Enhancing Effectiveness of a Dissonance-Based Obesity Prevention Program

提高基于失调的肥胖预防计划的有效性

• 批准号: 10469421
• 负责人: ERIC M STICE
• 金额: $ 43.91万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-11-01 至 2024-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10469421
• 关键词: 20 year old; Adolescence; Adolescent; Attention; Attitude; Attitude to Health; Behavior; Calories; Computers; Cues; Development; Dietary intake; Eating Disorders; Education; Effectiveness; Equilibrium; Exercise; Exhibits; Expenditure; Fatty acid glycerol esters; Female; Food; Functional Magnetic Resonance Imaging; Future; Goals; Health; Hyperphagia; Image; In complete remission; Intake; Intervention; Investigational Therapies; Life Style; Mediating; Morbidity - disease rate; Neurosciences; Obesity; Obesity Epidemic; Outcome; Overweight; Palate; Participant; Physical activity; Prevalence; Prevention; Prevention program; Procedures; Randomized; Reporting; Rewards; Risk; Signal Transduction; Testing; Thinness; Training; Unhealthy Diet; Weight Gain; Youth; attentional bias; base; behavioral response; cohesion; cost; diet and exercise; energy balance; evidence base; excessive weight gain; executive function; follow-up; good diet; health goals; improved; intervention effect; male; mortality; novel; obesity prevention; pilot trial; prevent; programs; randomized trial; relating to nervous system; response; sedentary lifestyle; sex; therapy design; visual search; weight gain prevention; willingness to pay

ABSTRACT Prevention is key for combating obesity, but few programs have prevented future increases in BMI and onset of overweight/obesity, particularly during late adolescence when youth often assume responsibility for dietary intake and exercise choices. One exception is a brief 6-hr dissonance-based program (Project Health) wherein participants make small lasting incremental lifestyle changes to dietary intake and exercise to reach energy balance, and discuss costs of obesity, an unhealthy diet, and sedentary behavior, and benefits of leanness, a healthy diet, and exercise, which prompts them to align their attitudes with their publically displayed behavior. These activities promote internalization of health goals and executive control over lifestyle behaviors. Late adolescents randomized to Project Health showed less increases in BMI and a 41% and 43% reduction in overweight/obesity onset over 2-yr follow-up compared to a version of the program lacking dissonance- induction activities and an obesity education condition. Project Health appears to be the first program to produce these key obesity prevention effects relative to an alternative intervention, but it is critical to increase effects. A dissonance-based prevention program was more effective when implemented in single- versus mixed-sex groups, theoretically because it promoted greater participation in dissonance-inducing discussions. Aim 1a is to test whether the weight gain prevention effects will be larger when Project Health is implemented in single-sex groups; we will randomize 450 17-20 year olds to complete Project Health in female, male, or mixed-sex groups, assessing outcomes at pretest, posttest, and 6, 12, 24, and 36-month follow-ups. Aim 1b is to test whether greater participation in dissonance-inducing discussions and group cohesion mediate the effect of condition on any superior weight gain prevention effects. Adolescents who show greater fMRI-assessed reward and attention region responsivity to food images exhibit elevated future weight gain, implying that reducing this responsivity may reduce future weight gain. In a pilot trial, late adolescents who completed go/no- go, stop-signal, and respond-signal computer training in which they repeatedly inhibit responses to high-calorie foods and respond to low-calorie foods, and dot-probe and visual-search computer tasks that train attention away from high-calorie foods and to low-calorie foods, showed a greater reduction in reward and attention region responsivity to, palatability rating of, and willingness to pay for, high-calorie foods, suggesting reduced valuation and attentional bias, as well as greater fat loss over 1-yr follow-up versus controls who completed the training with non-food images. Aim 2a is to test whether adding food response and attention training to Project Health will produce larger weight gain prevention effects. Participants in the 3 conditions will be randomized to complete response and attention training for 25-mins after each of the 6-sessions with either food or non-food images. Aim 2b is to test whether reduced palatability ratings of, willingness to pay, and attentional bias for high-calorie foods mediate the effect of training condition on any superior weight gain prevention effects.

摘要 预防是对抗肥胖的关键，但很少有计划能阻止未来BMI和发病的增加 超重/肥胖，特别是在青春期后期，年轻人经常承担饮食责任 摄入量和运动选择。一个例外是一个简短的6小时不和谐计划(Project Health)，其中 参与者对饮食摄入量和锻炼做出微小的、持久的增量生活方式改变，以获得能量 平衡，并讨论肥胖的成本，不健康的饮食，久坐的行为，以及瘦的好处，a 健康的饮食和锻炼，这促使他们将自己的态度与他们公开展示的行为相一致。 这些活动促进了健康目标的内在化和对生活方式行为的行政控制。晚些 随机参加项目健康计划的青少年BMI增加较少，分别减少了41%和43% 超重/肥胖在两年内开始随访，与缺乏不和谐的计划版本相比- 诱导活动和肥胖教育条件。项目健康似乎是第一个 与替代干预措施相比，产生这些关键的肥胖预防效果，但关键是增加 效果。以不和谐为基础的预防计划在实施时更有效 混合性别群体，理论上是因为它促进了更多人参与导致不和谐的讨论。 目标1a是测试当实施健康计划时，预防体重增加的效果是否会更大 在单一性别组中，我们将随机选择450名17-20岁的青少年来完成女性、男性或 男女混合分组，在前测试、后测试以及6、12、24和36个月的随访中评估结果。目标1b是 为了测试更多地参与引起不和谐的讨论和团队凝聚力是否会调解这种效果 对任何优越的体重增加预防效果的条件。表现出更大功能磁共振成像的青少年-评估 对食物图像的奖赏和注意力区域响应度显示出未来体重增加的增加，这意味着 减少这种响应性可能会减少未来的体重增加。在一项试点试验中，完成了通过/不通过的晚年青少年 GO、停止信号和响应信号计算机训练，在这些训练中，他们反复抑制对高卡路里的反应 食物和对低卡路里食物的反应，以及训练注意力的点探测器和视觉搜索计算机任务 远离高卡路里食物，转向低卡路里食物，表现出奖励和注意力的更大减少 地区对高卡路里食物的响应度、适口性评级和支付意愿，表明减少了 评估和注意偏差，以及在1年内与完成调查的对照组相比更大的脂肪损失 用非食物形象进行培训。目标2a是测试是否将食物反应和注意力训练添加到项目 健康会产生较大的预防体重增加的效果。三种情况下的参与者将被随机分配到 完成反应和注意力训练，每次25分钟，包括食物和非食物 图像。目标2b是测试降低的可口性评级，支付意愿和注意力偏向 高卡路里食物会影响训练条件对预防体重增加的效果。