Modifying obesogenic homes: Impact on weight maintenance

描述(申请人提供)：近年来观察到的肥胖症流行在很大程度上可以归因于鼓励暴饮暴食和久坐不动的肥胖环境。行为体重控制治疗是经验性最强的干预方法，其初始体重下降10%；然而，维持初始体重下降和行为改变尚未实现。这些令人失望的长期结果可能反映了这样一个事实，即参与者只得到了关于如何改变他们的环境以支持他们新的体重调节行为的最少、间接的指导。虽然在理论上，行为模型强调饮食和锻炼的环境前因和后果，但在实践中，标准治疗中只有1到2个疗程致力于刺激控制类型的技能。通过在背景真空中教授体重控制技能，参与者仍然容易受到维持其不健康饮食和锻炼习惯的相同环境影响的影响。鉴于大多数饮食和锻炼是在家中进行的，加强行为治疗并迈向行为生态模式的一个合乎逻辑的步骤是将治疗重点从个人扩大到个人和他们的家庭环境。我们建议测试一个行为体重控制计划的长期影响，该计划旨在直接改变减肥参与者的身体和社会家庭环境。200名超重和肥胖的男性和女性将被随机分配到24个月的标准行为治疗(SBT)或24个月的标准行为治疗加直接改善家庭环境(SBT+Home)。SBT+Home将纳入许多在改善减肥方面显示出希望的策略(例如，提供食物和锻炼器材，配偶参与)，但将是第一个同时研究家庭内的身体和社会因素的策略，将是迄今为止对家庭环境进行的最长时间的检查。参与者和配偶将在基线、6个月、12个月、18个月和24个月时进行评估。我们假设，通过将治疗重点从个人扩大到个人和他们的家庭环境，SBT+Home将产生更好的长期减肥效果，并更好地维持最初的减肥和行为改变。这种家庭环境方法，如果成功，将有可能应用于维持其他重要的健康行为。

DESCRIPTION (provided by applicant): The obesity epidemic observed in recent years can be largely attributed to an obesogenic environment that encourages overeating and sedentary lifestyles. Behavioral weight control treatment, the most empirically validated intervention approach, produces initial weight losses of 10%; however, maintenance of initial weight loss and behavior change has not been achieved. These disappointing long-term results may reflect the fact that participants are given only minimal, indirect instruction on how to change their environment to support their new weight-regulating behaviors. While in theory, the behavioral model emphasizes environmental antecedents and consequences of eating and exercise, in practice, only 1 to 2 sessions in standard treatment are dedicated to stimulus control-types of skills. By teaching weight control skills in a contextual vacuum, participants remain vulnerable to the same environmental influences that maintained their unhealthy eating and exercise habits. Given that the majority of eating and exercise is home-based, a logical step in strengthening behavioral treatment and moving toward an ecological model of behavior is to expand the focus of treatment from the individual to the individual plus their home environment. We propose to test the long-term impact of a behavioral weight control program designed to directly modify both the physical and social home environment of weight loss participants. Two hundred overweight and obese men and women will be randomly assigned to either 24 months of standard behavioral treatment (SBT) or 24 months of standard behavioral treatment plus direct modifications to the home environment (SBT+Home). SBT+Home will incorporate many strategies that have shown promise in improving weight loss (e.g., food and exercise equipment provision, spouse involvement) but will be the first to study both physical and social factors within the home simultaneously and will be the longest examination of the home environment conducted to date. Participants and spouses will be assessed at baseline, 6, 12, 18, and 24 months. We hypothesize that by broadening the focus of treatment from the individual to the individual plus their home environment, SBT+Home will produce both better long-term weight loss and better maintenance of initial weight loss and behavior change. This home environmental approach, if successful, has potential applications to the maintenance of other important health behaviors.