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

项目总结/摘要 社会经济地位较低的人在行为减肥中只减掉一半的体重 干预措施，因为那些更高的社经地位。这是一个具有临床意义的结果差异， 一贯记录。该项目的总体目标是确定造成这一现象的机制， SES相关的行为减肥结果的差异，这将使更多的发展， 低SES人群的有效肥胖治疗方法。一个潜在的机制是现在的偏见， 这是一种倾向，专注于一个人的直接需求，这可能是由于暴露在严酷的环境中， 不可预测的环境。现在的偏见是一个令人信服的候选人作为机制的SES相关的差距 在减肥结果中，因为它在较低的SES人群中更为明显， 肥胖风险，不良饮食行为和不良饮食质量。第二组潜在机制 包括不良的日常经历，如压力、认知需求和接触诱人的食物。应力 认知需求在社会经济地位较低人群的生活中更为普遍或严重，并可能破坏社会经济地位。 执行功能对于肥胖治疗期间坚持体重控制行为很重要。 本项目将分配相同数量的SES较低和较高的受试者进行标准治疗体重减轻 干预重要的是，社会经济地位群体将在少数民族/种族地位方面保持平衡。重量 减肥结果和坚持三个关键的体重控制行为（饮食失误，饮食自我监测， 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 将在基线时全面评估当前偏倚。生态瞬时评估将用于 捕捉暴露于不利的日常经验，以及当前偏见的瞬间变化。目标1：测试 目前的偏见是否解释了行为减肥结果和依从性中SES相关的差异 关键的体重控制行为。目标2a和2b将描述不良日常经历在SES中的作用- 减肥结果和坚持体重控制行为的相关差异，无论是整体还是 尤其是那些有当下偏见的人目的3是探讨种族对SES相关差异的贡献， 体重减轻结果，由于存在显著的混杂因素，在先前的研究中难以阐明 种族和社会经济地位的影响这项研究的结果可能会导致一个新的理解如何 社会经济劣势影响了对肥胖行为治疗的坚持，并提出了全新的建议。 治疗方法侧重于减轻目前的偏见或提供定制的干预内容， “风险时刻”指的是依从性的缺失。

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.