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）：对减肥肥胖的基于环境和接受的创新是一个严重而普遍的健康问题，存在广泛的医疗，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开始。在治疗后5年中，这些计划中几乎所有体重减轻都会恢复。似乎有几个因素使减肥维持挑战性，包括肥胖食品环境，食物的奖励价值以及节省劳动力的设备以及减少能源消耗的建筑环境。改善BT计划的一种有希望的方法是教参与者如何修改其个人食品和体育锻炼环境，以便为理想的体重控制行为提供最大的支持。干预组件可以包括修改家庭可用食物的类型，营养成分，品种和部分尺寸；修改房屋中锻炼设备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。改善BT计划的第二种创新方法是结合接受和承诺疗法（ACT）的组成部分，以（a）增强参与者对行为改变的承诺，（b）建立遇险能力，以及（c）提高对体重相关的行为和目标的注意。这样的技能应改善对饮食和体育锻炼建议的长期遵守（因此减肥）。我们预计这些治疗成分与环境治疗成分之间将有协同性和互补性。维持促进体重控制的家庭环境需要承诺，忍受的承受能力和意识，因为个人必须对环境修改做出决定并维护这些修改。此外，家庭环境方法有限制，因为个人将继续遇到许多具有挑战性的情况，在这种情况下，他们无法在任何有意义的程度上修改环境。基于验收的技能可以在这种挑战性的情况下促进健康的选择。作为对合并方法的测试，将将参与者随机分配到三个条件之一：1）BT，2）BT加上修改家庭环境（BT+E），或3）BT加上修改基于接受的技能（BT+EA）的家庭环境和培训。治疗将持续1年。参与者将是297个超重，从社区招募的肥胖个人。 30％的参与者将是少数民族。评估将在基线和第6个月，第12个月（治疗结束），18个（即6个月的随访）和24个（即12个月的随访）完成。该研究的主要目的是检验以下假设：BT+EA条件下的参与者比在12个月随访中的BT条件下的体重减轻更多。次要目的将比较BT+EA与BT+E的体重减轻，而BT+E与BT相比，并将饮食摄入量和体育锻炼视为结果。探索目的将检查治疗结果的调解和适度。