Novel Approaches to Weight Loss Maintenance

描述（由申请人提供）：维持体重减轻是肥胖治疗的关键挑战。延长治疗时间和制定关键行为（例如，身体活动、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，维持阶段发生在治疗新奇消失之后。增加持续时间可以改善减肥效果，但随着人们最终停止参加会议，收益会逐渐减少。招募最近减肥的人进行特定的维持干预可能是一个可行的选择。针对具体维护的干预措施的一个关键问题是确定最佳交付时间。一种方法认为，通过教导人们所需的关键行为并帮助他们进行这些行为，可以加强维护。按照这种方法，维护程序将被设计成类似于减肥程序，其中处理相关行为的会话按预先设定的时间表发生。另一种方法认识到，维持不可避免地包括体重反弹的时期，如果个人使用认知和行为策略来扭转体重小幅增加，则会得到加强。按照这种方法，干预联系将以“及时”的方式发生，以响应体重趋势。从我们的Keep It Off试点研究中获得的数据表明，通过将这两种互补的方法结合起来，并包括核心内容、持续的支持和有针对性的反馈，可以最大限度地提高效果。我们建议评估这种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名最近体重减轻至少5%的成年人将被招募并随机分配到：1）简短干预比较组，在此期间，参与者将接受两次电话会议，讨论关键维护行为，或2）增强型定期维护干预（SMI+），包括一组核心电话会议，讨论维护行为，第二阶段为每两个月一次的持续支持电话，每月量身定制的反馈报告和“及时”支持，以扭转体重小幅增加。将在6、12、18和24个月时评估结局，24个月体重变化和维持作为主要结局。这项研究是创新的，因为它针对的是最近减肥的人，并评估了一种新的干预措施，以加强体重维持。研究结果将提供有关新的减肥维持干预措施有效性的重要信息，这些信息可能会被广泛传播。

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.