Promotion of Successful Weight Management in Overweight and Obese Veterans

在退伍军人管理局接受医疗保健的退伍军人中，超过70%的人超重或肥胖，肥胖率 在退伍军人管理局接受护理的退伍军人比不使用退伍军人管理局的非退伍军人和退伍军人更高。 肥胖导致行动不便，这是发病率和丧失独立性的一个重要决定因素。 肥胖还与心脏代谢风险因素升高有关，包括血脂、胰岛素抵抗、 高血压和炎症。尽管体重减少了3%，但改善了身体机能和 减少2型糖尿病和心血管危险因素，大多数受试者在长期体重方面都不成功 维持，在接下来的两年内恢复几乎一半的体重，并恢复到基线体重 在未来3-5年内。这项临床试验接受了通过改变体重来保持体重减轻的挑战 能量平衡和可能的骨骼肌底物氧化以减轻超重和 行动不便的肥胖老年退伍军人。 这项奖励提案的目的是在随机临床试验中测试 有和没有间歇禁食(IF)的高强度体重管理计划，以对抗体重恢复和 退伍军人的肥胖危机。IF指的是短时间内的激烈能源限制。我们建议招收一名 将200名行动不便的超重和肥胖退伍军人纳入为期12周的减肥计划 这包括巴尔的摩和亚特兰大VAMC的低卡路里心脏健康(HH)饮食和锻炼。 在减肥(WL)后，退伍军人将被随机分配到体重维持(WM：HH和HH的延续 运动指南)通过间歇禁食(WM+IF)进行24周的计划或体重维持。我们的 中心假说是，IF将在36周时为防止体重回升提供刺激，并将 改善心脏代谢和功能健康因素。此外，我们假设，适当地 通过骨骼肌脂肪酸氧化酶改变燃料利用率是体重的一个重要因素 维持和恢复体重。 这项CSR&D临床试验优秀奖介绍了IF预防体重复发的创新实践 在临床上显著减轻体重之后，可以提供循证建议来促进这一点 对退伍军人群体的干预类型。

Over 70% of Veterans who receive health care at the VA are overweight or obese, and obesity rates of Veterans receiving care at the VA are higher compared to non-Veterans and Veterans who do not use the VA. Obesity contributes to loss of mobility which is a significant determinant of morbidity and loss of independence. Obesity also is associated with elevated cardiometabolic risk factors, including lipid profile, insulin resistance, hypertension, and inflammation. Though weight loss of as little as 3% improves physical functioning and reduces type 2 diabetes and cardiovascular risk factors, most subjects are unsuccessful at long-term weight maintenance, regaining almost half the weight lost within the following two years and return to baseline weight within the next 3-5 years. This clinical trial takes on the challenge of maintaining weight reduction by altering energy balance and possibly skeletal muscle substrate oxidation to mitigate weight regain in overweight and obese older Veterans with mobility limitations. The objective of this award proposal is to test in a randomized clinical trial the effectiveness of an intensive weight management program with and without intermittent fasting (IF) to combat weight regain and the obesity crisis in our Veterans. IF refers to short periods of intense energy restriction. We propose to enroll a total of 200 overweight and obese Veterans with mobility impairments into a 12 weeks weight loss program that incorporates a low calorie Heart Healthy (HH) diet and exercise at the Baltimore and Atlanta VAMCs. Following weight loss (WL), Veterans will be randomized to weight maintenance (WM: continuation of HH and exercise guidelines) program or weight maintenance with intermittent fasting (WM+IF) for 24 weeks. Our central hypothesis is that IF will provide the stimulus for prevention of weight regain at 36 weeks and will improve cardiometabolic and functional health factors. Further, we hypothesize that the ability to appropriately modify fuel utilization through skeletal muscle fatty acid oxidation enzymes is an important factor in weight maintenance and weight regain. This CSR&D Clinical Trial Merit Award introduces an innovative practice of IF to prevent weight relapse after clinically significant weight reduction and could provide evidence-based recommendations to promote this type of intervention in the Veteran population.