Novel Approaches to Weight Loss Maintenance

描述(由申请者提供)：减肥维持是肥胖治疗的一个关键挑战。延长治疗时间和制定关键行为(例如，体力活动、自我监测)可以改善维护。治疗研究已经纳入了这些策略；然而，最密集的治疗通常发生在减肥开始期间，而维持阶段发生在治疗新颖性消失之后。增加持续时间可以改善体重减轻，但随着人们最终停止参加治疗，回报也会减少。招募最近通过专门针对维护的干预措施减肥的人可能是一个可行的选择。针对维修的干预措施的一个关键问题是确定最佳的交付时间。一种方法建议通过向人们传授所需的关键行为并帮助他们进行这些行为来加强维护。按照这种方法，维护计划将被设计成像减肥计划一样，其中针对相关行为的会议将按照预先设定的时间表进行。另一种方法认识到，维持不可避免地包括体重恢复的时期，如果个人使用认知和行为策略来逆转微小的体重增加，这一阶段将得到加强。按照这种方法，干预接触将以“及时”的方式进行，以响应体重趋势。我们试点研究的数据表明，通过整合这两种互补的方法，并包括核心内容、持续支持和量身定制的反馈，可以最大限度地提高有效性。我们建议评估这一创新方法在最近减肥的成年人中促进长期维持的有效性。400名最近体重下降至少5%的成年人将被招募并随机分配到：1)简短的干预对照组，在此期间，参与者将收到两次针对关键维护行为的电话会话；或2)增强型定期维护干预(SMI)，其中包括一组针对维护行为的核心电话会话，以及第二阶段，包括双月持续支持电话、每月量身定制的反馈报告和为扭转体重小幅增加而提供的“及时”支持。结果将在6个月、12个月、18个月和24个月进行评估，24个月的体重变化和维持是主要结果。这项拟议的研究具有创新性，因为它针对的是最近减肥的个人，并评估了一种加强体重维持的新干预措施。结果将提供关于一种新的减肥维持干预措施的有效性的重要信息，该干预措施可能会被广泛传播。

DESCRIPTION (provided by applicant): Weight loss maintenance is a critical challenge for obesity treatment. Extended treatment length and enactment of key behaviors (e.g., physical activity, self-monitoring) can improve maintenance. Treatment studies have incorporated these strategies; however, the most intensive treatment typically occurs during weight loss initiation with the maintenance phase occurring after treatment novelty has faded. Increasing duration improves weight loss, but there is a point of diminishing returns as people eventually stop attending sessions. Recruiting people who have recently lost weight to a maintenance-specific intervention may be a viable alternative. A key issue for maintenance-specific interventions is defining the optimal timing of delivery. One approach suggests that maintenance will be enhanced by teaching people about the key behaviors required and assisting them with these behaviors. Following this approach, maintenance programs would be designed like weight loss programs where sessions addressing relevant behaviors occur on a pre- set schedule. Another approach recognizes that maintenance inevitably includes periods of weight regain and will be enhanced if individuals use cognitive and behavioral strategies to reverse small weight gains. Following this approach, intervention contact would occur in a "just-in-time" manner, in response to weight trends. Data from our Keep It Off pilot study suggest that effectiveness may be maximized by integrating these two complementary approaches and including core content, continued support and tailored feedback. We propose to evaluate the efficacy of this innovative approach to promoting long-term maintenance among adults who have recently lost weight. Four hundred adults who have recently lost at least 5 percent of their weight will be recruited and randomly assigned to: 1) a brief intervention comparison group during which participants will receive two phone sessions addressing key maintenance behaviors or 2) an enhanced scheduled maintenance intervention (SMI+) that includes a core set of phone sessions addressing maintenance behaviors and a second phase with bimonthly continued support calls, monthly tailored feedback reports and "just in time" support to reverse small weight gains. Outcomes will be assessed at 6, 12, 18, and 24 months, with 24-month weight change and maintenance as the primary outcomes. The proposed research is innovative because it targets individuals who have recently lost weight and evaluates a novel intervention to enhance weight maintenance. Results will provide important information on the effectiveness of a new weight loss maintenance intervention that could potentially be widely disseminated.