An innovative, physical activity-focused approach to weight loss maintenance

描述(申请人提供)：肥胖与许多健康问题有因果关系。最先进的肥胖行为干预措施在短期内可靠地促进了临床上显著的体重减轻，但体重回升(以及回到疾病风险升高是正常的。必须开发和测试改善生活方式改变的长期结果的创新干预措施。新的证据表明，高水平的体力活动(PA)是减肥维持的关键组成部分(并且有许多与体重无关的辅助健康益处)。大多数服用高水平PA的成年人(无论是作为体重管理计划的一部分还是其他干预措施)最终都没有遵守这些处方，这表明传统的行为技能和干预策略不足以应对这种关键的、长期的行为变化的挑战。理论和实证研究强烈表明，对于肥胖成年人来说，要想成功地持续保持高水平的PA，他们必须使用特定的心理技能，包括谨慎的决策，面对挑战时的行为承诺，容忍身体和心理不适的能力，以及明确个人价值观的能力。这些技能是以接受为基础的PA推广行为干预的重点。为了测试这种方法的有效性，这项研究将从社区招募300名成年人，并为他们提供为期6个月的基于群体的标准行为减肥治疗(第一阶段)。在第二阶段，参与者将接受三种干预措施之一，为期12个月：1)行为治疗，标准重点是保持饮食和PA(BT)的变化；2)行为治疗，主要强调使用这些技能维持PA(BT-PA)；或3)基于接受的行为治疗，主要强调使用这些技能保持PA(ABT-PA)。PA的处方将在不同条件下统一。将鼓励所有参与者逐步达到并随后维持将导致2000千卡/周能量消耗的PA量。评估将在基线、6个月(第一阶段治疗结束)、18个月(第二阶段治疗结束)、24个月(6个月随访)和36个月(18个月随访)进行。在最初的体重减轻(即BT-PA和ABT-PA)后，对PA的密集关注被假设为a)更好的减肥维持，以及b)与标准行为治疗(BT)相比，在治疗后和后续治疗中PA的量更高。与教授标准行为技能(BT-PA)相比，在最初减肥后对PA的密集关注也被假设为a)更好的减肥维持和b)在治疗后和后续教授基于接受的行为技能时(即ABT-PA)更多的PA。理论驱动的中介和干预效果的调节也将被考察。实现这些目标将推动健康相关行为变化的研究，并有可能对许多肥胖相关疾病和条件的行为预防和治疗产生有意义的影响。

DESCRIPTION (provided by applicant): Obesity is causally linked with numerous health problems. State-of-the-art behavioral interventions for obesity reliably facilitate clinically significant weight loss in the short-term, but weight regain (and a return to elevated disease risk is normative. Innovative interventions that improve long-term outcomes of lifestyle modification must be developed and tested. New evidence suggests that a high level of physical activity (PA) is a critical component of weight loss maintenance (and has numerous ancillary health benefits, independent of weight). Most adults who are prescribed high levels of PA (whether as part of a weight management program or other intervention) do not ultimately adhere to these prescriptions, suggesting that traditional behavioral skills and intervention strategies are not sufficiently matched to the challenges of this critical, long-term behavior change. Theoretical and empirical work strongly suggest that for obese adults to be successful at consistently engaging in high levels of PA they must employ specific psychological skills, including mindful decision-making, behavioral commitment in the face of challenges, an ability to tolerate physical and psychological discomfort, and an ability to achieve clarity about one's personal values. These skills are the focus of acceptance-based behavioral interventions for PA promotion. To test the effectiveness of this approach, this study will recruit 300 adults from the community and provide them with 6 months of group-based standard behavioral weight loss treatment (Phase I). In Phase II, participants will receive one of three interventions, to be delivered for an additional 12 months: 1) behavioral treatment, with the standard emphasis on maintaining changes in diet and PA (BT), 2) behavioral treatment, with a primary emphasis on using these skills to maintain PA (BT-PA), or 3) acceptance-based behavioral treatment, with a primary emphasis on using these skills to maintain PA (ABT- PA). The PA prescription will be uniform across conditions. All participants will be encouraged to gradually progress to and subsequently maintain an amount of PA that will result in 2000 kcal/wk of energy expenditure. Assessments will be conducted at baseline, 6 months (end of Phase I treatment), 18 months (end of Phase II treatment), 24 months (6-month follow-up), and 36 months (18-month follow-up). An intensive focus on PA after initial weight loss (i.e., BT-PA and ABT-PA) is hypothesized to result in a) better weight loss maintenance, and b) higher amounts of PA at post-treatment and follow-up compared to standard behavioral treatment (BT). An intensive focus on PA after initial weight loss is also hypothesized to result in a) better weight loss maintenance and b) higher amounts of PA at post-treatment and follow-up when acceptance-based behavioral skills are taught (i.e., ABT-PA), compared to when standard behavioral skills are taught (BT-PA). Theory- driven mediators and moderators of intervention effects also will be examined. Accomplishing these aims will advance research on health-related behavior change and has the potential to meaningfully impact the behavioral prevention and treatment of many obesity-related diseases and conditions.