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

黑人女性超重和肥胖的患病率比任何其他种族性别都高 在美国，五分之四的成年黑人女性超重或肥胖。此外，成人 黑人女性在接受同样的肥胖干预后， 治疗方式减肥结果中种族差异的原因尚不完全清楚，但 建议进一步优化肥胖症治疗方法以减少差异的机会。行为权重 减肥（BWL）干预提供了一种方法，已证明有效地促进适度的体重 在一些肥胖的参与者中，黑人女性的体重减少，但黑人女性的体重往往比白色女性的体重减少少。 在同一个BWL程序中的对应物。我们假设慢性心理疾病的患病率越高， 压力，这已被链接到体重增加随着时间的推移和较差的减肥BWL计划，报告说， 黑人女性导致肥胖症的不成比例的患病率和观察到的次优体重减轻 在这个群体中。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，将强大的压力管理组件纳入证据- 基于BWL的程序可能会导致更好的结果比基于证据的BWL程序单独。为 这项建议，我们将测试为期12个月的文化针对性，压力管理增强的有效性 BWL干预对体重减轻和压力减轻的充分把握度随机对照试验（n=340）。 肥胖的成年黑人女性将被随机分配到压力管理增强BWL组， 干预（BWL-压力）或单独的相同BWL干预（BWL-单独）。具体目标是：（1） 进行一项随机对照试验，以确定BWL-应激对体重的影响， BWL-单独在肥胖和压力升高的成年黑人女性中，2）评估干预对 通过经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 通过感知压力、能量摄入和身体活动来调节。主要结果是体重变化， 第六个月。次要结果将包括压力测量的变化（例如，调查措施，皮质醇），血液 第6个月时的葡萄糖、能量摄入和身体活动。我们还将评估过程措施（例如， 依从性、治疗负担）。我们还将在第12个月评估每个结果。这种新颖的方法， 加强以证据为基础的BWL计划与文化为目标的压力管理策略，为黑人 女性的目标是在肥胖高危人群中对体重管理的研究不足 和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 将我们的新干预与研究结果联系起来的机制。如果被证明有效，它将具有重大意义。 黑人女性体重管理的临床和公共卫生意义。

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.