Does aberrant decision-making prevent success in adolescent behavioral weight loss treatment?

项目概要/摘要 此 K23 申请旨在支持 Stephanie Manasse 博士实现成为一名 独立临床研究人员专注于开发和评估肥胖症的新疗法。的 拟议的申请将通过提供高级培训来增强候选人实现这一目标的能力： (1) 获得理论模型和决策测量方面的专业知识； (2) 发展专业知识 营养和膳食模式分析； (3) 设计并执行青少年肥胖症的临床试验； (4) 构建 熟练掌握与临床试验研究相关的多层次和纵向数据分析方法。至 为了实现这些目标，我们组建了一个专家导师团队，其中包括主要导师 Evan 博士 Forman（用于进行肥胖症临床试验）；共同导师 Adrienne Juarascio 博士（进行培训 饮食失调个体的临床试验），Joseph Kable 博士（模型和测量培训 决策制定）、Tanja Kral 博士（儿童肥胖膳食模式和营养分析培训）、Dr. Tanofsky-Kraff（用于青少年肥胖和失控的评估和临床试验方法培训 饮食）和 Zoe Zhang 博士（纵向统计方法培训）；和顾问罗伯特博士 Berkowitz（青春期体重和体重变化的生物学考虑）和 Laurence Steinberg 博士 （用于青少年决策模型的培训）。 作为本次培训的一部分，Manasse 博士将完成一个项目，该项目将检查以下因素的预测作用： 异常的决策过程（即延迟折扣、情感驱动的冲动和坚持不懈的行为） 决策）对青少年肥胖行为治疗的减肥结果的影响。二、学习 还将检查治疗期间异常决策对有问题的饮食行为的影响 可能导致减肥效果不佳的因素：奖励驱动的暴饮暴食、饮食失控以及 有问题的饮食限制。第三，该研究将检查这些有问题的饮食行为是否 调节异常决策对减肥结果的影响。我们将招募60名青少年 （14-18 岁）有（n = 30）和没有（n = 30）临床显着的 LOC 饮食谁将完成行为 减肥计划和基线决策的完整衡量标准。有问题的饮食行为和 体重结果将在治疗中期（6周）、治疗后（16周）、6个月随访时进行评估， 以及12个月的随访。当前的研究将提供关键信息，直接导致 开发一种新型青少年肥胖干预增强措施，有望减少异常肥胖 决策并改善减肥效果。鉴于减肥治疗效果不佳 对于青少年来说，针对青春期独特发育因素的新颖增强是必要的。 因此，除了帮助候选人进入独立研究生涯之外，该项目还将 通过提供青少年肥胖治疗开发急需的知识来满足关键需求。

PROJECT SUMMARY/ABSTRACT This K23 application aims to support Dr. Stephanie Manasse in her overarching goal of becoming an independent clinical researcher focused on developing and evaluating novel treatments for obesity. The proposed application will strengthen the candidate’s ability to meet this goal by providing advanced training to: (1) Gain expertise in theoretical models and measurement of decision-making; (2) develop expertise in nutritional and meal pattern analysis; (3) design and execute clinical trials for adolescent obesity; (4) Build proficiency with multilevel and longitudinal data analytic approaches related to clinical trial research. To achieve these goals, an expert team of mentors has been assembled, consisting of primary mentor Dr. Evan Forman (for conducting obesity clinical trials); co-mentors Dr. Adrienne Juarascio (for training in conduct of clinical trials for individuals with disordered eating), Dr. Joseph Kable (for training in models and measurement of decision-making), Dr. Tanja Kral (for training in meal pattern and nutritional analysis in pediatric obesity), Dr. Tanofsky-Kraff (for training in assessment and clinical trial methods in adolescent obesity and loss-of-control eating) and Dr. Zoe Zhang (for training in longitudinal statistical methods); and consultants Dr. Robert Berkowitz (biological considerations of adolescence on weight and weight change) and Dr. Laurence Steinberg (for training in models of adolescent decision-making). As part of this training, Dr. Manasse will complete a project that will examine the predictive role of aberrant decision-making processes (i.e., delay discounting, affect-driven impulsivity, and perseverative decision-making) in weight loss outcomes from behavioral treatment for adolescent obesity. Second, the study will also examine the influence of aberrant decision-making on problematic eating behaviors during treatment that are likely driving poor weight loss outcomes: reward-driven overeating, loss-of-control eating, and problematic dietary restriction. Third, the study will examine whether these problematic eating behaviors mediate the influence of aberrant decision-making on weight loss outcomes. We will recruit 60 adolescents (ages 14-18) with (n=30) and without (n=30) clinically significant LOC eating who will complete a behavioral weight loss program and complete measures of decision-making at baseline. Problematic eating behaviors and weight outcomes will be evaluated at mid-treatment (6 weeks), post-treatment (16 weeks), 6-month follow-up, and 12-month follow-up. The current study will provide critical information that will directly lead into the development of a novel adolescent obesity intervention augmentation that will be poised reduce aberrant decision-making and improve weight loss outcomes. Given the poor efficacy of weight loss treatments in adolescents, novel augmentations that target the unique developmental factors of adolescence are necessary. Therefore, in addition to helping launch the candidate into an independent research career, this project will meet a critical need by providing much-needed knowledge for adolescent obesity treatment development.