Evaluation of an Adaptive Intervention for Weight Loss Maintenance

减肥维持适应性干预措施的评估

• 批准号: 9760044
• 负责人: KATHRYN MARIE ROSS
• 金额: $ 64.29万
• 依托单位: UNIVERSITY OF FLORIDA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9760044
• 关键词: Adherence; Adult; Algorithms; Behavior; Behavior monitoring; Behavioral; Body Weight decreased; Caring; Cellular Phone; Chronic Disease; Clinical; Data; Data Set; Development; Diet; Diet Monitoring; Dietary intake; Eating; Ecological momentary assessment; Effectiveness; Evaluation; Feeling; Foundations; Frequencies; Frustration; Future; Goals; Gold; Guidelines; Hunger; Individual; Intervention; Lead; Life; Literature; Long-Term Care; Maintenance; Mediator of activation protein; Methods; Mission; Mobile Health Application; Modeling; Monitor; National Institute of Diabetes and Digestive and Kidney Diseases; Obesity; Outcome; Overweight; Participant; Patient Self-Report; Persons; Physical activity; Prevalence; Public Health; Randomized; Randomized Controlled Trials; Research; Schedule; Shame; Telephone; Testing; Time; Treatment Protocols; United States; Vision; Weight; Weight maintenance regimen; Work; adaptive intervention; base; behavior change; clinically significant; cost; evidence base; experience; health goals; high risk; improved; individual variation; innovation; knowledge base; lifestyle intervention; novel; prediction algorithm; preempt; prevent; programs; smartphone Application; success; therapy development; treatment response; weight loss intervention; weight maintenance

PROJECT SUMMARY Obesity remains a substantial public health challenge in the United States. Behavioral weight management programs have demonstrated effectiveness for weight loss, but long-term maintenance of these weight losses after the end of treatment tends to be poor. Evidence has demonstrated that individuals who can maintain their changes in eating and activity can successfully maintain their weight loss; thus, attempts to improve weight loss maintenance have often involved provision of continued support through monthly “extended-care” intervention sessions. While these interventions have demonstrated significant improvements in weight loss maintenance, effects have been modest. A key challenge is continued participant engagement (often assessed as attendance at intervention sessions). Attendance has been closely tied to weight outcomes, but rates tend to be poor and decline over time. The once-per-month, static treatment schedules of existing programs may contribute to these suboptimal outcomes; a participant experiencing a small lapse in weight-related behaviors may not receive support for several weeks, by which point they may be experiencing a larger lapse or weight regain. This can lead to feelings of frustration, shame, or embarrassment and disengagement from intervention. In contrast, tailoring intervention delivery such that sessions are provided when individuals are at “high risk” for weight regain offers potential to disrupt this cycle and significantly improve program engagement, adherence to program goals, and long-term weight maintenance outcomes. We propose to evaluate an innovative method of providing phone-based extended-care adaptive to participant needs. We have built a smartphone application that can be used by participants to track weight, dietary intake, and physical activity (key self-monitoring behaviors in traditional behavioral weight management programs) and can further query participants throughout the week regarding self-report factors (e.g., ratings of hunger and the importance of staying on track with weight management goals) that indicate high risk for weight regain. We have also developed a predictive algorithm that uses this data to identify when individuals are at “high risk” of weight regain. We propose to conduct a randomized controlled trial evaluating the impact of ADAPTIVE (delivered only when indicated by our algorithm or when initiated by participants via an in-app support request) versus STATIC (the monthly, pre-scheduled format used in existing extended-care programs) treatment provision on weight regain at 24 Months in 258 adults who successfully lose ≥ 5% of initial weight during a gold-standard 16-week behavioral weight management program. Results of this study have clear treatment implications for the timing/frequency of sessions within extended-care weight maintenance programs, and this study will result in an innovative, low-cost, and easily scalable intervention for weight loss maintenance. Further, the proposed research will fill a critical gap in the weight management literature by building a foundational evidence base of proximal predictors of weight-related behaviors for future adaptive intervention development.

项目总结 在美国，肥胖仍然是一个巨大的公共卫生挑战。行为体重管理 减肥计划已经证明了减肥的有效性，但这些减肥的长期维持 治疗结束后往往较差。有证据表明，那些能够维持他们的 饮食和活动的改变可以成功地保持他们的体重减轻；因此，尝试着增加体重 损失维护通常涉及通过每月“延长护理”提供持续支持 干预会议。虽然这些干预措施在减肥方面取得了显著的改善 在维护方面，影响一直不大。一个关键挑战是持续的参与者参与度(通常进行评估 作为参加干预会议)。上座率与体重结果密切相关，但出勤率往往 一贫如洗，日积月累。现有方案的每月一次的静态治疗时间表可以 导致这些不太理想的结果；参与者在与体重相关的行为中经历了小小的失误 可能在几周内得不到支持，到那时他们可能会经历更大的失误或体重 重获新生。这可能会导致挫败感、羞耻感或尴尬和脱离 干预。相比之下，定制干预交付，以便在个人处于 体重恢复的“高风险”可能会扰乱这一循环，并显著提高项目参与度。 坚持计划目标和长期体重维持结果。我们建议评估一个 提供适应参与者需求的基于电话的扩展护理的创新方法。我们已经建立了一个 参与者可以使用智能手机应用程序来跟踪体重、饮食摄入量和体力活动 (传统行为权重管理程序中的关键自我监控行为)，并可以进一步查询 整个星期的参与者都在讨论自我报告因素(例如，对饥饿的评级和对 与体重管理目标保持一致)，这表明体重回升的风险很高。我们还有 开发了一种预测性算法，使用这些数据来识别个人何时处于体重高危状态 重获新生。我们建议进行一项随机对照试验，评估自适应(交付)的影响 仅当我们的算法指示或参与者通过应用内支持请求发起时)与 静态(现有延长护理计划中使用的每月、预先计划的格式)治疗规定 258名成功减掉≥初始体重5%的成年人在24个月后体重恢复 为期16周的行为体重管理计划。这项研究的结果具有明确的治疗意义 延长护理体重维持计划中的会话时间/频率，这项研究将得出结论 这是一种创新、低成本且易于扩展的减肥维护干预方案。此外，建议的 研究将通过建立一个基本的证据基础来填补体重管理文献中的一个关键空白 体重相关行为的近端预测因子，用于未来适应性干预的发展。