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

适应行为减肥​​的情景未来思维：比较策略和描述治疗反应

• 批准号: 10366702
• 负责人: KATHRYN E DEMOS
• 金额: $ 57.75万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-23 至 2026-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10366702
• 关键词: Adherence; Aftercare; Age; Attention; Behavior; Behavioral; Body Image; Body Weight Changes; Body Weight decreased; Characteristics; Cognitive; Coupled; Data; Decision Making; Diet; Exercise; Exhibits; Feedback; Female; Food; Functional Magnetic Resonance Imaging; Future; Gender; Goals; Health; Health behavior; Individual; Individual Differences; Intake; Internet; Lead; Literature; Measurement; Measures; Mediating; Mental Depression; Modeling; Morbidity - disease rate; Obesity; Outcome; Overweight; Participant; Pattern; Physical activity; Predictive Factor; Prevention; Process; Public Health; Randomized; Randomized Controlled Trials; Research; Rewards; Self-control as a personality trait; Testing; Thinking; Training; Training Programs; Treatment Protocols; United States; Weight; Weight maintenance regimen; Work; adverse outcome; base; behavioral economics; control trial; craving; demographics; discount; experience; follow-up; imaging study; improved; individualized medicine; insight; intervention effect; male; mortality; neuroregulation; novel; novel strategies; obesity treatment; personalized medicine; pilot trial; pleasure; prevent; primary outcome; programs; response; standard care; success; theories; treatment response; treatment strategy; weight loss intervention; weight loss program

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.

项目概要/摘要 肥胖是当今最重要的公共卫生问题之一，是导致许多主要原因的原因之一 美国的发病率和死亡率。尽管强烈渴望实现长期减肥目标， 肥胖者往往高估眼前的回报而低估未来。情景式未来思考 (EFT)，一种认知策略，个人在其中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。 之前的大多数研究都使用以促销为重点的 EFT，其中参与者设想自己 体验积极的未来成果。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) 被随机分配至：(1) 标准 iBWL（无基于 EFT 的策略），(2) PREVENT（iBWL + 基于 EFT 的策略，重点关注 防止不健康选择的长期负面后果），或 (3) 促进（基于 iBWL + EFT 的 侧重于促进健康选择的长期利益的策略）。 PREVENT 优于标准 iBWL 产生最大的整体减肥效果，同时减少了食物奖励驱动力和 增强自我控制力。这与我们之前的工作是一致的，其中使用了 PREVENT 策略 与减少渴望和增加抑制控制神经活动有关。虽然 PREVENT 产生了 最大的体重减轻，变异性表明个体差异可能会影响每种治疗的成功率。 例如，高度关注促销的个人更有可能在促销中取得更大的减肥效果。 我们现在提出一项完全有效的随机对照试验（RCT）来测试这些新颖的 方法可能比标准治疗更有益。此外，拟议的研究将寻求确定 预测成功的主持人，确定每个策略最适合谁。个人有 超重/肥胖 (n=360) 将被随机分为 12 个月的 (1) 标准 iBWL、(2) 预防或 (3) 推动。所有参与者都将参加介绍性培训课程，在此期间预防和促进 各小组将接受有关其特定的基于 EFT 的策略的培训。 iBWL 课程将持续 3 个月，每周一次 接下来是所有组的“复习”培训课程，以及剩余 9 个月的每月 iBWL。在 预防和推广 iBWL 课程和反馈信息将持续包含练习和 提醒使用指定的基于 EFT 的策略。评估将在基线期间进行 治疗3个月和6个月、治疗结束时（12个月）和治疗后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重要的见解 改善体重减轻，并可能导致未来通过个性化定制治疗优化体重减轻。