Environmental and Acceptance-Based Innovations for Weight Loss Maintenance

维持减肥的环境和基于可接受性的创新

• 批准号: 8331551
• 负责人: Meghan Butryn
• 金额: $ 59.48万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8331551
• 关键词: Address; Adherence; Aftercare; Awareness; Behavior; Behavior Therapy; Behavioral; Biological Factors; Body Weight decreased; Communities; Cues; Decision Making; Devices; Diet; Dietary intake; Distress; Eating; Economics; Educational process of instructing; Effectiveness; Energy Metabolism; Environment; Environmental Risk Factor; Epidemic; Equipment; Event; Exercise; Feeling; Food; Goals; Gold; Health; Health behavior; Home environment; Impaired health; Individual; Intervention; Life Style; Maintenance; Mediation; Mediator of activation protein; Medical; Methods; Modification; Nature; Nutritional; Obesity; Outcome; Overweight; Participant; Physical activity; Psychological reinforcement; Quality of life; Randomized; Recommendation; Recruitment Activity; Restaurants; Rewards; Testing; Theoretical model; Training; Treatment outcome; Weight; Weight maintenance regimen; base; behavior change; deprivation; design; distress tolerance; environmental change; ethnic minority population; follow-up; food craving; improved; innovation; mindfulness; obesity treatment; programs; psychologic; psychosocial; sedentary; sex; skills; social; weight maintenance

DESCRIPTION (provided by applicant): Environmental and Acceptance-Based Innovations for Weight Loss Maintenance Obesity is a serious and prevalent health problem with widespread medical, psychosocial and economic consequences. Although behavior therapy (BT) is the gold standard among non-surgical approaches, weight regain usually begins shortly after treatment ends; nearly all of weight lost in these programs is regained by 5 years after treatment. Several factors appear to make weight loss maintenance challenging including the obesogenic food environment, the rewarding value of food, and labor-saving devices and a built environment that reduce energy expenditure. One promising way of improving BT programs is to teach participants how to modify their personal food and physical activity environment so that it provides maximal support for desirable weight control behaviors. Intervention components can include modifying the type, nutritional composition, variety, and portion size of food available at home; modifying the availability of exercise equipment and sedentary activities in the home; increasing the saliency of the consequences of eating and exercise choices; and obtaining support for environmental changes. A second innovative way of improving BT programs is to incorporate components of Acceptance and Commitment Therapy (ACT) in order to (a) bolster participants' commitment to behavior change, (b) build distress tolerance skills, and (c) promote mindful awareness of weight-related behaviors and goals. Such skills should improve long-term adherence to dietary and physical activity recommendations (and therefore weight loss maintenance). We expect that there will be a synergy and a complementary nature between these treatment components and the environmental treatment components. Maintaining a home environment that facilitates weight control requires commitment, distress tolerance, and awareness, because individuals must make decisions about environmental modifications and maintain these modifications. Additionally, there are limits to the home environment approach because individuals will continue to encounter many challenging situations in which they cannot modify the environment to any meaningful extent; acceptance-based skills may promote healthy choices in such challenging situations. As a test of the combined approach, participants will be randomly assigned to one of three conditions: 1)BT, 2) BT plus modifying the home environment (BT+E), or 3) BT plus modifying the home environment and training in acceptance-based skills (BT+EA). Treatment will last 1 year. Participants will be 297 overweight and obese individuals recruited from the community. Thirty percent of participants will be ethnic minorities. Assessments will be completed at baseline and Months 6, 12 (end of treatment), 18 (i.e., 6-month follow-up), and 24 (i.e., 12- month follow-up). The primary aim of the study is to test the hypothesis that participants in the BT+EA condition will maintain more weight loss than those in the BT condition at 12-month follow-up. Secondary aims will compare weight loss in BT+EA vs. BT+E, and BT+E vs. BT, and examine dietary intake and physical activity as outcomes. Exploratory aims will examine mediation and moderation of treatment outcome.

描述（由申请人提供）：环境和接受为基础的创新减肥维持肥胖是一个严重和普遍的健康问题，广泛的医疗，心理和经济后果。虽然行为疗法（BT）是非手术方法中的黄金标准，但体重恢复通常在治疗结束后不久开始;几乎所有在这些计划中失去的体重在治疗后5年内都会恢复。有几个因素似乎使减肥维持具有挑战性，包括致肥胖的食物环境，食物的奖励价值，节省劳动力的设备和减少能量消耗的建筑环境。改善BT计划的一个有希望的方法是教参与者如何改变他们的个人食物和体育活动环境，以便为理想的体重控制行为提供最大的支持。干预的组成部分可以包括修改类型，营养成分，品种，以及在家里可用的食物的部分大小;修改运动设备和久坐活动在家里的可用性;增加饮食和运动选择的后果的显着性;并获得支持环境变化。改进BT计划的第二种创新方法是纳入接受和承诺疗法（ACT）的组成部分，以便（a）支持参与者对行为改变的承诺，（B）建立痛苦容忍技能，以及（c）促进对体重相关行为和目标的意识。这些技能应该有助于长期坚持饮食和身体活动建议（从而维持减肥）。我们预期这些处理部分与环境处理部分之间会有协同作用和互补性。保持一个有利于体重控制的家庭环境需要承诺，痛苦容忍度和意识，因为个人必须做出关于环境改变的决定并保持这些改变。此外，家庭环境方法也有局限性，因为个人将继续遇到许多挑战性的情况，他们无法在任何有意义的程度上改变环境;基于接受的技能可能会在这种挑战性的情况下促进健康的选择。作为综合方法的测试，参与者将被随机分配到三个条件之一：1）BT，2）BT+修改家庭环境（BT+E），或3）BT+修改家庭环境和接受基于技能的培训（BT+EA）。治疗将持续1年。参与者将是从社区招募的297名超重和肥胖者。30%的参与者将是少数民族。将在基线和第6、12（治疗结束）、18（即，6-月随访），和24（即，12-月随访）。该研究的主要目的是检验以下假设：在12个月随访时，BT+EA条件下的参与者将比BT条件下的参与者保持更多的体重减轻。次要目的将比较BT+EA与BT+E以及BT+E与BT的体重减轻，并检查饮食摄入和体力活动作为结果。探索性目标将检查治疗结果的调解和适度。