Enhancing Weight Loss with Financial Incentives in Teens with Severe Obesity

通过经济激励促进严重肥胖青少年的减肥

• 批准号: 9308599
• 负责人: Aaron S Kelly
• 金额: $ 68.64万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-04-15 至 2022-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9308599
• 关键词: 17 year old; Accelerometer; Address; Adherence; Adolescent; Adult; Age; Behavior; Behavior Therapy; Benchmarking; Blood Pressure; Blood Vessels; Body Weight decreased; Body fat; Body mass index; Categories; Childhood; Clinical; Comorbidity; Data; Databases; Diet; Disease; Freezing; HDL-triglyceride; HIV Infections; Health; Health behavior change; Inflammation; Insulin-Dependent Diabetes Mellitus; Intervention; Knowledge; Laboratories; Liquid substance; Methods; Modeling; Morbid Obesity; Nature; Non-Insulin-Dependent Diabetes Mellitus; Obesity; Outcome; Overweight; Oxidative Stress; Participant; Patients; Physical activity; Prevalence; Public Health; Randomized Controlled Clinical Trials; Refractory; Regimen; Replacement Therapy; Reporting; Risk; Risk Factors; Schools; Selection for Treatments; Structure; Targeted Research; Teenagers; Testing; Time; United States; Weight; Withdrawal; Youth; arterial stiffness; behavior change; cardiometabolic risk; cardiovascular risk factor; clinical practice; conventional therapy; evidence base; financial incentive; improved; innovation; intimal medial thickening; obesity in children; patient population; pediatrician; post intervention; smoking cessation; synergism; treatment adherence; vascular abnormality; weight loss intervention

Abstract Severe obesity is the fastest growing category of pediatric obesity, with a reported prevalence near 6% in the United States. Unfortunately, conventional treatment approaches rarely result in sufficient weight loss in adolescents with severe obesity; therefore, innovative and effective strategies are desperately needed. The financial incentive model has been used successfully in adult obesity trials to address suboptimal adherence to lifestyle modification therapy and improves weight loss outcomes. Although yet to be investigated as a weight loss intervention among adolescents, financial incentives have been shown to improve many health-related behaviors in teenagers. Owing to the refractory nature of pediatric severe obesity, financial incentives are more likely to be effective if used in concert with a structured dietary plan such as meal replacement therapy (liquid shakes and frozen entrées). In a recent trial, meal replacement therapy produced promising short-term weight loss in adolescents with severe obesity; however, initial weight lost by participants was regained after 4 months, owing to diminished adherence to the meal replacement regimen over time. Our concept is to capitalize on the synergy of meal replacement therapy and financial incentives to optimize weight loss and improve cardiometabolic risk factors and vascular health in teens with severe obesity. This study will afford a unique opportunity to address another key unanswered question related to the treatment of pediatric severe obesity: how much weight loss is necessary to elicit clinically-meaningful improvements in cardiometabolic risk factors and vascular health? Although evidence-based benchmarks have been established for adults, no such thresholds have been identified for youth with severe obesity. Therefore, we plan to conduct a 12-month randomized, controlled clinical trial to evaluate the effects of meal replacement therapy plus financial incentives on weight loss and cardiometabolic/vascular outcomes among 142 adolescents with severe obesity and to identify thresholds of weight loss required to achieve clinically-meaningful cardiometabolic/vascular improvements in this patient population. This research targets a significant public health problem, will utilize an innovative treatment concept and approach, and will generate new knowledge to guide selection of treatment type and intensification, ultimately exerting a powerful and sustained influence on the field of pediatric obesity.

抽象的 重度肥胖是儿童肥胖中增长最快的类别，据报告在儿童肥胖中的患病率接近 6% 美国。不幸的是，传统的治疗方法很少能有效减轻体重 严重肥胖的青少年；因此，迫切需要创新和有效的战略。这 经济激励模型已成功用于成人肥胖试验，以解决不理想的依从性问题 生活方式改变疗法并改善减肥效果。虽然作为权重还有待研究 对青少年的失落干预和经济激励已被证明可以改善许多与健康相关的问题 青少年的行为。由于儿童严重肥胖症的难治性，财政激励措施是 如果与膳食替代疗法等结构化饮食计划配合使用，则更有可能有效 （液体奶昔和冷冻主菜）。在最近的一项试验中，膳食替代疗法产生了有希望的短期效果 严重肥胖青少年的体重减轻；然而，参与者最初减掉的体重在 4 年后又恢复了。 几个月，由于随着时间的推移，对代餐方案的依从性降低。我们的理念是 利用代餐疗法和经济激励的协同作用来优化减肥和 改善严重肥胖青少年的心脏代谢危险因素和血管健康。这项研究将提供 这是解决与儿科重症患者治疗相关的另一个关键未解答问题的独特机会 肥胖：需要减轻多少体重才能引起具有临床意义的心脏代谢风险改善 因素和血管健康？尽管已经为成年人建立了基于证据的基准，但还没有这样的基准 已经确定了严重肥胖青少年的阈值。因此，我们计划进行为期12个月的 评估膳食替代疗法加经济激励效果的随机对照临床试验 142 名严重肥胖青少年的体重减轻和心脏代谢/血管结果 确定实现具有临床意义的心脏代谢/血管所需的体重减轻阈值 该患者群体的改善。这项研究针对一个重大的公共卫生问题，将利用 创新的治疗理念和方法，将产生新的知识来指导治疗选择 类型和强化，最终对儿童肥胖领域产生强大而持续的影响。