Low Intensity Weight Loss for Young Adults: Autonomous vs. Extrinsic Motivation

年轻人的低强度减肥：自主动机与外在动机

• 批准号: 8797155
• 负责人: Jessica Gokee LaRose
• 金额: $ 68.11万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-25 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8797155
• 关键词: Address; Adult; Age; Behavioral; Blood Pressure; Body Composition; Body Weight Changes; Body Weight decreased; Body mass index; Cardiovascular system; Data; Diet; Drops; Economics; Enrollment; Feedback; Financial cost; Generations; Goals; Health; Health Care Costs; Health behavior change; Incentives; Individual; Informal Social Control; Internet; Intervention; Lead; Learning; Maintenance; Mediation; Mediator of activation protein; Mind; Monitor; Motivation; Obesity; Online Systems; Outcome; Overweight; Participant; Physical activity; Plant Roots; Play; Population; Public Health; Randomized; Randomized Controlled Trials; Relative (related person); Risk Factors; Role; Self Determination; Testing; Treatment outcome; United States National Institutes of Health; Weight; Weight Gain; Weight maintenance regimen; Work; age group; arm; base; behavior change; clinically significant; design; effective therapy; efficacy testing; experience; financial incentive; follow-up; high risk; improved; interest; intervention program; meetings; novel; novel strategies; programs; secondary outcome; theories; therapy development; treatment effect; treatment program; waist circumference; weight maintenance; young adult

DESCRIPTION (provided by applicant): Forty percent of 18-25 year olds are overweight or obese, yet this population is also markedly under- represented in standard behavioral weight loss (BWL) programs and to date, no fully powered trials exist which target this age group for weight loss. Formative work conducted with this age group revealed that existing BWL programs do not meet their unique needs, and also identified lack of motivation as a fundamental barrier for weight management. The primary aim of this proposal is to test the relative efficacy of two novel, low intensity web-based approaches to weight loss in this age group that are specifically focused on enhancing motivation, relative to a standard web-based program. We recently pilot tested these two approaches with promising results. Both 3-month intervention programs consisted of a single group based session, followed by a web- based program with weekly lessons, a self-monitoring platform and personalized feedback. One program was rooted in Self-Determination Theory and designed to facilitate intrinsic motivation and promote autonomous self-regulation by offering a variety of personal choices in the treatment program and emphasizing autonomy around behavioral goals and in weekly feedback. The other intervention was grounded in learning theory and principles of behavioral economics, and offered small financial incentives for meeting self-monitoring goals; further, participants achieving a clinically significant weight loss were entered into a raffle for additionl monetary incentives. Preliminary data for both approaches are quite promising - engagement and retention were strong, and participants achieved clinically significant weight losses at 3 months (ITT=4.8% in the Autonomous Motivation program and 8.8% in the Extrinsic Motivation program). Moreover, weight losses were maintained at 6 months without any additional contact (5.1% and 10.1%, respectively). We propose a 3-arm randomized controlled trial to test the longer-term efficacy of these novel approaches to weight loss in this high risk population. Participants will be 381 young adults, 18-25 years, with a body mass index (BMI) of 25-45 kg/m2, who will be randomized to 1 of 3 arms: 1) Standard Web BWL (Web), 2) Web + Autonomous Motivation (Web+Aut), or 3) Web + Extrinsic Motivation (Web+Ext). All arms will receive a 6-month program followed by a 6-month no-contact follow-up period. Motivation will be assessed at week 2 and months 2, 4, and 6. Assessments of weight and secondary outcomes will occur at 0, 3, 6, and 12 months. We will compare treatment effects across all three arms at 6 months, and compare arms on weight loss maintenance from 6 to 12 months. We will also examine mediators of treatment outcomes consistent with our theoretical framework (i.e. autonomous motivation, extrinsic motivation). We hypothesize that the Web+Aut and the Web+Ext conditions will produce greater weight loss and improvement in secondary outcomes at 6 months, compared with Web. We further hypothesize that Web+Ext will achieve greater weight loss and improvement in secondary outcomes at 6 months, relative to Web+Aut.

描述（由申请人提供）： 40% 的 18-25 岁人群超重或肥胖，但这一人群在标准行为减肥 (BWL) 计划中的代表性也明显不足，并且迄今为止，尚无针对此问题的全面试验适合减肥的年龄段。针对这个年龄段进行的形成性工作表明，现有的 BWL 计划不能满足他们的独特需求，并且还发现缺乏动力是体重管理的基本障碍。该提案的主要目的是测试该年龄组中两种新颖的、低强度的基于网络的减肥方法的相对功效，这些方法相对于标准的基于网络的计划特别注重增强动机。我们最近对这两种方法进行了试点测试，取得了可喜的结果。两个为期 3 个月的干预计划都包括一个基于小组的课程，然后是一个基于网络的计划，每周课程、自我监控平台和个性化反馈。其中一项计划植根于自我决定理论，旨在通过在治疗计划中提供多种个人选择并强调围绕行为目标和每周反馈的自主权来促进内在动机并促进自主自我调节。另一种干预措施以行为经济学的学习理论和原理为基础，并为实现自我监控目标提供小额经济激励；此外，达到临床显着减肥效果的参与者还可以参加抽奖活动，以获得额外的金钱奖励。这两种方法的初步数据都非常有前景——参与度和保留度都很高，参与者在 3 个月内实现了临床上显着的体重减轻（自主激励计划中的 ITT=4.8%，外在激励计划中的 ITT=8.8%）。此外，在没有任何额外接触的情况下，体重减轻维持了 6 个月（分别为 5.1% 和 10.1%）。我们提出了一项三组随机对照试验，以测试这些新的减肥方法在这一高风险人群中的长期疗效。参与者将是 381 名 18-25 岁、体重指数 (BMI) 为 25-45 kg/m2 的年轻人，他们将被随机分配到 3 个组中的 1 个组：1) 标准 Web BWL (Web)，2) Web + 自主动机 (Web+Aut)，或 3) Web + 外部动机 (Web+Ext)。所有手臂都将接受为期 6 个月的计划，然后是 6 个月的无接触随访期。动机将在第 2 周以及第 2、4 和 6 个月进行评估。体重和次要结果的评估将在第 0、3、6 和 12 个月时进行。我们将比较所有三组在 6 个月时的治疗效果，并比较各组在 6 至 12 个月期间的减肥维持情况。我们还将检查与我们的理论框架一致的治疗结果的中介因素（即自主动机、外在动机）。我们假设与 Web 相比，Web+Aut 和 Web+Ext 条件将在 6 个月时产生更大的体重减轻和次要结果的改善。我们进一步假设，相对于 Web+Aut，Web+Ext 将在 6 个月时实现更大的体重减轻和次要结果的改善。