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

一种以身体活动为重点的创新维持减肥方法

• 批准号: 8759928
• 负责人: Meghan Butryn
• 金额: $ 60.55万
• 依托单位: DREXEL UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-01 至 2019-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8759928
• 关键词: Address; Adherence; Adult; Aftercare; Behavior Therapy; Behavioral; Body Weight decreased; Communities; Decision Making; Diet; Eating Behavior; Educational process of instructing; Effectiveness; Energy Metabolism; Epidemic; Exercise; Health; Health Benefit; Impaired health; Individual; Intervention; Link; Maintenance; Mediating; Mediator of activation protein; Motivation; Obesity; Obesity associated disease; Outcome; Participant; Phase; Physical activity; Prevention; Quality of life; Recruitment Activity; Research; Testing; Time; Weight; Weight maintenance regimen; Work; base; behavior change; clinically significant; design; disorder risk; distress tolerance; disturbance in affect; follow-up; group intervention; improved; innovation; intervention effect; novel; programs; psychologic; public health relevance; skills; theories

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.

描述（由申请人提供）：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显著的体重减轻，但体重反弹（以及疾病风险升高的回归）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）是维持减肥的关键组成部分（并且具有许多辅助健康益处，与体重无关）。大多数服用高水平PA的成年人（无论是作为体重管理计划还是其他干预措施的一部分）最终都没有坚持这些处方，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行为改变的挑战。理论和实证研究强烈表明，对于肥胖的成年人来说，要成功地持续进行高水平的PA，他们必须采用特定的心理技能，包括谨慎的决策，面对挑战的行为承诺，容忍身体和心理不适的能力，以及实现个人价值的清晰度的能力。这些技能是以接受为基础的行为干预促进PA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个月的基于团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，标准重点是维持饮食和PA（BT）的变化，2）行为治疗，主要重点是使用这些技能来维持PA（BT-PA），或3）基于接受的行为治疗，主要强调使用这些技能来维持PA（ABT- PA）。PA处方将在所有条件下统一。将鼓励所有参与者逐渐进展到并随后维持一定量的PA，这将导致2000千卡/周的能量消耗。将在基线、6个月（I期治疗结束）、18个月（II期治疗结束）、24个月（6个月随访）和36个月（18个月随访）时进行评估。在最初的体重减轻后（即，BT-PA和ABT-PA）被假设导致a）更好的体重减轻维持，和B）与标准行为治疗（BT）相比，在治疗后和随访时更高量的PA。还假设在初始体重减轻后对PA的集中关注导致a）更好的体重减轻维持和B）当教导基于接受的行为技能时，治疗后和随访时PA的量更高（即，ABT-PA），与教授标准行为技能（BT-PA）相比。理论驱动的中介者和干预效果的主持人也将被检查。实现这些目标将推进对健康相关行为改变的研究，并有可能对许多肥胖相关疾病和病症的行为预防和治疗产生有意义的影响。