Improving weight loss outcomes of black women using a culturally relevant, stress management enhancement behavioral weight loss intervention

黑人女性的超重和肥胖率比任何其他种族性别都要高 在美国，每5名成年黑人女性中就有4人超重或肥胖。此外，成人 接受相同肥胖干预的黑人女性往往比白人减肥更少，无论 治疗方式。减肥结果的种族差异的原因尚不完全清楚，但 建议进一步优化肥胖治疗方法的机会，以减少差异。行为权重 减肥(BWL)干预提供了一种在促进适度体重方面已经证明有效的方法 一些肥胖参与者的体重下降，但黑人女性的体重往往比白人女性的体重减轻得少 在同一BWL计划中的对应者。我们假设慢性心理疾病的较高患病率 压力，这与BWL计划中随着时间推移而增加的体重和较差的体重减轻有关，由 黑人女性是肥胖和体重下降不成比例的主要原因 在这群人中。因此，压力管理为黑人女性的体重管理提供了一种新的方法。 我们的初步工作表明，将强大的压力管理成分纳入证据- 基于BWL的计划可能会比单纯的循证BWL计划带来更好的结果。为 在这项建议中，我们将测试为期12个月的有文化针对性的、加强压力管理的有效性 在一项完全有效的随机对照试验(n=340)中，体重指数对体重减轻和压力减轻的干预。 肥胖的成年黑人女性将被随机分配到压力管理增强型BWL 干预(BWL-应激)或相同的BWL单独干预(BWL-单独)。具体目标为1) 进行一项随机对照试验，以确定体重应激对体重的影响。 BWL-在肥胖和压力增加的成年黑人女性中单独使用，2)评估干预效果 通过有效的调查工具和压力生物标记物测量的心理压力，以及3)使用 多元中介模型，检验干预与体重变化之间的关系 由感知到的压力、能量摄入量和体力活动调节。主要结果是体重在 6个月。次要结果将包括压力测量(例如，调查测量、皮质醇)、血液 6个月时的血糖、能量摄入和体力活动。我们还将评估过程措施(例如，治疗 坚持、治疗负担)。我们还将在12个月时评估每个结果。 用针对黑人的文化目标压力管理策略加强循证BWL计划 女性针对肥胖高危人群中未被充分研究的体重管理贡献者 和肥胖相关的慢性病(如2型糖尿病、癌症)。这项研究还将阐明行为 将我们的新型干预措施与研究结果联系起来的机制。如果被证明是有效的，它将具有重要的 黑人女性体重管理的临床和公共卫生影响。

Black females have the highest prevalence of overweight and obesity than any other racial-gender group in the United States with 4 out of 5 adult black females being overweight or obese. Furthermore, adult black females tend to lose less weight than whites undergoing the same obesity intervention regardless of treatment modality. Reasons for racial differences in weight loss outcomes are not fully understood, but suggest opportunities to further optimize obesity treatment approaches to reduce disparities. Behavioral weight loss (BWL) interventions offer one approach that has demonstrated effectiveness in promoting modest weight loss among some participants with obesity, but black females tend to lose less weight than their white counterparts in the same BWL program. We hypothesize that the higher prevalence of chronic psychological stress, which has been linked to weight gain over time and poorer weight loss in BWL programs, reported by black females contributes to the disproportionate prevalence of obesity and suboptimal weight loss observed among this group. Thus, stress management offers a novel approach to weight management for black females. Our preliminary work suggests that incorporating a strong stress management component into an evidence- based BWL program can potentially lead to better outcomes than an evidence-based BWL program alone. For this proposal, we will test the effectiveness of a 12-month culturally-targeted, stress management-enhanced BWL intervention on weight loss and stress reduction in a fully powered randomized, controlled trial (n=340). Adult black females with obesity will be randomized to either a stress-management enhanced BWL intervention (BWL-Stress) or the same BWL intervention alone (BWL-alone). The specific aims are to 1) conduct a randomized, controlled trial to determine the effects on body weight of BWL-Stress compared to BWL-Alone among adult black females with obesity and elevated stress, 2) evaluate intervention effects on psychological stress as measured by a validated survey instrument and a stress biomarker, and 3) using a multiple mediation model, test whether the relationship between the intervention and weight change is mediated by perceived stress, energy intake, and physical activity. The primary outcome is weight change at month 6. Secondary outcomes will include changes in stress measures (e.g., survey measures, cortisol), blood glucose, energy intake, and physical activity at month 6. We will also assess process measures (e.g, treatment adherence, treatment burden). We will also evaluate each outcome at month 12. This novel approach for enhancing an evidence-based BWL program with culturally-targeted stress management strategies for black females targets an understudied contributor to weight management among a population at high risk for obesity and obesity-related chronic diseases (e.g. type 2 diabetes, cancer). This study will also elucidate behavioral mechanisms linking our novel intervention to study outcomes. If proven effective, it would have significant clinical and public health implications for weight management among black females.