Reducing Obesity Using Social Ties (ROBUST)

黑人和西班牙裔成年人不成比例地患有肥胖症和与肥胖有关的疾病（例如， 西班牙裔/白色比例：糖尿病（1.7）与他们的白色同行相比。行为减肥（WL） 干预措施是治疗肥胖症的第一线，但结果好坏参半。大多数人都无法坚持 影响，特别是在特定的种族/族裔亚组。例如，黑人女性的体重比黑人女性少50%。 白色人，即使是在充分的权力，精心设计的行为WL试验登记。一个貌似有理 这些次优结果的原因是只关注个人层面的行为变化，而忽视了 关键的社会和环境力量。社交网络越来越多地被证明对健康有影响 行为，但它们很少被利用在针对减肥的研究中，特别是在种族/民族之间 少数群体响应PAS-20 - 160针对使命内疾病的临床试验小型R01 该应用程序将比较社交网络增强的生活方式干预的效果（以下简称 称为"ROBUST"使用社会关系减少肥胖）到个体水平的生活方式干预（对照）， 改变减肥的多个网络级障碍。我们将随机招募132名黑人或西班牙裔成年人， 肥胖（BMI> 30 kg/m2），并邀请ROBUST组参与者的两名社交网络成员 24周的多功能生活方式干预我们将评估稳健的干预是否 仅解决个体级行为（即，健康饮食，增加体力活动），但也：1）减少 社会破坏以及通过激活社区应对改变感知的健康规范-一种行为 一个涉及思考、沟通和行动的过程，就像一个健康风险（即，2型糖尿病）共享; 2）通过教参与者如何减少人际冲突对体重的有害影响， 诱导积极的情感和自我肯定的心态，我们已经在以前的试验（NHLBI-U01HL07843）中显示 防止不必要的体重增加对照组的参与者将接受相同数量的生活方式会议 与随机分配至ROBUST组的受试者相同。但是，他们的社交网络不会直接参与这项研究。我们 假设ROBUST干预将满足招募的所有先验可行性/可接受性标准， 保留和研究实施。此外，稳健的干预措施将导致多个领域的积极变化。 行为改变的障碍，导致更大比例的参与者经历了改善 与对照组相比，24周时饮食、体力活动和体重减轻。如果证明有效， 从这个小的RO 1收集的初步数据将支持一个完全有效的RCT， 影响关键临床终点的多水平肥胖干预（即，BMI、胰岛素抵抗和 血红蛋白A1c）在与肥胖及其代谢后遗症相关的不良结局风险极高的人群中的作用。

Black and Hispanic adults suffer disproportionately from obesity and obesity-related conditions (e.g., Hispanic/White ratio: diabetes (1.7) compared to their white counterparts. While behavioral weight loss (WL) interventions are the first line in treating obesity, they have mixed outcomes. Most fail to make a persistent impact, especially in specific racial/ethnic subgroups. For example, Black women lose 50% less weight than their white counterparts, even when enrolled in fully powered, well-designed behavioral WL trials. One plausible reason for these sub-optimal results is a focus on behavior change at the individual level alone while neglecting critical social and environmental forces. Social networks have been increasingly shown to influence health behaviors, yet they have seldom been harnessed in studies targeting weight loss, especially among racial/ethnic minorities. In response to PAS-20-160 Small R01s for Clinical Trials Targeting Diseases within the Mission of NIDDK, this application will compare the effects of a social-network enhanced lifestyle intervention (hereafter termed "ROBUST" Reducing OBesity Using Social Ties) to an individual level lifestyle intervention (control) on modifying multiple network-level barriers to weight loss. We will randomly enroll 132 Black or Hispanic adults with obesity (BMI > 30 kg/m2) and invite up to two social network members of participants in the ROBUST arm to a 24 –week multi-competent lifestyle intervention. We will evaluate whether the ROBUST intervention not only addresses individual-level behaviors (i.e., healthy eating, increased physical activity) but also: 1) reduces social undermining as well as changes perceived health norms by activating communal coping - a behavioral process that involves thinking, communicating, and acting as if a health risk (i.e., Type 2 diabetes) is shared; and 2) dampens the harmful effects of increased interpersonal conflict on weight by teaching participants how to induce a positive affect and self-affirming mindset which we have shown in a previous trial (NHLBI-U01HL07843) prevents unwanted weight gain. Participants in the control arm will receive the same number of lifestyle sessions as those randomized to ROBUST. But, their social network will not be directly engaged in the study. We hypothesize that the ROBUST intervention will satisfy all a priori feasibility/acceptability criteria for recruitment, retention, and study conduct. Additionally, the ROBUST intervention will result in positive changes in multiple barriers to behavior change, leading to a more significant proportion of participants experiencing improvements in diet, physical activity, and weight loss at 24 weeks compared to the control group. If proven effective, the preliminary data gathered from this small RO1 will support a fully powered RCT that will result in an optimized multi-level obesity intervention that impacts critical clinical endpoints (i.e., BMI, insulin resistance, and hemoglobin A1c) in a population at very high risk of poor outcomes related to obesity and its metabolic sequelae.