facilitate clinically significant weight loss in the short-term, but weight regain (and a return to elevated disease risk is normative. Innovative interventions that improve long-term outcomes of lifestyle modification must be developed and tested. New evidence suggests that a high level of physical activity (PA) is a critical component of weight loss maintenance (and has numerous ancillary health benefits, independent of weight). Most adults who are prescribed high levels of PA (whether as part of a weight management program or other intervention) do not ultimately adhere to these prescriptions, suggesting that traditional behavioral skills and intervention strategies are not sufficiently matched to the challenges of this critical, long-term behavior change. Theoretical and empirical work strongly suggest that for obese adults to be successful at consistently engaging in high levels of PA they must employ specific psychological skills, including mindful decision-making, behavioral commitment in the face of challenges, an ability to tolerate physical and psychological discomfort, and an ability to achieve clarity about one's personal values. These skills are the focus of acceptance-based behavioral interventions for PA promotion. To test the effectiveness of this approach, this study will recruit 300 adults from the community and provide them with 6 months of group-based standard behavioral weight loss treatment (Phase I). In Phase II, participants will receive one of three interventions, to be delivered for an additional 12 months: 1) behavioral treatment, with the standard emphasis on maintaining changes in diet and PA (BT), 2) behavioral treatment, with a primary emphasis on using these skills to maintain PA (BT-PA), or 3) acceptance-based behavioral treatment, with a primary emphasis on using these skills to maintain PA (ABT- PA). The PA prescription will be uniform across conditions. All participants will be encouraged to gradually progress to and subsequently maintain an amount of PA that will result in 2000 kcal/wk of energy expenditure. Assessments will be conducted at baseline, 6 months (end of Phase I treatment), 18 months (end of Phase II treatment), 24 months (6-month follow-up), and 36 months (18-month follow-up). An intensive focus on PA after initial weight loss (i.e., BT-PA and ABT-PA) is hypothesized to result in a) better weight loss maintenance, and b) higher amounts of PA at post-treatment and follow-up compared to standard behavioral treatment (BT). An intensive focus on PA after initial weight loss is also hypothesized to result in a) better weight loss maintenance and b) higher amounts of PA at post-treatment and follow-up when acceptance-based behavioral skills are taught (i.e., ABT-PA), compared to when standard behavioral skills are taught (BT-PA). Theory- driven mediators and moderators of intervention effects also will be examined. Accomplishing these aims will advance research on health-related behavior change and has the potential to meaningfully impact the behavioral prevention and treatment of many obesity-related diseases and conditions.

描述（由申请人提供）：肥胖与许多健康问题存在因果关系。最先进的肥胖行为干预措施确实可以在短期内促进临床上显着的体重减轻，但体重反弹（以及疾病风险升高的恢复是正常的）。改善生活方式改变的长期结果的创新干预措施必须是新的证据表明，高水平的体力活动 (PA) 是维持减肥的关键组成部分（并且具有许多辅助健康益处，与体重无关）。体重管理计划或其他干预措施的一部分）最终没有遵守这些规定，这表明传统的行为技能和干预策略不足以应对这一关键的长期行为改变的挑战。理论和实证工作强烈表明，肥胖成年人能够成功地持续参与。要获得高水平的 PA，他们必须运用特定的心理技能，包括深思熟虑的决策、面对挑战时的行为承诺、容忍身体和心理不适的能力，以及明确个人价值观的能力。这些技能是基于接受的行为干预以促进 PA 的重点。为了测试这种方法的有效性，本研究将从社区招募 300 名成年人，并为他们提供为期 6 个月的基于团体的标准行为减肥治疗（第一阶段）。在第二阶段，参与者将接受三种干预措施中的一种，并持续 12 个月：1) 行为治疗，标准重点是维持饮食和 PA (BT) 的变化，2) 行为治疗，主要重点是使用这些技能来维持 PA (BT-PA)，或 3) 基于接受的行为治疗，主要强调使用这些技能来维持 PA (ABT-PA)。 PA 处方在不同情况下是统一的。我们将鼓励所有参与者逐步进步并随后维持一定量的 PA，这将导致每周 2000 kcal 的能量消耗。评估将在基线、6个月（I期治疗结束）、18个月（II期治疗结束）、24个月（6个月随访）和36个月（18个月随访）时进行。假设初始减肥后集中关注 PA（即 BT-PA 和 ABT-PA），可以实现 a) 更好的减肥维持效果，以及 b) 与标准相比，治疗后和随访时的 PA 含量更高行为治疗（BT）。假设最初减肥后对 PA 的集中关注会导致 a) 更好地维持减肥效果，b) 当教授基于接受的行为技能（即 ABT-PA）时，治疗后和随访中的 PA 量会更高），与教授标准行为技能（BT-PA）相比。理论驱动的中介因素和干预效果的调节因素也将受到研究。实现这些目标将推进与健康相关的行为改变的研究，并有可能对许多与肥胖相关的疾病和病症的行为预防和治疗产生有意义的影响。