Novel interventions to reduce stress induced non-homeostatic eating

描述（由申请人提供）： 该应用程序汇集了加州大学旧金山分校肥胖评估、研究和治疗中心 (COAST) 的强大跨学科科学家团队与 Kaiser-Permanente 的研究人员，以测试基于生理学的新颖干预措施，通过可口食物的压力和奖励影响饮食行为和腹部脂肪沉积。这种类型的饮食通常是非稳态的（不满足热量赤字）。我们计划通过在怀孕前为肥胖低收入女性量身定制的概念验证和干预策略来减少此类摄入量，怀孕前是干预的关键时期，可能会影响妊娠期体重增加、产后体重保留和后代体重。我们的转化方法借鉴了饮食和行为改变的心理学，以及压力、食欲和奖励的神经科学，来测试调节奖励和压力反应系统是否可以减少腹部肥胖和体重。在第一阶段和第二阶段，我们将开发和比较两种针对饮食、活动和压力但具有不同概念基础的不同干预措施：(1)：发展技能训练 (DST)，旨在通过促进情绪和饮食行为的自我调节来抑制成瘾。 (2);正念与饮食（MIND）旨在通过正念和正念饮食来减轻压力并提高对饥饿-饱足线索和自动饮食模式的认识。每项干预措施的初步数据都充满希望。我们还将测试内源性阿片类药物张力的间接测量，这可能有助于深入了解减肥机制。试点研究表明，对纳曲酮“阿片类药物探针”的反应与非稳态饮食指数相关，并可预测体重减轻。我们将测试这种阿片类药物探针的实用性，以确定它在治疗过程中是否发生变化，并预测饮食和腹部脂肪的变化。在第二阶段，我们将随机抽取 80 名打算怀孕的肥胖女性进行为期 3 个月的 DST 和 MIND 概念验证试验，以比较对拟议机制（压力、阿片类药物张力）的相对影响和可行性。在第 3 阶段，我们将完善并测试最成功干预措施的功效，然后将 120 名孕前肥胖女性随机分配到选定的干预措施或主动控制条件（仅饮食和运动）中。这些努力将产生有希望的干预策略，以遏制育龄妇女的肥胖。所有阶段都将听取科学顾问小组和数据安全与监测委员会的意见。实现该提案的目标将扩大目前对导致持续体重减轻的机制的理解，并将为肥胖干预替代策略的进一步研究提供信息。相关性：拟议的研究基于压力如何影响食物的奖励价值并促进强迫性饮食的科学，开发了新的肥胖干预措施。我们将测试有希望的干预措施，针对打算怀孕的女性，这将导致新的预防计划，比目前的计划更有效地维持持续减肥。该计划可以通过改善孕产妇健康产生广泛的公共卫生影响，并可能造福下一代。 （摘要完）

DESCRIPTION (provided by applicant): This application brings together a strong interdisciplinary team of scientists at the UCSF Center for Obesity Assessment, Study and Treatment (COAST) with researchers at Kaiser-Permanente to test novel interventions based on the physiology by which stress and reward from palatable food influence eating behaviors and abdominal fat deposition. This type of eating is typically non-homeostatic (not meeting caloric deficit). We plan to reduce this type of intake through proof-of-concept and intervention strategies tailored for obese lower income women prior to pregnancy, a critical period for intervention, which may affect gestational weight gain, postpartum weight retention, and offspring weight. Our translational approach draws from the psychology of eating and behavior change, and neuroscience of stress, appetite and reward, to test whether modulating the reward and stress response systems reduces abdominal obesity and weight. In Phase 1 & 2, we will develop and compare two distinct interventions that target diet, activity, and stress but with different conceptual bases: (1): Developmental Skills Training (DST) designed to curb addictions through promoting self-regulation of emotions and eating behavior. (2); Mindfulness and Diet (MIND) aimed to reduce stress and improve awareness of hunger-satiety cues and automatic eating patterns through mindfulness and mindful eating. Preliminary data on each intervention are promising. We will also test an indirect measure of endogenous opioid tone that may provide insight into mechanisms of weight loss. Pilot research has shown that response to a naltrexone "opioid probe" is linked to indices of non-homeostatic eating and predicts weight loss. We will test the utility of this opioid probe to determine if it changes during treatment and predicts change in eating and abdominal fat. In Phase 2, we will randomize 80 obese women intending to become pregnant to a 3 month proof-of-concept trial of DST and MIND, to compare relative effects on proposed mechanisms (stress, opioid tone), and feasibility. In Phase 3, we will refine and test the efficacy of the most successful intervention then randomize 120 pre-pregnant obese women to the selected intervention or active control condition (diet and exercise alone). These efforts will produce promising intervention strategies for curbing obesity in women during their reproductive years. All phases will be informed by input from a Scientific Advisory panel and Data Safety and Monitoring Board. Accomplishing the aims of this proposal will expand current understanding of the mechanisms that lead to sustained weight reduction, and will inform further study of alternative strategies for obesity intervention. RELEVANCE: The proposed research develops new obesity interventions based on the science of how stress influences the rewarding value of food, and promotes compulsive eating. We will test promising interventions, with women intending to become pregnant that will result in a new prevention programs that are more effective for sustained weight loss maintenance than what is currently available. This program could have a broad public health impact by improving maternal heath and potentially benefiting the next generation. (End of Abstract)