Stress, race, and cognitive mediators of SES-related disparities in behavioral obesity treatment outcomes

项目摘要/摘要 社会经济地位(SES)较低的人在行为减肥方面只减掉一半的体重 与更高社会经济地位的干预措施相同。这是一个临床上有意义的结果差异，已经 一直有记录在案。该项目的总体目标是确定 与自闭症相关的行为减肥结果的差异，这将使更多的 针对低SES人群的有效肥胖治疗方法。一种可能的机制是存在偏见， 这是一种专注于一个人的即时需求的倾向，这些需求可能是由于暴露在恶劣的和 不可预测的环境。目前的偏见是SES相关差异的一个引人注目的候选机制 在减肥效果上，因为这在SES较低的人群中更加明显，而且它与 肥胖风险、饮食行为不适应和饮食质量差。第二套潜在的机制 包括日常不良体验，如压力、认知需求和接触诱人的食物。压力 认知需求在较低SES人群的生活中更为普遍或严重，并可能扰乱 执行功能对于在肥胖治疗过程中坚持体重控制行为很重要。 该项目将分配同等数量的较低和较高SES的受试者进行标准护理减肥 干预。重要的是，经济特区的群体将在族裔/种族少数地位方面保持平衡。重量 减肥结果和坚持三种关键的体重控制行为(饮食失误、饮食自我监控、 和体力活动)将在六个月的随访中进行严格测量。的个体差异 目前的偏见将在基线时进行彻底评估。生态瞬时评估将用于 捕捉暴露在不利的日常经历中，以及当前偏见的瞬间变化。目标1是测试 目前的偏见是否解释了与SES相关的行为减肥结果和依从性的差异 控制体重的关键行为。目标2a和2b将描述日常不良经历在SES中的作用- 体重减轻结果和坚持体重控制行为的相关差异，无论是总体上还是 尤其是偏向于当下的个人。目标3是探索种族对社会经济地位相关差异的贡献 体重减轻的结果，这在以前的研究中由于严重的混淆而难以阐明 在社会层面上的种族和社会地位。这项研究的结果可能会导致对如何 社会经济上的不利因素影响了对肥胖行为治疗的坚持，并表明了全新的 治疗方法侧重于减轻目前的偏见或提供量身定制的干预内容 坚持失误的“风险时刻”。

PROJECT SUMMARY/ABSTRACT Individuals of lower socioeconomic status (SES) lose only half as much weight in behavioral weight loss interventions as those of higher SES. This is a clinically meaningful difference in outcomes that has been consistently documented. The overarching aim of this project is to identify the mechanisms that account for SES-related disparities in behavioral weight loss outcomes, which would enable the development of more effective obesity treatment approaches for lower SES populations. One potential mechanism is present bias, which is a tendency to focus on one’s immediate needs that may result from exposure to harsh and unpredictable environments. Present bias is a compelling candidate as a mechanism of SES-related disparities in weight loss outcomes because it is much more pronounced in lower SES populations, and it has been linked to obesity risk, maladaptive eating behaviors, and poor diet quality. A second set of potential mechanisms includes adverse daily experiences such as stress, cognitive demands, and exposure to tempting foods. Stress and cognitive demands are more prevalent or severe in the lives of lower SES populations, and can disrupt the executive functions that are important for adhering to weight control behaviors during obesity treatment. This project will allocate equal numbers of subjects of lower and higher SES to a standard-of-care weight loss intervention. Importantly, the SES groups will be balanced with respect to ethnic/racial minority status. Weight loss outcomes and adherence to three key weight control behaviors (dietary lapses, dietary self-monitoring, and physical activity) will be rigorously measured across six months of follow up. Individual differences in present bias will be thoroughly assessed at baseline. Ecological momentary assessment will be used to capture exposure to adverse daily experiences, as well as momentary changes in present bias. Aim 1 is to test whether present bias accounts for SES-related disparities in behavioral weight loss outcomes and adherence to key weight control behaviors. Aims 2a and 2b will characterize the role of adverse daily experiences in SES- related disparities in weight loss outcomes and adherence to weight control behaviors, both overall and among present-biased individuals in particular. Aim 3 is to explore the contribution of race to SES-related disparities in weight loss outcomes, which has been challenging to elucidate in prior studies due to significant confounding of race and SES at the societal level. The results of this study could lead to a new understanding of how socioeconomic disadvantage impacts adherence to behavioral treatment for obesity, and suggest entirely new treatment approaches focused on mitigating present bias or delivering tailored intervention content during “moments of risk” for lapses in adherence.