Addressing Weight Bias Internalization to Improve Adolescent Weight Management Outcomes

项目总结/摘要 体重偏见内化（WBI），或自我导向的基于体重的耻辱，与许多 对肥胖青少年的身心健康产生负面影响，包括负体重， 相关结果（例如，卡路里消耗增加，减肥效果较差）。患病率和 WBI作为影响青少年体重相关结局的压力源的显著性与异质性配对 对青少年肥胖干预的反应突出了联合干预的潜在效用， WBI和青少年肥胖症，以促进在这一关键发展时期改善体重管理结果 期这个K23奖项旨在填补我在培训中的空白，并支持一项研究， 改善肥胖青少年健康的措施。研究项目的第一阶段将采用 焦点小组和一个开放的试点试验，以开发和测试综合干预的可行性， 治疗WBI与基于证据的青少年行为体重控制（BWC）。然后我将进行一次 小型随机对照试验，以测试新设计的WBI+BWC干预措施对WBI的影响和体重- 柱头应激诱导体重增加，特别是应激（昼夜皮质醇）和炎症的生理标志物 （c-反应蛋白，白细胞介素-6）和饮食行为失调（情绪化饮食，失控，不健康 体重控制行为）。我假设，《生物武器公约》与对《世界生物多样性公约》的干预相结合， 在体重污名应激诱导体重增加的机制中，反过来又促进了体重减轻结果的改善。 该研究项目对改善青少年BWC和减少BWC的发生具有重要的临床意义。 体重歧视对青少年的负面影响。进行这项研究，填补关键空白， 我所接受的培训将有助于我成为一名专注于肥胖行为治疗的独立调查员 在青少年时期，我会完成一个严格的、有针对性的训练计划。拟议的培训计划包括 发展以下方面的专门知识：（1）开展随机对照试验，以制定和检验《生物武器公约》对青少年的干预措施;（2）理论 基于体重的污名和WBI的概念模型; 3）在临床试验中整合机制， 生物标志物和饮食行为失调;和4）专业发展。将培训以文件形式进行 在Elissa Jelalian博士的主要指导下进行，与Rebecca Puhl博士，Stephanie博士共同指导 Parade，Andrea Goldschmidt和撰稿人大卫巴克博士。我将获得的技能直接映射到 建议的研究项目，并提供必要的知识和专业知识，以准备一个成功的R 01 在奖励期结束前申请。导师团队，结合严谨的学术和 由米里亚姆医院体重控制和糖尿病研究中心提供的训练环境， 布朗大学是实现这些培训和研究目标的理想环境。通过这个 职业发展奖，我将建立自己作为一个独立的调查员，致力于发展 新的干预措施来改善肥胖青少年的健康状况。

PROJECT SUMMARY/ABSTRACT Weight bias internalization (WBI), or self-directed weight-based stigma, has been associated with a number of negative physical and mental health consequences for adolescents with obesity, including negative weight- related outcomes (e.g., increased calorie consumption, poorer weight loss outcomes). The prevalence and salience of WBI as a stressor impacting weight-related outcomes in adolescents paired with the heterogeneous response to interventions for adolescents with obesity highlights the potential utility of combined intervention for WBI and obesity in youth to promote improved weight management outcomes during this critical developmental period. This K23 award is designed to fill gaps in my training and support a research study that will provide next steps in improving the health of adolescents with obesity. The first phase of the research project will employ focus groups and an open pilot trial to develop and test feasibility of an integrated intervention that combines treatment for WBI with an evidence-based adolescent behavioral weight control (BWC). I will then conduct a small RCT to test the effects of the newly designed WBI+BWC intervention on WBI and mechanisms of weight- stigma stress induced weight gain, specifically physiological markers of stress (diurnal cortisol) and inflammation (c-reactive protein, interleukin-6), and dysregulated eating behaviors (emotional eating, loss of control, unhealthy weight control behaviors). I hypothesize that BWC combined with intervention for WBI, will lead to improvements in mechanisms of weight-stigma stress induced weight gain, in turn promoting improved weight loss outcomes. This research project has significant clinical implications for the improvement of adolescent BWC and reduction of the negative effects of weight-based stigma in adolescents. To conduct this research and fill critical gaps in my training that will facilitate becoming an independent investigator focused on behavioral treatment of obesity in adolescents, I will complete a rigorous, targeted training program. The proposed training plan includes developing expertise in 1) conducting RCTs to develop and test BWC interventions for adolescents; 2) theoretical and conceptual models of weight-based stigma and WBI; 3) integration of mechanisms in clinical trials focused on biological markers and dysregulated eating behaviors; and 4) professional development. This training will be conducted under the primary mentorship of Dr. Elissa Jelalian, with co-mentors Drs. Rebecca Puhl, Stephanie Parade, Andrea Goldschmidt, and contributor Dr. David Barker. The skills I will acquire map directly onto the proposed research project and provide the knowledge and expertise necessary to prepare a successful R01 application by the end of the award period. The mentorship team, in combination with the rigorous academic and training environment provided by the Weight Control and Diabetes Research Center at The Miriam Hospital and Brown University, represent an ideal environment to accomplish these training and research goals. Through this Career Development Award, I will establish myself as an independent investigator dedicated to the development of novel interventions to improve health outcomes for adolescents with obesity.