Adapting Episodic Future Thinking for Behavioral Weight Loss: Comparing Strategies and Characterizing Treatment Response

项目摘要/摘要 肥胖是当今最重要的公共卫生问题之一，是导致肥胖的许多主要原因之一 美国的发病率和死亡率。尽管有实现长期减肥目标的强烈愿望， 患有肥胖症的人往往高估眼前的回报，而不看重未来。情节式的未来思考 (EFT)，一种认知策略，在这种策略中，个体设想自己的未来并模拟潜力 经验，已被证明有助于将注意力转移到未来，改善食物选择，并减少摄入量。 大多数以前的研究都使用了以晋升为中心的EFT，参与者在其中想象自己 体验积极的未来结果。然而，理论表明，基于EFT的策略可能是 或者侧重于预防，引导参与者考虑不健康选择的未来后果。 我们最近的试点(R03 DK106405)随机对照试验在3个月内实施了这些方法 互联网提供的行为减肥计划(IBWL)。参与者(n=95)被随机分为两组：(1) 标准iBWL(无基于EFT的策略)，(2)预防(基于iBWL EFT的策略侧重于 防止不健康选择的长期负面后果)，或(3)促进(基于iBWL EFT 重点是促进健康选择的长期利益的战略)。预防优于标准 IBWL产生了最大的总体减肥效果，同时减少了食物奖励和 增强自制力。这与我们之前使用预防策略的工作是一致的 与减少渴望和增加抑制控制神经活动有关。虽然防止产生 最大的体重减轻，变异性表明个体差异可能会在每种治疗中适中成功。 例如，关注晋升的人在晋升中更有可能减掉更多的体重。 我们现在提出一个完全有效的随机对照试验(RCT)来测试这两种新技术中的任何一种 与标准治疗相比，这些方法可能会带来好处。此外，拟议的研究将寻求确定 主持人预测成功，决定每种策略对谁是最好的。具有以下特征的个人 超重/肥胖(n=360)将随机分为(1)标准iBWL、(2)预防或(3)12个月 宣传推广。所有参与者都将有一个入门培训课程，在此期间，预防和促进 小组将接受关于其特定的基于EFT的战略的培训。IBWL课程将持续3个月，每周一次 然后是针对所有小组的“复习”训练课程，并在其余9个月每月进行iBWL。在……里面 预防和推广iBWL课程和反馈信息将继续以练习和 提醒您使用所分配的基于EFT的策略。评估将在基准线上进行， 治疗3个月、6个月、治疗结束时(12个月)、治疗后6个月(18个月)。 主要结果是体重变化。这项随机对照试验将为新的治疗策略提供关键的见解 改善体重减轻，并可能导致未来通过个性化治疗优化减肥。

Project Summary/Abstract Obesity is one of the most important public health issues today, contributing to many of the leading causes of morbidity and mortality in the United States. Despite strong desires to achieve long-term weight loss goals, individuals with obesity tend to overvalue immediate rewards and discount the future. Episodic Future Thinking (EFT), a cognitive strategy in which individuals envision themselves in the future and simulate potential experiences, has been shown to help shift attention to the future, improve food choices, and reduce intake. Most previous studies have used promotion-focused EFT, in which participants envision themselves experiencing positive future outcomes. However, theories suggest it is possible EFT-based strategies may be alternatively focused on prevention, guiding participants to consider future consequences of unhealthy choices. Our recent pilot (R03 DK106405) randomized controlled trial implemented these approaches in a 3-month Internet-delivered behavioral weight loss program (iBWL). Participants (n=95) were randomized to either: (1) Standard iBWL (no EFT-based strategies), (2) PREVENT (iBWL + EFT-based strategies focused on preventing long-term negative consequences of unhealthy choices), or (3) PROMOTE (iBWL + EFT-based strategies focused on promoting long-term benefits of healthy choices). PREVENT was superior to standard iBWL producing the greatest overall weight loss, which was coupled with reduced food reward drive and increased self-control. This is consistent with our previous work in which use of the PREVENT strategy was associated with reduced craving and increased inhibitory control neural activity. Although PREVENT produced the greatest weight loss, variability suggests individual differences may moderate success in each treatment. For instance, individuals high in promotion-focus were more likely to have greater weight loss in PROMOTE. We now propose a fully powered randomized controlled trial (RCT) to test if either of these novel approaches may provide benefit over standard treatment. Further, the proposed study will seek to identify moderators that predict success, determining for whom each strategy is best. Individuals with overweight/obesity (n=360) will be randomized to 12 months of either (1) Standard iBWL, (2) PREVENT, or (3) PROMOTE. All participants will have an introductory training session, during which PREVENT and PROMOTE groups will receive training in their specific EFT-based strategy. iBWL lessons will then be weekly for 3 months followed by a ‘refresher’ training session for all groups, and monthly iBWL for the remaining 9 months. In PREVENT and PROMOTE iBWL lessons and feedback messages will continuously feature exercises and reminders to utilize the assigned EFT-based strategies. Assessments will be conducted at baseline, during treatment at 3 and 6 months, at the end of treatment (12 months), and 6 months post-treatment (18 months). The primary outcome is weight change. This RCT will provide critical insight into novel treatment strategies for improving weight loss and may lead to future optimization of weight loss via individually tailored treatment.