Promotion of Successful Weight Management in Overweight and Obese Veterans

促进超重和肥胖退伍军人成功的体重管理

• 批准号: 9889739
• 负责人: HEIDI K ORTMEYER
• 金额: --
• 依托单位: BALTIMORE VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/9889739
• 关键词: Abdomen; Adopted; Adoption; Aging; Animal Model; Award; Baltimore; Body Weight; Body Weight Changes; Body Weight decreased; Calories; Cardiovascular Diseases; Caring; Clinical; Clinical Trials; Defect; Diabetes Mellitus; Diet; Dietary intake; Energy Intake; Energy Metabolism; Enrollment; Enzymes; Exercise; Expenditure; Fatty Acids; Fatty acid glycerol esters; Functional disorder; Gene Expression; Glucose; Goals; Guidelines; Health; Health Benefit; Healthcare; Heart; Human; Hypertension; Impairment; Individual; Inflammation; Insulin Resistance; Intermittent fasting; Intervention; Intramuscular; Knowledge; Lead; Lipids; Long-Term Effects; Maintenance; Metabolic; Methods; Mitochondria; Morbidity - disease rate; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Overweight; Pharmacologic Substance; Phase; Physical Function; Physical activity; Play; Population; Prevention; Production; Protocols documentation; Randomized; Randomized Clinical Trials; Recommendation; Relapse; Research; Risk; Risk Factors; Rogaine; Role; Skeletal Muscle; Stimulus; Testing; Veterans; Weight; Weight maintenance regimen; Woman; cardiometabolic risk; cardiometabolism; cardiovascular disorder risk; cardiovascular risk factor; clinical care; clinically significant; combat; cost; diabetes risk; diet and exercise; dietary approach; effectiveness clinical trial; energy balance; evidence based guidelines; fatty acid metabolism; fatty acid oxidation; flexibility; follow-up; good diet; healthy lifestyle; healthy weight; improved; innovation; insulin sensitivity; lipoprotein lipase; mitochondrial dysfunction; novel; obesity management; oxidation; prevent; primary outcome; programs; risk minimization; sedentary lifestyle; trend; weight loss program; weight maintenance

Over 70% of Veterans who receive health care at the VA are overweight or obese, and obesity rates of Veterans receiving care at the VA are higher compared to non-Veterans and Veterans who do not use the VA. Obesity contributes to loss of mobility which is a significant determinant of morbidity and loss of independence. Obesity also is associated with elevated cardiometabolic risk factors, including lipid profile, insulin resistance, hypertension, and inflammation. Though weight loss of as little as 3% improves physical functioning and reduces type 2 diabetes and cardiovascular risk factors, most subjects are unsuccessful at long-term weight maintenance, regaining almost half the weight lost within the following two years and return to baseline weight within the next 3-5 years. This clinical trial takes on the challenge of maintaining weight reduction by altering energy balance and possibly skeletal muscle substrate oxidation to mitigate weight regain in overweight and obese older Veterans with mobility limitations. The objective of this award proposal is to test in a randomized clinical trial the effectiveness of an intensive weight management program with and without intermittent fasting (IF) to combat weight regain and the obesity crisis in our Veterans. IF refers to short periods of intense energy restriction. We propose to enroll a total of 200 overweight and obese Veterans with mobility impairments into a 12 weeks weight loss program that incorporates a low calorie Heart Healthy (HH) diet and exercise at the Baltimore and Atlanta VAMCs. Following weight loss (WL), Veterans will be randomized to weight maintenance (WM: continuation of HH and exercise guidelines) program or weight maintenance with intermittent fasting (WM+IF) for 24 weeks. Our central hypothesis is that IF will provide the stimulus for prevention of weight regain at 36 weeks and will improve cardiometabolic and functional health factors. Further, we hypothesize that the ability to appropriately modify fuel utilization through skeletal muscle fatty acid oxidation enzymes is an important factor in weight maintenance and weight regain. This CSR&D Clinical Trial Merit Award introduces an innovative practice of IF to prevent weight relapse after clinically significant weight reduction and could provide evidence-based recommendations to promote this type of intervention in the Veteran population.

超过 70% 在 VA 接受医疗保健的退伍军人超重或肥胖，肥胖率 与非退伍军人和不使用 VA 的退伍军人相比，在 VA 接受护理的退伍军人的比例更高。 肥胖会导致行动能力丧失，这是发病和丧失独立性的重要决定因素。 肥胖还与心脏代谢危险因素升高有关，包括血脂、胰岛素抵抗、 高血压、炎症。尽管体重减轻 3% 就能改善身体机能 减少 2 型糖尿病和心血管危险因素，大多数受试者在长期体重方面不成功 维持，在接下来的两年内恢复几乎一半的体重并恢复到基线体重 未来3-5年内。这项临床试验面临着通过改变体重来维持体重减轻的挑战 能量平衡和可能的骨骼肌底物氧化，以减轻超重和肥胖患者的体重反弹 行动不便的肥胖老年退伍军人。 该奖项提案的目的是在随机临床试验中测试一项药物的有效性 有或没有间歇性禁食（IF）的强化体重管理计划，以对抗体重反弹和 我们退伍军人的肥胖危机。 IF 指的是短期的强烈能量限制。我们建议报名参加 总共 200 名行动不便的超重和肥胖退伍军人参加了为期 12 周的减肥计划 其中包括巴尔的摩和亚特兰大 VAMC 的低热量心脏健康 (HH) 饮食和锻炼。 减肥 (WL) 后，退伍军人将被随机分配至体重维持（WM：继续 HH 和 锻炼指南）计划或通过间歇性禁食 (WM+IF) 维持体重 24 周。我们的 中心假设是 IF 将提供刺激以防止 36 周时体重反弹，并且将 改善心脏代谢和功能健康因素。此外，我们假设能够适当地 通过骨骼肌脂肪酸氧化酶改变燃料利用率是体重的一个重要因素 维持和体重恢复。 该 CSR&D 临床试验优异奖介绍了 IF 预防体重复发的创新实践 在临床上显着减轻体重后，可以提供基于证据的建议来促进这一点 对退伍军人群体的干预类型。