Environmental and Acceptance-Based Innovations for Weight Loss Maintenance

维持减肥的环境和基于可接受性的创新

• 批准号: 8700390
• 负责人: Meghan Butryn
• 金额: $ 45.24万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8700390
• 关键词: Address; Adherence; Aftercare; Awareness; Behavior; Behavior Therapy; Behavioral; Biological Factors; Body Weight decreased; Communities; Cues; Decision Making; Devices; Diet; Dietary intake; Distress; Eating; Economics; Educational process of instructing; Effectiveness; Energy Metabolism; Environment; Environmental Risk Factor; Epidemic; Equipment; Event; Exercise; Feeling; Food; Goals; Gold; Health; Health behavior; Home environment; Impaired health; Individual; Intervention; Life Style; Maintenance; Mediation; Mediator of activation protein; Medical; Methods; Modification; Nature; Nutritional; Obesity; Outcome; Overweight; Participant; Physical activity; Psychological reinforcement; Quality of life; Randomized; Recommendation; Recruitment Activity; Restaurants; Rewards; Testing; Theoretical model; Training; Treatment outcome; Weight; Weight maintenance regimen; base; behavior change; deprivation; design; distress tolerance; environmental change; ethnic minority population; follow-up; food craving; food environment; improved; innovation; mindfulness; obesity treatment; programs; psychologic; psychosocial; sedentary; sex; skills; social; weight maintenance

DESCRIPTION (provided by applicant): Environmental and Acceptance-Based Innovations for Weight Loss Maintenance Obesity is a serious and prevalent health problem with widespread medical, psychosocial and economic consequences. Although behavior therapy (BT) is the gold standard among non-surgical approaches, weight regain usually begins shortly after treatment ends; nearly all of weight lost in these programs is regained by 5 years after treatment. Several factors appear to make weight loss maintenance challenging including the obesogenic food environment, the rewarding value of food, and labor-saving devices and a built environment that reduce energy expenditure. One promising way of improving BT programs is to teach participants how to modify their personal food and physical activity environment so that it provides maximal support for desirable weight control behaviors. Intervention components can include modifying the type, nutritional composition, variety, and portion size of food available at home; modifying the availability of exercise equipment and sedentary activities in the home; increasing the saliency of the consequences of eating and exercise choices; and obtaining support for environmental changes. A second innovative way of improving BT programs is to incorporate components of Acceptance and Commitment Therapy (ACT) in order to (a) bolster participants' commitment to behavior change, (b) build distress tolerance skills, and (c) promote mindful awareness of weight-related behaviors and goals. Such skills should improve long-term adherence to dietary and physical activity recommendations (and therefore weight loss maintenance). We expect that there will be a synergy and a complementary nature between these treatment components and the environmental treatment components. Maintaining a home environment that facilitates weight control requires commitment, distress tolerance, and awareness, because individuals must make decisions about environmental modifications and maintain these modifications. Additionally, there are limits to the home environment approach because individuals will continue to encounter many challenging situations in which they cannot modify the environment to any meaningful extent; acceptance-based skills may promote healthy choices in such challenging situations. As a test of the combined approach, participants will be randomly assigned to one of three conditions: 1)BT, 2) BT plus modifying the home environment (BT+E), or 3) BT plus modifying the home environment and training in acceptance-based skills (BT+EA). Treatment will last 1 year. Participants will be 297 overweight and obese individuals recruited from the community. Thirty percent of participants will be ethnic minorities. Assessments will be completed at baseline and Months 6, 12 (end of treatment), 18 (i.e., 6-month follow-up), and 24 (i.e., 12- month follow-up). The primary aim of the study is to test the hypothesis that participants in the BT+EA condition will maintain more weight loss than those in the BT condition at 12-month follow-up. Secondary aims will compare weight loss in BT+EA vs. BT+E, and BT+E vs. BT, and examine dietary intake and physical activity as outcomes. Exploratory aims will examine mediation and moderation of treatment outcome.

描述（由申请人提供）：基于环境和接受度的减肥维持创新 肥胖是一种严重且普遍的健康问题，具有广泛的医疗、社会心理和经济后果。尽管行为疗法 (BT) 是非手术方法中的黄金标准，但体重通常在治疗结束后不久就会开始反弹；治疗后 5 年内，几乎所有在这些计划中减掉的体重都会恢复。有几个因素似乎使减肥维持具有挑战性，包括致胖的食物环境、食物的奖励价值、节省劳力的设备和减少能量消耗的建筑环境。改进 BT 计划的一种有前途的方法是教导参与者如何改变他们的个人食物和身体活动环境，以便为理想的体重控制行为提供最大的支持。干预措施可包括改变家庭可用食物的类型、营养成分、品种和份量；改变家中健身器材和久坐活动的可用性；提高饮食和运动选择后果的显着性；并获得对环境变化的支持。改进 BT 计划的第二种创新方法是纳入接受与承诺疗法 (ACT) 的组成部分，以便 (a) 增强参与者对行为改变的承诺，(b) 培养痛苦承受能力，以及 (c) 促进对行为改变的正念意识。与体重相关的行为和目标。这些技能应该可以提高对饮食和身体活动建议的长期坚持（从而维持减肥效果）。我们期望这些处理成分与环境处理成分之间将具有协同作用和互补性。维持有利于体重控制的家庭环境需要承诺、抗压能力和意识，因为个人必须就环境改变做出决定并维持这些改变。此外，家庭环境方法也存在局限性，因为个人将继续遇到许多具有挑战性的情况，在这些情况下他们无法在任何有意义的程度上改变环境；基于接受的技能可以在这种充满挑战的情况下促进健康的选择。作为组合方法的测试，参与者将被随机分配到以下三种条件之一：1）BT，2）BT加修改家庭环境（BT+E），或3）BT加修改家庭环境和接受培训基于技能（BT+EA）。治疗将持续1年。参与者将从社区招募 297 名超重和肥胖者。百分之三十的参与者将是少数民族。评估将在基线以及第 6 个月、第 12 个月（治疗结束）、第 18 个月（即 6 个月随访）和第 24 个月（即 12 个月随访）完成。该研究的主要目的是检验以下假设：在 12 个月的随访中，BT+EA 条件下的参与者将比 BT 条件下的参与者保持更多的体重减轻。次要目标将比较 BT+EA 与 BT+E 以及 BT+E 与 BT 的减肥效果，并检查饮食摄入量和身体活动作为结果。探索性目标将检查治疗结果的中介和调节。