Effectiveness Trial of a Dissonance-Based Obesity Prevention Program

描述（由申请人提供）：很少有肥胖预防计划在随访期间降低了体重增加的风险，并且那些计划非常密集（M持续时间= 52小时），使得传播困难且昂贵。一个简短的3小时选择性预防计划（健康体重），涉及参与者驱动的健康饮食和体育活动的生活方式的变化显着减少增加BMI和肥胖的发病相对于替代干预措施和评估-只有控制通过3年的随访。它针对的是对身体不满意的年轻人，因为这是肥胖的普遍风险因素，这些人有动力改变健康的生活方式。为了提高疗效，我们增加了旨在诱导不健康饮食和活动习惯不和谐的活动，借鉴了一个非常有效的基于不和谐的饮食失调预防计划。社会心理学实验表明，人们努力保持思想、言语和行动之间的一致性。因此，我们增加了口头，书面和行为练习，其中青年讨论肥胖的成本，不健康的饮食，久坐不动的行为，瘦的好处，健康的饮食，体育活动，以及导致肥胖的机构。参与这些活动可以增加参与者寻求将自己的行动与会议中表达的观点保持一致的可能性，从而带来更健康的未来生活方式选择。一项试点试验发现，相对于健康体重干预和教育手册条件，这种新的项目健康干预从治疗前到治疗后显著降低了BMI的增加（d分别为0.40和0.42），与最有效的强化预防计划的效果大小相比，效果更好。此外，其他肥胖预防计划的效果并没有明显优于可靠的替代干预措施。我们建议进行一项严格的多地点有效性试验，以测试在最初有效的健康体重干预措施中加入不和谐诱导元素是否会提高体重增加的预防效果：300名因对身体不满而有未来不健康体重增加风险的大学生将被纳入研究。 随机分配到一个完善的8小时失调为基础的项目健康干预或8小时健康体重干预，完成评估的身体脂肪和其他结果在前，后，和6，12，24个月的后续行动。目标1将测试项目健康是否减少相对于健康体重的体脂百分比增加;次要结果是抑郁和饮食失调症状。目标2将测试健康项目参与者是否报告了关于吃不健康食物和从事久坐行为的认知失调，以及失调的变化，以及报告的饮食摄入量和客观测量的活动水平，是否介导了干预对体脂%变化的影响。目标3将调查可能放大（预测身体不满，对一致性的偏好）或减轻（情绪化饮食，物质使用）干预效果的潜在调节因素。我们将通过使用长期随访、主动控制条件和直接测量身体成分和活动来改善大多数肥胖预防试验。 公共卫生相关性：一个简单有效的肥胖预防计划，可以很容易和廉价地传播，可以大大降低肥胖的发病率，这是至关重要的，因为肥胖是普遍的，导致显着的发病率和死亡率，是治疗抵抗。该项目基于严格的预防试验和高效的基于失调的饮食失调预防计划的有希望的初步数据，将是第一个使用社会心理学的说服原则预防肥胖的翻译项目。

DESCRIPTION (provided by applicant): Few obesity prevention programs have reduced risk for weight gain over follow-up and those that have are very intensive (M duration = 52 hrs.), making dissemination difficult and costly. A brief 3-hr selective prevention program (Healthy Weight) involving participant-driven healthy dietary and physical activity lifestyle changes significantly reduced increases in BMI and obesity onset relative to alternative interventions and assessment- only controls through 3-yr follow-up. It targets young adults with body dissatisfaction as this is a prevalent risk factor for obesity and such individuals are motivated t make healthy lifestyle changes. To enhance efficacy, we added activities designed to induce dissonance regarding unhealthy dietary and activity practices, drawing from a highly efficacious dissonance-based eating disorder prevention program. Social psychology experiments show that people strive to maintain consistency between thoughts, words, and actions. Thus, we added verbal, written, and behavioral exercises wherein youth discuss costs of obesity, an unhealthy diet, and sedentary behaviors, benefits of leanness, a healthy diet, and physical activity, and institutions that contribute to obesity. Engaging in these activities putatively increases the likelihood that participants will seek to align their actions with the perspectives expressed in the sessions, resulting in healthier future lifestyle choices. A pilot trial found tha this new Project Health intervention significantly reduced increases in BMI relative to both the Healthy Weight intervention and an educational brochure condition from pre to post (d = .40 and .42 respectively), comparing favorably to effect sizes from the most efficacious intensive prevention programs. Further, other obesity prevention programs have not significantly outperformed credible alternative interventions. We propose to conduct a rigorous multisite effectiveness trial that will test whether adding the dissonance-induction elements to the originally efficacious Healthy Weight intervention improves weight gain prevention effects: 300 college students at risk for future unhealthy weight gain by virtue of body dissatisfaction will be randomized to a refined 8-hr dissonance-based Project Health intervention or an 8-hr Healthy Weight intervention, completing assessments of body fat and other outcomes at pre, post, and 6, 12, and 24 month follow-ups. Aim 1 will test whether Project Health reduces increases in % body fat relative to Healthy Weight; secondary outcomes are depressive and eating disorder symptoms. Aim 2 will test whether Project Health participants report cognitive dissonance regarding eating unhealthy foods and engaging in sedentary behaviors and whether changes in dissonance, as well as reported dietary intake and objectively measured activity level, mediate the effects of the intervention on change in % body fat. Aim 3 will investigate potential moderators that may amplify (pretest body dissatisfaction, preference for consistency) or mitigate (emotional eating, substance use) intervention effects. We will improve upon most obesity prevention trials by using a long-term follow-up, an active control condition, and direct measures of body composition and activity. PUBLIC HEALTH RELEVANCE: A brief effective obesity prevention program that can be easily and inexpensively disseminated could substantially reduce the incidence of obesity, which is vital because obesity is prevalent, causes marked morbidity and mortality, and is treatment resistant. The proposed project, which is based on promising preliminary data from rigorous prevention trials and a highly efficacious dissonance-based eating disorder prevention program, would be the first translational project to use persuasion principles from social psychology for obesity prevention.