Stress, race, and cognitive mediators of SES-related disparities in behavioral obesity treatment outcomes

行为性肥胖治疗结果中与 SES 相关的差异的压力、种族和认知调节因素

• 批准号: 10514449
• 负责人: Bradley M. Appelhans
• 金额: $ 70.57万
• 依托单位: RUSH UNIVERSITY MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2027-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10514449
• 关键词: Accelerometer; Address; Adherence; Adult; Adverse event; Attention; Behavior Control; Behavior Therapy; Behavioral; Body Weight decreased; Cardiovascular Diseases; Clinical; Cognitive; Development; Dietary intake; Disadvantaged; Eating Behavior; Ecological momentary assessment; Enrollment; Environment; Ethnic Origin; Event; Exposure to; Food; Future; Goals; Income; Individual; Individual Differences; Intervention; Lead; Link; Measures; Mediating; Mediator of activation protein; Modeling; Monitor; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Palate; Pattern; Phenotype; Physical activity; Population; Poverty; Psychology; Race; Risk; Role; Sampling; Socioeconomic Status; Stress; Testing; Time; Treatment outcome; Unhealthy Diet; Weight; Weight maintenance regimen; adaptive intervention; adult obesity; base; cognitive neuroscience; cohort; comorbidity; design; dietary; executive function; experience; follow-up; increased appetite; individualized medicine; low socioeconomic status; obesity risk; obesity treatment; racial and ethnic; racial disparity; racial minority; socioeconomic disadvantage; socioeconomic disparity; standard of care; theories; weight loss intervention

PROJECT SUMMARY/ABSTRACT Individuals of lower socioeconomic status (SES) lose only half as much weight in behavioral weight loss interventions as those of higher SES. This is a clinically meaningful difference in outcomes that has been consistently documented. The overarching aim of this project is to identify the mechanisms that account for SES-related disparities in behavioral weight loss outcomes, which would enable the development of more effective obesity treatment approaches for lower SES populations. One potential mechanism is present bias, which is a tendency to focus on one’s immediate needs that may result from exposure to harsh and unpredictable environments. Present bias is a compelling candidate as a mechanism of SES-related disparities in weight loss outcomes because it is much more pronounced in lower SES populations, and it has been linked to obesity risk, maladaptive eating behaviors, and poor diet quality. A second set of potential mechanisms includes adverse daily experiences such as stress, cognitive demands, and exposure to tempting foods. Stress and cognitive demands are more prevalent or severe in the lives of lower SES populations, and can disrupt the executive functions that are important for adhering to weight control behaviors during obesity treatment. This project will allocate equal numbers of subjects of lower and higher SES to a standard-of-care weight loss intervention. Importantly, the SES groups will be balanced with respect to ethnic/racial minority status. Weight loss outcomes and adherence to three key weight control behaviors (dietary lapses, dietary self-monitoring, and physical activity) will be rigorously measured across six months of follow up. Individual differences in present bias will be thoroughly assessed at baseline. Ecological momentary assessment will be used to capture exposure to adverse daily experiences, as well as momentary changes in present bias. Aim 1 is to test whether present bias accounts for SES-related disparities in behavioral weight loss outcomes and adherence to key weight control behaviors. Aims 2a and 2b will characterize the role of adverse daily experiences in SES- related disparities in weight loss outcomes and adherence to weight control behaviors, both overall and among present-biased individuals in particular. Aim 3 is to explore the contribution of race to SES-related disparities in weight loss outcomes, which has been challenging to elucidate in prior studies due to significant confounding of race and SES at the societal level. The results of this study could lead to a new understanding of how socioeconomic disadvantage impacts adherence to behavioral treatment for obesity, and suggest entirely new treatment approaches focused on mitigating present bias or delivering tailored intervention content during “moments of risk” for lapses in adherence.

项目摘要/摘要 较低的社会经济地位（SES）的个人在行为减肥中的体重仅为一半 干预措施是较高SE的干预措施。这是临床上有意义的结果差异 一贯记录。该项目的总体目的是确定所解释的机制 行为减肥结果中与SES相关的分布，这将使更多 SES种群的有效肥胖治疗方法。一个潜在的机制是存在的偏见， 这是关注一个人的直接需求，这可能是由于暴露于Harmsh和 不可预测的环境。当前偏见是一种引人入胜的候选人，作为SES相关差异的机制 在体重减轻结果中，因为它在较低的SES种群中更为明显，并且已链接 肥胖风险，适应不良的饮食行为和饮食质量差。第二组潜在机制 包括不利的日常经历，例如压力，认知需求以及暴露于诱人的食物。压力 在较低的SES人群的生活中，认知需求更为普遍或更严重，可能会破坏 对于肥胖治疗期间遵守体重控制行为很重要的执行功能。 该项目将分配相等数量的较低和较高SE的受试者为护理标准的减肥 干涉。重要的是，SES群体将在种族/种族少数群体地位方面保持平衡。重量 损失结果和遵守三种关键体重控制行为（饮食失误，饮食自我监控， 和体育锻炼）将在六个月的随访中严格测量。个体差异 目前的偏见将在基线时进行彻底评估。生态瞬间评估将用于 捕获暴露于不利的日常经历，以及当前偏见的瞬间变化。目标1是测试 目前的偏见是否在行为减肥结果和依从性中占SES相关的分布 关键的体重控制行为。 AIMS 2a和2b将表征不利的日常经历在SES中的作用 整体和之间的体重控制行为的相关分布和遵守体重控制行为 特别是偏见的人。 AIM 3是探索种族对与SES相关分布的贡献 减肥结果，由于严重的混杂而在先前的研究中受到挑战。 社会层面的种族和SES。这项研究的结果可能会导致对如何 社会经济劣势影响遵守肥胖行为治疗的行为，并建议全新 治疗方法的重点是减轻当前偏见或在期间提供量身定制的干预内容 遵守失误的“风险瞬间”。