Metabolic and Immunologic Effects of Meditation

描述（由申请人提供）：肥胖是流行病，是我们最严重的公共卫生问题之一。许多肥胖对健康的不利影响与中心性（腹部和上躯干）肥胖的关系比与周围性肥胖的关系更密切。中心性肥胖与代谢综合征的其他组成部分密切相关：胆固醇升高，高血压和胰岛素抵抗。不利的应激激素模式似乎有利于中央脂肪沉积。此外，不良的压力反应可能会导致导致肥胖的饮食模式。该项目的总体目标是测试是否基于冥想的干预，可以改变压力激素模式，当添加到饮食和锻炼计划中时，改善脂肪分布，增强减肥和维持减肥。我们已经开发了一种干预措施，将正念冥想实践应用于肥胖和代谢综合征，通过正念改变渴望和生活方式（CALMM）。该干预利用基于正念的减压和基于正念的饮食意识训练。CALMM旨在减少不良的压力反应，提高对饥饿感的敏感性，并发展注意饮食习惯。最初的数据表明，CALMM支持逐渐减肥，改善应激皮质醇反应，减少腹部脂肪。CALMM+的饮食部分旨在适度减少热量（通常为500千卡/天），并侧重于促进热量减少的健康饮食选择。CALMM+的运动部分侧重于适度运动，主要是通过增加每日步行以及通过有组织的运动时间。CALMM+的饮食和运动部分都包含正念，例如正念步行运动和正念饮食。我们还开发了一个名为Diet-Ex的项目，该项目使用了CALMM+的饮食和运动成分，但没有将正念练习融入饮食和运动中。在本项目中，200名受试者将以1：1的比例随机分配至CALMM+或Diet-Ex组。小组将举行16次每周会议，然后在4个月的维护阶段每月一次。我们将在18个月的时间内比较每种干预措施对体重减轻及其维持、脂肪分布、胰岛素敏感性、感知压力和情绪的影响。我们假设CALMM+组将在脂肪分布方面取得更大的改善，并在18个月内保持最大的体重减轻。这项研究的结果将提供重要的新信息，即针对减少不良应激反应和提高饮食行为意识的身心干预是否有助于治疗肥胖和改变代谢综合征的特征。 公共卫生相关性：肥胖的许多健康问题来自代谢综合征（腹部脂肪、高血压、胰岛素抵抗和脂肪水平异常的综合）。压力荷尔蒙可能会导致代谢综合征。我们正在测试的冥想干预针对的是压力荷尔蒙，我帮助人们改变饮食行为。如果干预措施奏效，将有助于解决我们的一个关键公共卫生问题。

DESCRIPTION (provided by applicant): Obesity is epidemic and is one of our most serious public health problems. Many of obesity's unfavorable health effects are more strongly related to central (abdominal and upper trunk) adiposity than to peripheral adiposity. Central adiposity is closely linked to other components of metabolic syndrome: increased cholesterol, hypertension, and insulin resistance. Adverse stress hormone patterns appear to favor central fat deposition. In addition, adverse stress responses may drive eating patterns that lead to obesity. The overall goal of this project is to test whether a meditation based intervention that can shift stress hormone patterns, when added to a diet and exercise program, improves fat distribution and enhances weight loss and maintenance of weight loss. We have developed an intervention that applies mindfulness meditation practices to obesity and metabolic syndrome, Craving and Lifestyle Modification through Mindfulness (CALMM). The intervention draws on Mindfulness Based Stress Reduction and Mindfulness Based Eating Awareness Training. CALMM aims to decrease adverse stress responses, improve sensitivity to hunger satiety cues, and develop mindful eating practices. Initial data suggests that CALMM supports gradual weight loss, improvements in stress cortisol responses, and decreased abdominal fat. The diet component of CALMM+ aims for a modest calorie reduction (typically 500 Kcal/day) and focuses on healthy diet choices that facilitate caloric reduction. The exercise component of CALMM+ focuses on moderate exercise, primarily through increased daily walking as well as through structured exercise time. Both the diet and exercise components of CALMM+ incorporate mindfulness, e.g. mindful walking exercise and mindful eating. We have also developed a program, Diet-Ex, that uses the diet and exercise components from CALMM+, without the integration of mindfulness practices into diet and exercise. In this project, 200 participants will be randomized in a 1:1 ratio to CALMM+ or Diet-Ex. Groups will meet for 16 weekly sessions, then monthly during a 4 month maintenance phase. We will compare the effects of each intervention on weight loss and its maintenance, fat distribution, insulin sensitivity, and perceived stress and mood over an 18 month period. We hypothesize that the CALMM+ group will achieve greater improvements in fat distribution and maintain the most weight loss over 18 months. The results of the study will provide important new information about whether a mind-body intervention targeted to reduce adverse stress reactions and improve awareness of eating behaviors is useful in treating obesity and altering features of the metabolic syndrome. PUBLIC HEALTH RELEVANCE: Many health problems in obesity come from metabolic syndrome (the combination of abdominal fat, high blood pressure, insulin resistance, and abnormal fat levels). Stress hormones may help cause metabolic syndrome. The meditation intervention we are testing targets stress hormones and my help people change eating behaviors. If the intervention works, it will help to address one of our key public health problems.