Telephone Delivered Acceptance & Commitment Therapy for Weight Loss

项目总结/摘要（描述） 在美国，超过三分之二的成年人超重或肥胖[1，2]。这两种情况，尤其是 肥胖导致许多健康状况，包括糖尿病、心脏病和癌症[3-5]。国家 肥胖导致的成本很高：医疗成本为3420亿美元（2013年），占所有成人医疗保健的28% 支出[6]。减肥的行为干预的一种形式是电话辅导[7-9]。 电话辅导有明显的优势：高人口水平的覆盖面和个性化定制的培训， 教练[10-12]。电话减肥教练达到每年超过120万美国成年人[7，12-14]。 然而，在该领域取得进展的一个关键障碍是，标准行为治疗（SBT）电话辅导 干预措施的效应量很小，很少对照积极治疗对照进行评估。现在需要 是电话辅导计划，有可能提高减肥成功超过SBT。我们 提出了一种新的电话辅导行为干预：接纳与承诺疗法（ACT） [15]第10段。与SBT不同，ACT干预措施解决了减肥的根本挑战： 到内部（例如，应力）和外部（例如，高热量食物）线索[16-19]。ACT减肥地址 通过专注于（1）增加体验身体渴望，情绪和思想的意愿来解除抑制 提示进食和阻碍身体活动，同时（2）指导健康饮食和身体活动选择 的价值观[16，20]。虽然ACT已被应用于许多行为和各种交付 模式[21-24]，对于体重减轻，仅在RCT中进行了现场干预[23，25-30]的测试。博士 Bricker的团队最近进行了一个多步骤的设计过程，产生了ACT电话辅导 议定书我们在一项试点RCT（N = 105）中测试了该方案，并将其与电话辅导SBT进行了比较。 与SBT相比，ACT参与者在体重减轻10%或更多的主要结局方面取得了更大的成功， 3个月和6个月随访。在这些令人鼓舞的成果基础上，我们建议进行全面的 ACT电话辅导（n = 199）与SBT电话辅导（n = 199）的有把握度的随机对照试验。 199），以确定电话辅导ACT：（1）在12个月时是否具有显著更高的体重减轻 随机化后，（2）主要结局（和次要结局）体重减轻12个月 由这些ACT一致的心理过程介导：（a）接受食物渴望，（B）接受 身体活动带来的不适，（c）注意饮食，（d）价值观引导的改变动机。我们将 探索ACT与SBT的12个月体重减轻主要结局是否在这些基线上存在差异 因素：（a）年龄，（B）性别，（c）种族/民族，（d）BMI，（e）抑郁，（f）焦虑。如果成功，请致电 指导ACT将提供一种更有效、更广泛的减肥治疗方法，从而使公众对ACT的关注度更高。 健康影响。

PROJECT SUMMARY/ABSTRACT (DESCRIPTION) More than 2 in 3 adults in the US are overweight or obese [1, 2]. Both conditions, and especially obesity, contribute to many health conditions including diabetes, heart disease, and cancers [3-5]. National costs due to obesity are high: $342 billion dollars (2013) in medical costs, which is 28% of all adult healthcare spending [6]. One form of behavioral intervention for weight loss is telephone-delivered coaching [7-9]. Telephone coaching has clear advantages: high population level reach and individually tailored training from a coach [10-12]. Telephone coaching for weight loss reaches over 1.2 million US adults per year [7, 12-14]. However, a critical barrier to progress in the field is that standard behavioral therapy (SBT) telephone coaching interventions have small effect sizes that are rarely evaluated against active treatment controls. Needed now are telephone coaching programs with the potential to boost weight loss success over and above SBT. We propose a new behavioral intervention for telephone coaching: Acceptance and Commitment Therapy (ACT) [15]. Unlike SBT, ACT interventions address the fundamental challenge of weight loss: overeating in response to internal (e.g., stress) and external (e.g., high calorie foods) cues [16-19]. ACT for weight loss addresses disinhibition by focusing on (1) increasing willingness to experience physical cravings, emotions, and thoughts that cue eating and impede physical activity while (2) making healthy diet and physical activity choices guided by deeply held values [16, 20]. While ACT has been applied to many behaviors and in a variety of delivery modalities [21-24], for weight loss it has only been tested in RCTs for in-person interventions [23, 25-30]. Dr. Bricker’s team recently conducted a multi-step design process that yielded an ACT telephone coaching protocol. We tested the protocol in a pilot RCT (N = 105), comparing it with telephone coaching SBT. Compared to SBT, ACT participants had greater success on the 10% or more weight loss main outcome, at both the 3- and 6-month follow-up. Building on these encouraging results, we propose to conduct a fully powered randomized controlled trial of ACT telephone coaching (n = 199) versus SBT telephone coaching (n = 199), in order to determine if telephone coaching ACT: (1) has significantly higher weight loss at 12 months post randomization, and (2) has 12-month weight loss on the main outcome (and secondary outcomes) mediated by these ACT-consistent psychological processes: (a) acceptance of food cravings, (b) acceptance of discomfort from physical activity, (c) mindful eating, and (d) values guided motivation to change. We will explore whether the 12-month weight loss main outcome for ACT, versus SBT, differs by these baseline factors: (a) age, (b) sex, (c) race/ethnicity, (d) BMI, (e) depression, (f) anxiety. If successful, telephone coaching ACT will offer a more effective, broadly scalable weight loss treatment—thereby making a high public health impact.