Test of a theory-based weight loss program for couples: Project TEAMS

描述(申请人提供)：肥胖在家庭中流行--配偶以相似的体重状况进入婚姻，随着时间的推移一起增加体重，并为他们的孩子示范肥胖行为。许多能量平衡的决定都是在家里做出的，这种重要的社交/人际环境既可以帮助也可以阻碍体重管理。肥胖症的生态模型认识到家庭和更大的环境背景对体重的影响，然而，现有的治疗模型仍然以个体为重点。通过将治疗的重点从个人扩大到婚姻双方，针对联合行为的改变，以及创造一个支持长期行为改变的人际环境，减肥结果可能会得到改善。根据自我决定理论，当个人在生活中有重要的其他人提供一个支持个人有意义的选择并最大限度地减少批评和控制的环境时，可以观察到更大的自主行为自我调节和随后更好的治疗结果。之前的研究，包括我们自己正在进行的工作表明，来自重要他人的自主性支持的增加与自主减肥自我调节的增加有关，而且自主自我调节的这些变化确实与减肥结果有关。需要更多的研究来建立因果联系，开发和测试旨在促进家庭环境中重要他人的自主性支持行为的干预措施。这种基于理论的方法具有巨大的潜力，可以增加已发表的文献中关于配偶参与减肥治疗的适度影响。这项拟议的研究是一项随机对照试验，旨在测试一对夫妇基于自我决定理论的干预，旨在通过训练配偶为彼此的饮食和体育活动行为改变提供自主支持，来改变减肥的社会背景。64对夫妇将被随机分为基于SDT-WL(SDT-WL)的6个月治疗或基于行为理论(BWL)的6个月治疗。夫妇将参加为期6个月的每周会议，并在0、6和12个月时接受评估。我们预测，通过加强自主支持，SDT-WL将增加自主自我调节和感知能力，并将产生比标准行为治疗更大的体重减轻和维持。这项研究关注的是夫妻，而不是个人，有理论基础，关注自主支持，并将其与其他类型的支持区分开来，并直接培训伴侣此类支持行为。如果成功，我们将寻求资金，在一项更大规模的试验中测试SDT方法，并进行更长的跟踪期。

DESCRIPTION (provided by applicant): Obesity runs in families - spouses enter marriage with similar weight statuses, gain weight together over time and model obesogenic behaviors for their children. Many energy balance decisions are made in the home and this important social/interpersonal environment can either help or hinder weight management. Ecological models of obesity recognize the impact of the home and larger environment contexts on weight, however, existing treatment models remain individual-focused. Weight loss outcomes might be improved by expanding the focus of treatment from the individual to the marital dyad, targeting joint behavior change and the creation of an interpersonal milieu that supports long-term behavior change. According to Self Determination Theory, greater autonomous self-regulation of behaviors and subsequently better treatment outcomes are observed when individuals have important others in their lives who provide an environment in which personally meaningful choice is supported and criticism and control are minimized. Previous research including our own ongoing work suggests that increases in autonomy support from important others are associated with increases in autonomous self-regulation for weight loss and that these changes in autonomous self-regulation are indeed associated with weight loss outcomes. Additional research is needed to establish causal links and to develop and test interventions designed to facilitate the autonomy supportive behavior of significant others in the home environment. This theoretically based approach has tremendous potential to add to the modest effects found in the published literature on the involvement of spouses in weight loss treatment. The proposed study is a randomized controlled trial testing a couple's intervention based on Self Determination Theory that is designed to change the social context of weight loss by training spouses to provide autonomy support for each other's eating and physical activity behavior change. Sixty-four couples will be randomized to either 6 months of treatment based on SDT (SDT-WL) or to 6 months of treatment based on behavioral theory (BWL). Couples will attend weekly sessions for 6 months and will be assessed at 0, 6, and 12 months. We predict that by bolstering autonomy support, SDT-WL will increase autonomous self-regulation and perceived competence and will produce greater weight loss and maintenance than standard behavioral treatment. The study focuses on couples rather than individuals, is theoretically based, focusing on autonomy support and distinguishing this from other types of support, and directly trains partners in such supportive behaviors. If successful, we will seek funding to test the SDT approach in a larger trial with a longer follow-up period.