SELF EFFICACY, METABOLISM AND WEIGHT LOSS IN OLDER WOMEN

近27%的美国女性患有肥胖症。其流行率的增加 随着年龄的增长和绝经与糖尿病的风险增加有关， 高脂血症、高血压、心血管疾病（CVD）和其他 这些疾病每年给国家造成400多亿美元的损失。肥胖是 行为和代谢疾病，因此体重减轻（WL） 干预措施必须对心理行为和生物 流程.这项肥胖研究的前提是， 绝经后妇女的疗效信念和脂肪组织代谢， 与WL及其维护有关。假设是：1）多- 针对不同自我效能需求的多方面干预将更多地 有效地改变认知，情绪和行为，以减少食物 摄入，增加每日总能量消耗，促进WL和 适应于脂质、葡萄糖、脂肪组织代谢较平时护理; 和2）心理行为以及代谢适应WL及其 自我效能导向的WL和复发预防治疗将是 保持减肥的状态。90例肥胖（BMI 27 - 40 kg/m2），健康，不吸烟，50 - 60岁绝经后妇女， 药物（特别是雌激素）已知影响肥胖，新陈代谢或 行为将被研究。确定自我效能感的影响 有针对性的干预措施，妇女将按种族和自我效能分层 类型（确信者和不信者），并随机接受靶向治疗 （心理行为、饮食和低强度运动）或常规护理。到 确定WL及其维持是否需要心理行为 和代谢适应，妇女接受自我效能导向的WL， 复发预防治疗（每次持续6个月）或常规护理 同样的时间。研究设计允许：l）横断面分析 心理行为状态、能量平衡和代谢功能; 2） 自我行为和代谢效应的纵向测定 疗效靶向WL和复发预防治疗;以及3） 确定所需的心理行为和代谢适应， WL及其维护。这项临床研究的重点是健康 促进，疾病预防和个性化的病人护理，使护士 特别适合与跨学科团队合作， 提供关注个人信仰和内在的WL干预措施 肥胖绝经后妇女的需求。

Obesity occurs in nearly 27% of American women. Its increase in prevalence with age and menopause is associated with an increased risk of diabetes, hyperlipidemia, hypertension, cardiovascular disease (CVD) and other illnesses that cost the nation more than $40 billion annually. Obesity is both a behavioral and a metabolic disease, hence weight loss (WL) interventions must impact on both psychobehavioral and biological processes. This obesity research is based on the premise that the self efficacy beliefs and adipose tissue metabolism of postmenopausal women are linked to WL and its maintenance. The hypotheses are that: l) multi- faceted interventions that target distinct self efficacy needs will more effectively modify cognitions, emotions, and behavior to diminish food intake, increase total daily energy expenditure, and promote WL and adaptations in lipid, glucose, adipose tissue metabolism than usual care; and 2) psychobehavioral as well as metabolic adaptations to WL and its self efficacy directed WL and relapse prevention treatments will be necessary to maintain the weight-reduced state. Ninety obese (BMI 27-40 kg/m2), healthy, non-smoking, 50-60 year old postmenopausal women not on medications (esp. estrogen) known to affect obesity, metabolism or behavior will be studied. To determine the effects of self efficacy targeted interventions, women will be stratified by race and self efficacy type (Assureds and Disbelievers) and randomized to targeted treatments (psychobehavior, diet and low intensity exercise) or usual care. To determine whether WL and its maintenance requires both psychobehavioral and metabolic adaptations, women receive self efficacy directed WL and relapse prevention treatments (each lasting six months) or usual care of the same duration. The study design permits: l) cross-sectional analysis of psychobehavioral status, energy balance and metabolic function; 2) longitudinal determination of the behavioral and metabolic effects of self efficacy targeted WL and relapse prevention treatments; and 3) identification of psychobehavioral and metabolic adaptations required for WL and its maintenance. The emphasis of this clinical research on health promotion, disease prevention and individualized patient care makes nurses particularly well-suited to collaborate on interdisciplinary teams that deliver WL interventions focused on the personal beliefs and intrinsic needs of obese postmenopausal women.