Enhancing Weight Loss with Financial Incentives in Teens with Severe Obesity

通过经济激励促进严重肥胖青少年的减肥

• 批准号: 9891050
• 负责人: Aaron S Kelly
• 金额: $ 69.27万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9891050
• 关键词: 17 year old; Accelerometer; Address; Adherence; Adolescent; Adult; Age; Behavior; Benchmarking; Blood Pressure; Blood Vessels; Body Weight decreased; Body fat; Body mass index; Categories; Childhood; Clinical; Data; Databases; Diet; Disease; Endothelium; Freezing; HDL-triglyceride; HIV Infections; Health; Health behavior change; Inflammation; Insulin-Dependent Diabetes Mellitus; Intervention; Knowledge; Laboratories; Life Style Modification; Liquid substance; Methods; Modeling; Morbid Obesity; Nature; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Oxidative Stress; Participant; Patients; Physical activity; Prevalence; Public Health; Randomized Controlled Clinical Trials; Refractory; Regimen; Replacement Therapy; Reporting; Risk; Risk Factors; Schools; Selection for Treatments; Structure; Targeted Research; Teenagers; Testing; Time; United States; Weight; Withdrawal; Youth; adult obesity; arterial stiffness; behavior change; cardiometabolic risk; cardiometabolism; cardiovascular risk factor; carotid intima-media thickness; clinical practice; comorbidity; conventional therapy; evidence base; financial incentive; improved; innovation; obesity in children; patient population; pediatrician; post intervention; primary endpoint; smoking cessation; synergism; treatment adherence; vascular abnormality; weight loss intervention

Abstract Severe obesity is the fastest growing category of pediatric obesity, with a reported prevalence near 6% in the United States. Unfortunately, conventional treatment approaches rarely result in sufficient weight loss in adolescents with severe obesity; therefore, innovative and effective strategies are desperately needed. The financial incentive model has been used successfully in adult obesity trials to address suboptimal adherence to lifestyle modification therapy and improves weight loss outcomes. Although yet to be investigated as a weight loss intervention among adolescents, financial incentives have been shown to improve many health-related behaviors in teenagers. Owing to the refractory nature of pediatric severe obesity, financial incentives are more likely to be effective if used in concert with a structured dietary plan such as meal replacement therapy (liquid shakes and frozen entrées). In a recent trial, meal replacement therapy produced promising short-term weight loss in adolescents with severe obesity; however, initial weight lost by participants was regained after 4 months, owing to diminished adherence to the meal replacement regimen over time. Our concept is to capitalize on the synergy of meal replacement therapy and financial incentives to optimize weight loss and improve cardiometabolic risk factors and vascular health in teens with severe obesity. This study will afford a unique opportunity to address another key unanswered question related to the treatment of pediatric severe obesity: how much weight loss is necessary to elicit clinically-meaningful improvements in cardiometabolic risk factors and vascular health? Although evidence-based benchmarks have been established for adults, no such thresholds have been identified for youth with severe obesity. Therefore, we plan to conduct a 12-month randomized, controlled clinical trial to evaluate the effects of meal replacement therapy plus financial incentives on weight loss and cardiometabolic/vascular outcomes among 142 adolescents with severe obesity and to identify thresholds of weight loss required to achieve clinically-meaningful cardiometabolic/vascular improvements in this patient population. This research targets a significant public health problem, will utilize an innovative treatment concept and approach, and will generate new knowledge to guide selection of treatment type and intensification, ultimately exerting a powerful and sustained influence on the field of pediatric obesity.

抽象的 严重的肥胖症是儿科肥胖的增长最快的类别，据报道患病率接近6％ 美国。不幸的是，常规治疗方法很少导致足够的体重减轻 患有严重肥胖症的青少年；因此，迫切需要创新和有效的策略。这 经济激励模型已成功地用于成人肥胖试验中，以解决次优的依从性 生活方式修改疗法并改善减肥结果。虽然尚未被调查为重量 青少年之间的损失干预，已证明经济激励措施可改善许多与健康有关的 青少年的行为。由于小儿严重肥胖的难治性，经济激励措施是 如果与结构化饮食计划（例如替代疗法）一起使用，则更有可能有效 （液体奶昔和冷冻主菜）。在最近的试验中，膳食替代疗法产生了有希望的短期 严重肥胖的青少年体重减轻；但是，参与者的初始减肥在4后持续了 几个月，由于随着时间的推移依从性较低，因此依靠膳食替代方案。我们的概念是 利用膳食替代疗法和经济激励措施的协同作用，以优化体重减轻和 改善严重肥胖症青少年的心脏代谢危险因素和血管健康。这项研究将负担得起 独特的机会来解决与小儿严重治疗有关的另一个关键未解决的问题 肥胖症：在心脏代谢风险中获得临床上的改善需要多少体重减轻 因素和血管健康？尽管已经为成年人建立了基于证据的基准测试 已经为患有严重肥胖症的年轻人确定了阈值。因此，我们计划进行12个月 随机，对照临床试验，以评估膳食替代疗法的影响以及经济激励措施 关于体重减轻和心脏代谢/血管结局，有142名患有严重肥胖症的青少年 确定实现临床上的心脏代谢/血管所需的体重减轻阈值 该患者人群的改善。这项研究针对一个重大的公共卫生问题，将利用 创新的治疗概念和方法，并将产生新知识以指导治疗的选择 类型和强化，最终对小儿肥胖领域产生强大而持续的影响。