Environmental Attributes and Weight Control: Study of Over 1.3 Million Veterans

环境属性和体重控制：对超过 130 万退伍军人的研究

• 批准号: 8737814
• 负责人: Elizabeth Tarlov
• 金额: $ 58.95万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-19 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8737814
• 关键词: Accounting; Address; Adult; Affect; American; Area; Behavioral; Blood Pressure; Body Weight; Body Weight decreased; Caring; Characteristics; Chronic; Clinical; Communities; Computerized Medical Record; Consensus; Control Groups; Controlled Study; Country; Cross-Sectional Studies; Data; Development; Diet; Eating; Effectiveness; Electronics; Enrollment; Environment; Environmental Impact; Esthetics; Etiology; Food; Glucose; Goals; Health; Health Food; Health Policy; Healthcare Systems; Healthy People 2020; Improve Access; Income; Individual; Intervention; Investments; Knowledge; Life Expectancy; Link; Lipids; Location; Measures; Medical; Metabolic; Modeling; Obesity; Outcome; Physical activity; Physical environment; Population; Price; Primary Health Care; Program Effectiveness; Public Health; Research; Research Personnel; Resources; Restaurants; Retrospective Studies; Risk; Sampling; Serum; Social Environment; Solutions; Source; Statistical Models; Supermarket; System; Taxes; Time; Veterans; Weight; Weight maintenance regimen; base; clinically significant; environmental intervention; fast food; fitness; fruits and vegetables; health administration; innovation; metropolitan; obesity treatment; programs; public health relevance; socioeconomics; sugar; sweetened beverage

DESCRIPTION (provided by applicant): Obesity contributes to the development of debilitating chronic health conditions in millions of Americans, underlies nearly 10 percent of all U.S. medical spending, and conservatively accounts for 30% of the gap in life expectancy between Americans and their counterparts in 13 other high-income countries. Despite tremendous investment in obesity treatment, little headway has been made. Of those who try, less than half succeed in losing a clinically significant amount of weight; few maintain weight loss; and adult obesity rates, currently 35.7% overall, have not declined. These disappointing outcomes challenge researchers and policymakers to consider how the residential environment can facilitate healthful eating and physical activity. Despite promising early research, there is no consensus about environmental contributors to body weight. To address this gap, the objective of the proposed study is to estimate the contributions of residential environment attributes (walkability, aesthetics, recreational places, healthy and unhealthy food availability, and prices for healthy and less healthy foods) to BMI and other diet-sensitive and physical activity-sensitive measures of metabolic risk (blood pressure, serum glucose, and lipids) among adults. Specific aims are: (1) Through a retrospective 10- year longitudinal nationwide study of over 1.3 million veterans, determine specific attributes of the residential environment that help individuals to maintain healthier BMI, BMI trajectory, and metabolic risk status; and (2) In over 200,000 veterans who participated in the MOVE! weight management program and a similar number of matched controls, determine the extent to which specific attributes of the residential environment help individuals lose weight at six months, maintain weight loss at 18 months, and achieve healthier BMI trajectory longer term (5 years). To achieve these aims, we will link data on veterans' health to public and proprietary data characterizing attributes of their residential environments and employ panel data statistical models that are robust to a broad class of potential sources of bias and reverse causality. We will use similar models with a matched control group derived through propensity score analysis to determine the moderating impact of environmental attributes on MOVE! program effectiveness. The proposed study is highly innovative because it draws on the largest sample and the broadest geographic coverage of any study to date. We will use unique electronic health data stores, information on precise residential location, and detailed and repeated measures of environmental attributes, allowing us to capture changes in the environment and residential location over time to examine effects on individuals' BMI and metabolic risk over periods up to 10 years, including determining whether environmental attributes moderate the effectiveness of a weight management intervention. This research is significant because it will provide the most robust evidence to date that is needed to formulate effective public health policies to eradicate obesity and because it has the potential to fundamentally transform weight management intervention approaches.

描述（由申请人提供）：肥胖导致数百万美国人罹患慢性健康问题，占美国所有医疗支出的近 10%，保守估计，肥胖导致美国人与其他 13 个高收入国家的预期寿命差距达 30%。尽管在肥胖治疗方面投入巨大，但进展甚微。在那些尝试的人中，只有不到一半的人成功减掉了具有临床意义的体重；很少有人坚持减肥；目前成人肥胖率总体为 35.7%，但并未下降。这些令人失望的结果要求研究人员和政策制定者考虑居住环境如何促进健康饮食和身体活动。尽管早期研究很有前景，但关于环境对体重的影响因素尚未达成共识。为了解决这一差距，本研究的目的是估计居住环境属性（步行性、美观、娱乐场所、健康和不健康食品的供应以及健康和不太健康食品的价格）对体重指数和其他饮食敏感和身体活动敏感的贡献 成人代谢风险（血压、血糖和血脂）的测量。具体目标是：（1）通过对全国超过130万名退伍军人进行为期10年的纵向回顾性研究，确定有助于个人保持更健康BMI、BMI轨迹和代谢风险状态的居住环境的具体属性； (2) 超过 200,000 名退伍军人参加了 MOVE！体重管理计划和类似数量的匹配对照，确定居住环境的特定属性在多大程度上帮助个人在 6 个月时减肥、在 18 个月时维持减肥以及在更长期（5 年）内实现更健康的 BMI 轨迹。为了实现这些目标，我们将把退伍军人健康数据与表征其居住环境属性的公共和专有数据联系起来，并采用对广泛的潜在偏差和反向因果关系来源稳健的面板数据统计模型。我们将使用类似的模型以及通过倾向得分分析得出的匹配对照组，以确定环境属性对 MOVE 的调节影响！计划的有效性。拟议的研究具有高度创新性，因为它利用了迄今为止所有研究中最大的样本和最广泛的地理覆盖范围。我们将使用独特的电子健康数据存储、精确居住位置信息以及对环境属性的详细和重复测量，使我们能够捕捉环境和居住位置随时间的变化，以检查长达 10 年的时间对个人体重指数和代谢风险的影响，包括确定环境属性是否会调节体重管理干预措施的有效性。这项研究意义重大，因为它将提供迄今为止最有力的证据 这是制定有效的公共卫生政策以消除肥胖所必需的，因为它有可能从根本上改变体重管理干预方法。