Metabolic and Immunologic Effects of Meditation

描述(申请人提供)：肥胖是一种流行病，是我们最严重的公共卫生问题之一。肥胖对健康的许多不利影响与中心性(腹部和上躯干)肥胖的关系比与外周肥胖的关系更强。中心性肥胖与代谢综合征的其他组成部分密切相关：胆固醇升高、高血压和胰岛素抵抗。不利的压力荷尔蒙模式似乎有利于中枢脂肪沉积。此外，不利的压力反应可能会导致饮食模式导致肥胖。这个项目的总体目标是测试一种基于冥想的干预措施，这种干预可以改变压力荷尔蒙模式，当添加到饮食和锻炼计划中时，是否可以改善脂肪分布，增强减肥和保持减肥的能力。我们开发了一种干预方法，将正念冥想练习应用于肥胖和代谢综合征、渴望和通过正念改变生活方式(CALMM)。这项干预利用了基于正念的压力缓解和基于正念的饮食意识训练。CALMM的目标是减少不良压力反应，提高对饥饿暗示的敏感度，并养成正念的饮食习惯。初步数据表明，CALMM支持逐步减肥，改善应激皮质醇反应，并减少腹部脂肪。CALMM的饮食部分旨在适度减少卡路里(通常为每天500大卡)，并侧重于有助于减少卡路里的健康饮食选择。CALMM的锻炼部分侧重于适度锻炼，主要是通过增加日常步行以及有计划的锻炼时间。CALMM的饮食和运动部分都包含了正念，例如正念的步行运动和正念的饮食。我们还开发了一个名为Diet-Ex的程序，它使用CALMM的饮食和锻炼成分，而不是将正念练习整合到饮食和锻炼中。在这个项目中，200名参与者将按1：1的比例随机分配到CALMM或Diet-Ex。小组将每周开会16次，然后在为期4个月的维护阶段每月开会。我们将在18个月的时间里比较每种干预措施在减肥和维持体重、脂肪分布、胰岛素敏感性以及感觉到的压力和情绪方面的效果。我们假设CALMM组将在脂肪分布方面取得更大的改善，并在18个月内保持最大的体重减轻。这项研究的结果将提供重要的新信息，即旨在减少不良应激反应和提高对饮食行为的认识的心身干预是否有助于治疗肥胖和改变代谢综合征的特征。

DESCRIPTION (provided by applicant): Obesity is epidemic and is one of our most serious public health problems. Many of obesity's unfavorable health effects are more strongly related to central (abdominal and upper trunk) adiposity than to peripheral adiposity. Central adiposity is closely linked to other components of metabolic syndrome: increased cholesterol, hypertension, and insulin resistance. Adverse stress hormone patterns appear to favor central fat deposition. In addition, adverse stress responses may drive eating patterns that lead to obesity. The overall goal of this project is to test whether a meditation based intervention that can shift stress hormone patterns, when added to a diet and exercise program, improves fat distribution and enhances weight loss and maintenance of weight loss. We have developed an intervention that applies mindfulness meditation practices to obesity and metabolic syndrome, Craving and Lifestyle Modification through Mindfulness (CALMM). The intervention draws on Mindfulness Based Stress Reduction and Mindfulness Based Eating Awareness Training. CALMM aims to decrease adverse stress responses, improve sensitivity to hunger satiety cues, and develop mindful eating practices. Initial data suggests that CALMM supports gradual weight loss, improvements in stress cortisol responses, and decreased abdominal fat. The diet component of CALMM+ aims for a modest calorie reduction (typically 500 Kcal/day) and focuses on healthy diet choices that facilitate caloric reduction. The exercise component of CALMM+ focuses on moderate exercise, primarily through increased daily walking as well as through structured exercise time. Both the diet and exercise components of CALMM+ incorporate mindfulness, e.g. mindful walking exercise and mindful eating. We have also developed a program, Diet-Ex, that uses the diet and exercise components from CALMM+, without the integration of mindfulness practices into diet and exercise. In this project, 200 participants will be randomized in a 1:1 ratio to CALMM+ or Diet-Ex. Groups will meet for 16 weekly sessions, then monthly during a 4 month maintenance phase. We will compare the effects of each intervention on weight loss and its maintenance, fat distribution, insulin sensitivity, and perceived stress and mood over an 18 month period. We hypothesize that the CALMM+ group will achieve greater improvements in fat distribution and maintain the most weight loss over 18 months. The results of the study will provide important new information about whether a mind-body intervention targeted to reduce adverse stress reactions and improve awareness of eating behaviors is useful in treating obesity and altering features of the metabolic syndrome.