Self-weighing for Weight Management in Adolescents with Obesity

项目总结 在美国，大约20%的青少年患有肥胖症，这一点很重要，因为它有很多健康问题 后果，包括导致过早死亡的心脏代谢疾病。肥胖症的治疗是 对青少年来说尤其重要，因为这个年龄段的肥胖也会增加患低血压的风险 成年后收入和受教育程度较低。所有形式的肥胖治疗的基石是 支持日常饮食和体力活动改变的行为调整策略。自我监控是一种 以社会认知理论为基础的强大的行为工具。这一理论认为，更大的自我 通过近距离的自我测量提高自我效能、自我控制和自我强化。 在家中通过日常自我称重(SW)自我监测体重被发现是有效和安全的 成年人的减肥和维护，特别是当有外部责任对家庭体重负责的时候。 在家中对诊所负责的日常软件代表了一种可行的可扩展干预 落实到肥胖青少年的临床护理中。然而，家里的日常软件一直没有 在寻求肥胖治疗的青少年肥胖患者中进行前瞻性评估。的目标是 这项建议是为了评估可行性，可接受性，安全性，并估计对体重的影响 家庭，与肥胖青少年的电子健康记录(EHR)和临床护理相结合。我会：1) 使用混合方法确定青少年和家长对智能秤上的日常体重的看法 连接到EHR，作为寻求减肥治疗的肥胖青少年的工具；2) 确定临床医生和诊所工作人员对与EHR连接的日常体重的看法；以及3) 进行一项以临床为基础的随机试点研究，比较其可行性、可接受性、安全性和估计值 体重管理诊所对肥胖青少年的三种条件的影响大小：a)常规护理，b) 日常护理+简单规模的家庭日常软件，以及c)日常护理+智能规模的家庭日常软件， 与临床相关(向患者提供个性化反馈)。我将前瞻性地、连续地评估情绪， 身体形象、压力、体重管理实践和饮食行为紊乱。该项目将生成 为设计一项更大规模的研究(R01)提供重要的初步数据，该研究全面评估 在肥胖青少年中，在有和没有来自诊所的定期外部责任的情况下，每天在家中进行检查。 完成这项K23培训计划将使我建立混合方法、流行病学方法的技能 和干预设计，以及实施数字技术的基本技能，以及奠定 为领导新颖和高影响力的肥胖研究奠定基础。在此期间的多学科指导 职业发展奖将使我成为一名独立的、由医疗外资金资助的临床医生科学家 世卫组织研究以临床为基础的肥胖治疗干预措施。

PROJECT SUMMARY Approximately 20% of adolescents in the US have obesity, which is significant because of its many health consequences, including cardiometabolic disease leading to premature death. Treatment of obesity is particularly important for adolescents because obesity in this age group also increases the risk for lower income and lower educational attainment in adulthood. The cornerstone of all forms of obesity treatment is behavioral modification strategies that support daily dietary and physical activity change. Self-monitoring is a powerful behavioral tool that is grounded in Social Cognitive Theory. This theory states that greater self- awareness through proximate self-measurement improves self-efficacy, self-control, and self-reinforcement. Self-monitoring of weight through daily self-weighing (SW) at home has been found to be effective and safe for weight loss and maintenance in adults, particularly when there is external accountability for the home weights. Daily SW at home with accountability to clinic represents a scalable intervention that can be feasibly implemented into the clinical care for adolescents with obesity. However, daily SW at home has not been prospectively assessed in adolescent patients with obesity who are seeking obesity treatment. The objective of this proposal is to evaluate the feasibility, acceptability, safety, and estimate the effect on weight of daily SW at home, integrated with the electronic health record (EHR) and clinical care of adolescents with obesity. I will: 1) Use mixed methods to determine adolescent and parent perspectives on daily weighing on smart scales connected to the EHR as a tool for adolescents with obesity who are seeking weight loss treatment; 2) Determine clinician and clinic staff perspectives on daily weighing on connected to the EHR; and 3) Conduct a randomized, clinic-based pilot study to compare the feasibility, acceptability, safety, and estimate the effect size of three conditions in a weight management clinic for adolescents with obesity: a) usual care, b) usual care + daily SW at home on a simple scale, and c) usual care + daily SW at home on a smart scale that is connected to clinic (with individualized feedback to the patient). I will prospectively and serially assess mood, body image, stress, weight management practices, and disordered eating behaviors. This project will generate critical preliminary data to inform the design of a larger study (R01) that fully evaluates safety and efficacy of daily SW at home, with and without regular external accountability from clinic, in adolescents with obesity. Completing this K23 training program will allow me to establish skills in mixed methods, epidemiologic methods and intervention design, and foundational skills in implementation of digital technology, as well as lay the groundwork for leading novel and high-impact obesity studies. The multidisciplinary mentorship during this career development award will prepare me to become an independent, extramurally-funded clinician scientist who investigates clinic-based interventions for obesity treatment.