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

项目摘要/摘要 此K23应用程序旨在支持Stephanie Manasse博士成为一名 独立的临床研究人员专注于开发和评估肥胖症的新疗法。这个 拟议的申请将通过为以下方面提供高级培训来加强候选人实现这一目标的能力： (1)在理论模型和决策衡量方面获得专业知识；(2)在以下方面发展专业知识 营养和膳食模式分析；(3)设计和执行青少年肥胖的临床试验；(4)建立 精通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，已经组建了一个由主要导师埃文博士组成的导师专家团队 Forman(进行肥胖临床试验)；共同导师Adrienne Juarascio博士(进行 饮食紊乱患者的临床试验)，Joseph Kable博士(模型和测量方面的培训 Tanja Kral博士(针对儿童肥胖的膳食模式和营养分析方面的培训)、 Tanofsky-Kraff(对青少年肥胖和失控的评估和临床试验方法的培训 和Zoe Zhang博士(接受纵向统计方法培训)；以及咨询人Robert博士 伯科维茨(青春期体重和体重变化的生物学考量)和劳伦斯·斯坦伯格博士 (用于青少年决策模型的培训)。 作为这次培训的一部分，马纳塞博士将完成一个项目，该项目将检验 异常的决策过程(例如，延迟折扣、情感驱动的冲动和坚持不懈 青少年肥胖症的行为治疗的减肥效果。第二，研究 还将研究在治疗期间异常决策对有问题的饮食行为的影响 可能导致不良减肥结果的因素：奖励驱动的暴饮暴食，失控的饮食，以及 有问题的饮食限制。第三，这项研究将检查这些有问题的饮食行为 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)临床上有意义的低脂饮食的人将完成一项行为 减肥计划和完成基线决策的措施。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、 并进行了12个月的随访。目前的研究将提供关键信息，将直接导致 一种新的青少年肥胖干预措施的开发将稳定地减少异常 做出决策，改善减肥效果。鉴于减肥治疗的效果很差， 对于青少年来说，针对青春期独特的发展因素的新的补充是必要的。 因此，除了帮助候选人进入独立的研究生涯之外，这个项目还将 通过为青少年肥胖症治疗发展提供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.