Promotion of Successful Weight Management in Overweight and Obese Veterans

超过70%的退伍军人谁接受医疗保健在弗吉尼亚州超重或肥胖，肥胖率 在退伍军人管理局接受护理的退伍军人高于非退伍军人和不使用退伍军人管理局的退伍军人。 肥胖导致丧失活动能力，这是发病率和丧失独立性的重要决定因素。 肥胖还与心血管代谢危险因素升高有关，包括血脂谱、胰岛素抵抗， 高血压和炎症。尽管体重减轻3%可以改善身体功能， 降低2型糖尿病和心血管风险因素，大多数受试者在长期体重控制方面不成功 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。这项临床试验的挑战是通过改变 能量平衡和可能的骨骼肌基质氧化，以减轻超重和 肥胖且行动不便的老年退伍军人。 该奖项的目的是在一项随机临床试验中测试 强化体重管理计划，有或没有间歇性禁食（IF），以对抗体重反弹， 我们退伍军人的肥胖危机IF指的是短时间的强烈能量限制。我们建议招收一名 总共有200名超重和肥胖的退伍军人与行动不便的12周减肥计划 在巴尔的摩和亚特兰大的VAMCs采用低热量的心脏健康（HH）饮食和锻炼。 体重减轻（WL）后，退伍军人将随机接受体重维持（WM：继续HH和 运动指南）计划或间歇性禁食（WM+IF）维持体重24周。我们 中心假设是，IF将在36周时提供预防体重反弹的刺激， 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重要因素 维持和体重恢复。 这项CSR&D临床试验优异奖介绍了IF预防体重复发的创新实践 在临床上显著的体重减轻后，可以提供基于证据的建议，以促进这一点 对退伍军人进行干预。

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.