Maintenance After Initiation of Nutrition TrAINing (MAINTAIN)

描述（由申请人提供）： 肥胖是美国可预防死亡的第二大原因，与多种疾病有关。在肥胖人群中，减肥可以改善血压、血脂异常、关节炎和关节炎症状;减少几种疾病过程的药物使用;增加身体功能;并提高与健康相关的生活质量。尽管有这些好处，但大多数体重减轻的患者在一年内又恢复了大部分体重，并且很少有有效的行为体重维持干预措施。因此，迫切需要有效的干预措施，可以促进减肥的维持。理论和实证研究表明，行为维持是一个独特的状态，涉及不同的心理过程和行为技能比初始行为改变。少数测试减肥维持干预措施的试验没有考虑到这种区别，这可能部分解释了他们的温和结果。目前的研究将评估理论上知情的维持干预。如果有效的话，这种干预可以减少未来诊所就诊治疗肥胖及其许多相关疾病的需求，并可以作为重新设计MOVE的模型！程序.这项为期3.5年的研究涉及一项双臂随机对照试验。在导入阶段，330名年龄为75岁、BMI为30 kg/m2的退伍军人将参加为期4个月的强化组减肥计划。在4个月结束时至少减轻4 kg的受试者（n~230）将随机接受（a）常规护理（n~115）14个月或（B）理论上知情的维持干预（n~115）10个月，随后4个月无干预接触，以检查可持续性。维持性干预将包括面对面的小组访问，然后过渡到个性化的电话访问，与干预者接触的频率将随着时间的推移逐渐减少。将在随机化时和随机化后3、6、10和14个月评估结局。我们的假设是，维持干预将导致至少3.5公斤以上的体重减轻和更大的改善热量摄入和体力活动在研究期间，它将是具有成本效益的，与常规护理相比。

DESCRIPTION (provided by applicant): Obesity is the second leading cause of preventable deaths in the United States and is associated with a wide range of diseases. In people who are obese, weight loss improves blood pressure, dyslipidemia, glycemia, and arthritis symptoms; reduces medication use for several disease processes; increases physical functioning; and enhances health-related quality of life. Despite these benefits, most patients who achieve weight loss regain much of this weight within a year, and few effective behavioral weight maintenance interventions have been identified. Thus, there is a dire need for effective interventions that can promote weight loss maintenance. Theoretical and empirical studies indicate that behavior maintenance is a distinct state that involves different psychological processes and behavioral skills than initial behavior change. The few trials that have tested weight loss maintenance interventions have not taken this distinction into account, which may partially explain their modest findings. The current study will evaluate a theoretically informed maintenance intervention. If effective, this intervention could reduce the need for future clinic visits to treat obesity and its many associated illnesses and could serve as a model for redesigning the MOVE! program. This 3.5-year study involves a two-arm randomized, controlled trial. During the run-in phase, 330 veterans aged d 75 with BMI e30 kg/m2 will participate in a 4-month, intensive, group-based weight loss program. Participants who lose at least 4 kg by the end of 4 months (n~230) will be randomized to receive (a) usual care (n~115) for 14 months or (b) a theoretically-informed maintenance intervention (n~115) for 10 months, followed by 4 months of no intervention contact to examine sustainability. The maintenance intervention will involve in-person group visits that transition to individualized telephone calls, and the frequency of contact with the interventionist will gradually taper over time. Outcomes will be assessed at the time of randomization and at 3, 6, 10, and 14 months post-randomization. Our hypotheses are that the maintenance intervention will result in at least 3.5 kg greater weight loss and greater improvements in caloric intake and physical activity over the study period, and that it will be cost-effective, compared to usual care.