Adapting Episodic Future Thinking for Behavioral Weight Loss: Comparing Strategies and Characterizing Treatment Response

适应行为减肥​​的情景未来思维：比较策略和描述治疗反应

• 批准号: 10490406
• 负责人: KATHRYN E DEMOS
• 金额: $ 59.2万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-23 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10490406
• 关键词: Adherence; Aftercare; Age; Attention; Behavior; Behavioral; Body Image; Body Weight Changes; Body Weight decreased; Characteristics; Cognitive; Coupled; Data; Decision Making; Diet; Exercise; Exhibits; Feedback; Female; Food; Functional Magnetic Resonance Imaging; Future; Gender; Goals; Health; Health behavior; Individual; Individual Differences; Intake; Internet; Lead; Literature; Measurement; Measures; Mediating; Mental Depression; Modeling; Morbidity - disease rate; Obesity; Outcome; Overweight; Participant; Pattern; Physical activity; Predictive Factor; Prevention; Process; Public Health; Randomized; Randomized Controlled Trials; Research; Rewards; Self-control as a personality trait; Testing; Thinking; Training; Training Programs; Treatment Protocols; United States; Weight; Weight maintenance regimen; Work; adverse outcome; base; behavioral economics; craving; demographics; discount; experience; follow-up; imaging study; improved; individualized medicine; insight; intervention effect; male; mortality; neuroregulation; novel; novel strategies; obesity treatment; personalized medicine; pilot trial; pleasure; prevent; primary outcome; programs; response; standard care; success; theories; treatment response; treatment strategy; weight loss intervention; weight loss program

Project Summary/Abstract Obesity is one of the most important public health issues today, contributing to many of the leading causes of morbidity and mortality in the United States. Despite strong desires to achieve long-term weight loss goals, individuals with obesity tend to overvalue immediate rewards and discount the future. Episodic Future Thinking (EFT), a cognitive strategy in which individuals envision themselves in the future and simulate potential experiences, has been shown to help shift attention to the future, improve food choices, and reduce intake. Most previous studies have used promotion-focused EFT, in which participants envision themselves experiencing positive future outcomes. However, theories suggest it is possible EFT-based strategies may be alternatively focused on prevention, guiding participants to consider future consequences of unhealthy choices. Our recent pilot (R03 DK106405) randomized controlled trial implemented these approaches in a 3-month Internet-delivered behavioral weight loss program (iBWL). Participants (n=95) were randomized to either: (1) Standard iBWL (no EFT-based strategies), (2) PREVENT (iBWL + EFT-based strategies focused on preventing long-term negative consequences of unhealthy choices), or (3) PROMOTE (iBWL + EFT-based strategies focused on promoting long-term benefits of healthy choices). PREVENT was superior to standard iBWL producing the greatest overall weight loss, which was coupled with reduced food reward drive and increased self-control. This is consistent with our previous work in which use of the PREVENT strategy was associated with reduced craving and increased inhibitory control neural activity. Although PREVENT produced the greatest weight loss, variability suggests individual differences may moderate success in each treatment. For instance, individuals high in promotion-focus were more likely to have greater weight loss in PROMOTE. We now propose a fully powered randomized controlled trial (RCT) to test if either of these novel approaches may provide benefit over standard treatment. Further, the proposed study will seek to identify moderators that predict success, determining for whom each strategy is best. Individuals with overweight/obesity (n=360) will be randomized to 12 months of either (1) Standard iBWL, (2) PREVENT, or (3) PROMOTE. All participants will have an introductory training session, during which PREVENT and PROMOTE groups will receive training in their specific EFT-based strategy. iBWL lessons will then be weekly for 3 months followed by a ‘refresher’ training session for all groups, and monthly iBWL for the remaining 9 months. In PREVENT and PROMOTE iBWL lessons and feedback messages will continuously feature exercises and reminders to utilize the assigned EFT-based strategies. Assessments will be conducted at baseline, during treatment at 3 and 6 months, at the end of treatment (12 months), and 6 months post-treatment (18 months). The primary outcome is weight change. This RCT will provide critical insight into novel treatment strategies for improving weight loss and may lead to future optimization of weight loss via individually tailored treatment.

项目总结/摘要 肥胖是当今最重要的公共卫生问题之一，导致了许多主要原因 美国的发病率和死亡率。尽管强烈的愿望，以实现长期的减肥目标， 肥胖者往往高估眼前的回报，而低估未来。未来的思考 (EFT)，一种认知策略，其中个人设想自己的未来，并模拟潜力 经验，已被证明有助于将注意力转移到未来，改善食物选择，减少摄入量。 大多数以前的研究都使用了以促进为中心的EFT，参与者在其中想象自己 体验积极的未来成果。然而，理论表明，基于EFT的策略可能是 另一个重点是预防，引导参与者考虑不健康选择的未来后果。 我们最近的试点（R 03 DK 106405）随机对照试验在3个月内实施了这些方法， 网络行为减肥计划（iBWL）参与者（n=95）被随机分为：（1） 标准iBWL（无基于EFT的策略），（2）预防（iBWL +基于EFT的策略，侧重于 预防不健康选择的长期负面后果），或（3）促进（基于iBWL + EFT 战略侧重于促进健康选择的长期效益）。PREVENT上级优于标准 iBWL产生最大的整体体重减轻，这与减少的食物奖励驱动相结合， 加强自我控制。这与我们以前的工作是一致的，在我们以前的工作中， 与减少的渴望和增加的抑制控制神经活动有关。虽然预防生产 最大的体重减轻，变异性表明个体差异可能会影响每种治疗的成功率。 例如，高度关注晋升的人更有可能在PROMOTE中减肥。 我们现在提出一项完全有效的随机对照试验（RCT），以测试这些新的 方法可能比标准治疗更有益。此外，拟议的研究将寻求确定 预测成功的主持人，决定每个策略对谁来说是最好的。人士 超重/肥胖患者（n=360）将随机接受12个月的（1）标准iBWL、（2）预防或（3） 促进。所有参与者都将参加一个介绍性培训课程，在此期间， 这些团体将接受基于EFT的特定策略的培训。iBWL课程将每周进行一次，为期3个月 随后为所有组进行“复习”培训，并在剩余的9个月内每月进行一次iBWL。在 预防和促进iBWL课程和反馈信息将不断特色练习， 提醒使用分配的基于EFT的策略。评估将在基线、 治疗3个月和6个月、治疗结束时（12个月）和治疗后6个月（18个月）。 主要结果是体重变化。这项随机对照试验将为新的治疗策略提供重要的见解， 改善体重减轻，并可能导致未来通过个体定制的治疗来优化体重减轻。