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

使用文化相关的压力管理增强行为减肥干预措施改善黑人女性的减肥结果

• 批准号: 10370478
• 负责人: Tiffany LaShaun Carson
• 金额: $ 65.2万
• 依托单位: H. LEE MOFFITT CANCER CTR & RES INST
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10370478
• 关键词: Address; Adult; Affect; Behavioral; Behavioral Mechanisms; Biological Markers; Blood Glucose; Body Weight; Body Weight Changes; Body Weight decreased; Chronic; Chronic Disease; Chronic stress; Clinical; Effectiveness; Energy Intake; Energy Metabolism; Gender; Gold; Health; High Prevalence; Hydrocortisone; Individual; Intervention; Lead; Link; Literature; Malignant Neoplasms; Measures; Mediating; Mediation; Modality; Modeling; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Obesity Epidemic; Outcome; Outcome Study; Overweight; Participant; Physical activity; Population; Prevalence; Process Measure; Psychological Stress; Public Health; Publishing; Race; Randomized; Randomized Controlled Trials; Reporting; Risk; Risk Factors; Role; Salivary; Stress; Surveys; Testing; Time; Training; United States; Weight; Weight Gain; Weight maintenance regimen; Woman; Work; arm; black women; combat; coping; diabetes prevention program; diabetes risk; disparity reduction; effectiveness testing; evidence base; experience; follow-up; group intervention; high body mass index; high risk; improved; improved outcome; intersectionality; intervention effect; lifestyle intervention; lifetime risk; member; novel; novel strategies; obesity risk; obesity treatment; perceived stress; primary outcome; public health relevance; racial difference; secondary outcome; sex; stress management; stress reduction; systematic review; treatment adherence; treatment strategy; trend; weight loss intervention; weight loss program

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.

黑人女性的超重和肥胖患病率高于任何其他种族性别 在美国，五分之四的成年黑人女性超重或肥胖。此外，成人 在接受相同的肥胖干预措施时，黑人女性的体重往往比白人女性减轻的体重少，无论其体重如何 治疗方式。减肥结果存在种族差异的原因尚不完全清楚，但 提出进一步优化肥胖治疗方法以减少差异的机会。行为权重 减重（BWL）干预措施提供了一种已被证明可有效促进适度体重的方法 一些肥胖参与者的体重减轻，但黑人女性的体重减轻往往少于白人女性 同一 BWL 计划中的对应人员。我们假设慢性心理疾病的患病率较高 据报道，压力与体重随着时间的推移而增加以及 BWL 计划中体重减轻效果较差有关 黑人女性导致肥胖和体重减轻不理想的比例过高 在这个群体中。因此，压力管理为黑人女性提供了一种新的体重管理方法。 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 计划可能比单独基于证据的 BWL 计划带来更好的结果。为了 根据这项建议，我们将测试为期 12 个月的针对文化、压力管理增强的计划的有效性 在一项完全有力的随机对照试验中，BWL 对减肥和减轻压力的干预（n=340）。 患有肥胖症的成年黑人女性将被随机分配到压力管理增强型 BWL 组 干预（BWL-Stress）或相同的单独 BWL 干预（BWL-alone）。具体目标是 1) 进行一项随机对照试验，以确定与 BWL-Stress 相比，BWL-Stress 对体重的影响 BWL-单独在肥胖和压力升高的成年黑人女性中，2）评估干预效果 通过经过验证的调查工具和压力生物标志物测量的心理压力，以及 3) 使用 多重中介模型，检验干预与体重变化之间的关系是否成立 由感知压力、能量摄入和体力活动介导。主要结果是体重变化 第 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 第 6 个月的血糖、能量摄入和体力活动。我们还将评估过程措施（例如治疗 依从性、治疗负担）。我们还将在第 12 个月评估每个结果。 通过针对黑人文化的压力管理策略来加强基于证据的 BWL 计划 女性目标是肥胖高风险人群中体重管理的一个尚未得到充分研究的因素 以及与肥胖相关的慢性疾病（例如 2 型糖尿病、癌症）。这项研究还将阐明行为 将我们的新颖干预措施与研究结果联系起来的机制。如果被证明有效，将会产生重大影响 对黑人女性体重管理的临床和公共卫生影响。