Telephone Delivered Acceptance & Commitment Therapy for Weight Loss

项目摘要/摘要(说明) 美国超过三分之二的成年人超重或肥胖[1，2]。这两个条件，特别是 肥胖会导致许多健康问题，包括糖尿病、心脏病和癌症[3-5]。全国 肥胖造成的成本很高：3420亿美元(2013年)的医疗成本，占所有成人医疗保健的28% 支出[6]。减肥的一种行为干预形式是电话传授的教练[7-9]。 电话辅导具有明显的优势：覆盖人群水平较高，并从 教练[10-12]。每年有120多万美国成年人接受电话减肥辅导[7，12-14]。 然而，在这一领域取得进展的一个关键障碍是标准的行为疗法(SBT)电话辅导 干预措施的效果很小，很少针对积极的治疗对照进行评估。现在就需要 除了SBT之外，电话教练计划还有可能促进减肥成功。我们 提出一种新的电话辅导行为干预方法：接受与承诺疗法(ACT) [15]。与SBT不同，ACT干预措施解决了减肥的根本挑战：作为回应，暴饮暴食 对内部(例如，压力)和外部(例如，高卡路里食物)的暗示[16-19]。为减肥地址行动 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 这会提示饮食并阻碍体力活动，同时(2)指导人们做出健康的饮食和体力活动选择 通过根深蒂固的价值观[16，20]。虽然ACT已经被应用于许多行为和各种交付中 对于减肥模式[21-24]，它只在随机对照试验中进行了面对面干预的测试[23，25-30]。Dr。 Bricker的团队最近进行了一个多步骤的设计过程，产生了ACT电话教练 协议。我们在试点RCT(N=105)中测试了该协议，并将其与电话培训SBT进行了比较。 与SBT相比，ACT参与者在10%或更多的体重减轻主要结果上取得了更大的成功，在 分别进行3个月和6个月的随访。在这些令人鼓舞的结果的基础上，我们建议进行全面的 ACT电话教练(n=199)与SBT电话教练(n=)的动力型随机对照试验 199)，以确定电话教练法：(1)在12个月时是否有明显更高的减肥效果 随机化后，(2)主要结果(和次要结果)有12个月的体重减轻 由这些与ACT一致的心理过程调节：(A)接受食物渴望，(B)接受 体力活动带来的不适，(C)用心的饮食，(D)价值观引导改变的动力。我们会 探索ACT与SBT的12个月减重主要结果是否与这些基线不同 因素：(A)年龄、(B)性别、(C)种族/民族、(D)体重指数、(E)抑郁、(F)焦虑。如果成功，请致电 教练ACT将提供更有效的、可广泛扩展的减肥治疗-从而使公众 对健康的影响。

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.