Enhancing Weight Loss with Financial Incentives in Teens with Severe Obesity

摘要 严重肥胖是儿童肥胖症中增长最快的一类，据报道， 美国的不幸的是，传统的治疗方法很少导致足够的体重减轻， 严重肥胖的青少年;因此，迫切需要创新和有效的战略。的 经济激励模型已成功用于成人肥胖试验，以解决次优的依从性， 生活方式改变疗法和改善减肥结果。虽然还没有被调查的重量 在青少年中，经济激励措施已被证明可以改善许多与健康有关的问题。 青少年的行为。由于儿童严重肥胖症的难治性， 如果与结构化饮食计划（如膳食替代疗法）配合使用， （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疗效。 严重肥胖青少年的体重减轻;然而，参与者最初减轻的体重在4小时后恢复。 几个月，由于随着时间的推移，对膳食替代方案的坚持程度降低。我们的理念是 利用膳食替代疗法和经济激励的协同作用来优化减肥， 改善严重肥胖青少年的心脏代谢危险因素和血管健康。这项研究将提供一个 这是一个独特的机会，可以解决另一个关键的悬而未决的问题，与治疗小儿严重 肥胖：需要减重多少才能引起心脏代谢风险的临床有意义的改善 因素和血管健康？虽然已经为成年人建立了基于证据的基准，但没有这样的基准。 已经确定了严重肥胖青年的临界值。因此，我们计划进行为期12个月的 随机对照临床试验，以评估膳食替代疗法加经济激励的效果 在142名重度肥胖青少年中进行体重减轻和心脏代谢/血管结局的研究， 确定达到具有临床意义的心脏代谢/血管所需的体重减轻阈值 这一患者群体的改善。这项研究针对一个重大的公共卫生问题，将利用一个 创新的治疗概念和方法，并将产生新的知识，以指导治疗的选择 类型和强化，最终对儿童肥胖领域产生强大而持续的影响。

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.