Randomized Explanatory Trial of a Mediterranean Dietary Pattern Weight Loss Intervention for Primary Care Practices

摘要 在美国，大约43%的成年男性受肥胖症影响（身体质量指数（BMI）>30 kg/m2）。 2017年，心脏病、癌症、慢性下呼吸道疾病和中风是导致死亡的五大原因之一。 男性死亡率，每一个都与肥胖有关。2为了改善或减少与这些相关的风险因素， 在某些情况下，通常通过行为减肥干预措施规定适度减肥5-10%。然而， 尽管男性中存在与肥胖相关的死亡率，但男性参与减肥干预（27%）的比例相当高， 低初步数据显示，当黑人男性确实参与减肥干预措施时， 与配偶一起，他们经历了成功的减肥。然而，动机、行为和策略 与成功减肥相关的因素在不同种族/民族的男性中没有得到很好的理解或研究 组识别这些动机、行为和策略对于增加体重的参与至关重要 减肥干预以及改善男性减肥策略。与减肥相关的行为 体重的维持受个人、社会和环境因素的影响。了解社会 与个体水平相比， 因素对于男性来说，这表明家庭发挥了作用，因为与减肥相关的行为， 体重维持通常发生在家庭行为环境中。妇女经常被要求 指导家庭环境和家庭行为的责任，特别是关于购买 食物和准备膳食。因此，减肥干预措施通常针对妇女。这种方法失败了 为了解决家庭中男性成员对体重和体重相关行为的影响， 除了自己，还有家里的其他人。深入了解家庭行为 背景和家庭互动影响行为将是重要的设计家庭为中心的减肥 干预，其中男性是索引伙伴。我们的长期目标是开发减肥干预措施 专为男性设计的，导致体重减轻，随着时间的推移保持在自己和家人之间 成员使用混合方法，拟议的补充研究将确定因素 与成功减肥的男性在家庭行为的背景下，在减肥阶段， DELISH研究。DELISH是一种减肥干预措施，测试地中海式饮食模式的功效， 适应美国东南部人口，招收至少40%的男性，以解决低男性 参与减肥研究。核心假设是与家庭动力学相关的特定社会因素 与男性体重减轻有关。我们的目标是更多地了解这些因素， 为今后的干预提供信息。

ABSTRACT In the United States, approximately 43 % of adult men are affected by obesity (body mass index (BMI)>30 kg/m2). In 2017, heart disease, cancer, chronic lower respiratory disease, and stroke were among the top five causes of mortality among men, each associated with obesity.2 To improve or reduce risk factors associated with these conditions, modest weight loss of 5-10% is often prescribed through behavioral weight loss interventions. Yet, despite obesity-linked mortality among men, male participation in weight loss interventions (27%) is considerably low. Preliminary data have shown that when Black men do participate in weight loss interventions, alone and with their spouses, they experience successful weight loss. However, the motivations, behaviors and strategies associated with successful weight loss are not well understood nor studied among men across racial/ethnic groups. Identifying these motivations, behaviors and strategies is essential to increase participation in weight loss interventions as well as to improve weight loss strategies for men. Behaviors associated with weight loss and weight maintenance are influenced by individual, social and environmental factors. Understanding the social and environmental factors and their interactions has been understudied when compared to individual level factors. For men, it is suggested that family plays a role because behaviors associated with weight loss and weight maintenance typically occur within the family behavioral context. Women are often tasked with the responsibility of directing the home environment and family behaviors, especially regarding the purchasing of food and preparation of meals. As a result, weight loss interventions typically target women. This approach fails to address the influence male members in the family have on weight and weight related behaviors not only for themselves but other family members within the household. Gaining insight into how the family behavioral context and family interactions influence behavior will be important in designing family centered weight loss intervention where the male is the index partner. Our long-term goal is to develop weight loss interventions designed specifically for men that lead to weight loss maintained over time among themselves and family members. Using a mixed methods approach, the proposed supplemental research will identify the factors associated with successful weight loss among men in a family behavior context in the weight loss phase of the DELISH study. DELISH is a weight loss intervention testing the efficacy of a Mediterranean-style dietary pattern, adapted for a southeastern United States population, enrolling at least 40% males to address the low male participation in weight loss studies. The central hypothesis is that specific social factors related tofamily dynamics and functioning are associated with weight loss among men. Our aim is to learn more about these factors to inform future interventions.