Development of an integrative intervention to decrease overeating drive and improve weight loss maintenancee

项目概要/摘要 肥胖成年人行为减肥干预面临的一个关键问题是减肥后体重反弹的趋势。这在一定程度上是由于未能解决导致肥胖的行为关键：暴饮暴食（例如，为了心理缓解而进食，强迫性进食）。这种驱动力可以独立地导致胰岛素抵抗和代谢综合征，使其成为一个关键的行为目标。这个K23指导的以患者为导向的研究职业发展应用程序的目标是为我提供高水平的培训，使我成为针对暴饮暴食冲动、使用基于正念和激励的方法来促进健康饮食的专家。正念饮食（ME）的组成部分可能是减肥计划的重要补充，更直接地针对暴饮暴食的驱动力。动机访谈（MI）已经被确立为一种有效的治疗成分，以帮助减肥，并可能有助于减少暴饮暴食的驱动器。没有研究检查MI与ME的组合，本文称为“正念动机”（MM）。与NCCIH关于通过综合健康干预措施推进症状管理科学的倡议一致，拟议项目旨在1）确定和优化MM干预措施的特定目标，这些干预措施可能会减少暴饮暴食的冲动，2）在RCT设计中对改进的MM干预措施进行试点测试，并采用主动控制条件（一般数字正念）。为此，我将检查试点研究数据，其中超重的成年人接受8周的MM。根据这些发现，沿着来自焦点小组的数据和专家团队的咨询，我将确定MM干预的哪些方面最能加强目标（暴饮暴食驱动器），并优化这些组件。我将利用MI和ME组件开发一种轻触式干预。我将研究哪些治疗成分是最有效的（与积极控制相比）在目标机制暴饮暴食驱动器（主要是自我效能，冲动控制）。初步结果将告知R级应用程序，该应用程序在充分把握度的RCT中评价MM干预。这项研究将有助于开发最适合超重和暴饮暴食的成年人的正念治疗方法，并可能促进长期的代谢健康。 基于我作为一名具有饮食行为专业知识的临床健康心理学家的高级培训，K23机制解决了我在以机制为中心的干预开发和评估方面的关键培训需求。培训计划包括课程，会议，阅读和定性研究，以填补这些空白。我在UCSF（Epel博士，Mason博士，Adler博士，Hartogensis博士，Le Grange博士和Garber博士）和UCSF之外（Wolever博士，Cassin博士和West博士）组建了一支优秀的导师和顾问团队，他们在互补领域具有专业知识。由于我的长期职业目标是开发和传播综合干预措施，以改善肥胖患者的健康状况，K23机制将为我提供机会，使我能够成长为一名独立的临床研究人员，并制定更好的循证策略。

Project Summary/Abstract A critical problem facing behavioral weight-loss interventions for adults with obesity is the tendency towards weight regain following weight loss. This is due in part to a failure to address the behavioral lynchpins that underlie obesity for a significant subset: overeating drive (e.g., eating for psychological relief, compulsive eating). This drive can independently lead to insulin resistance and metabolic syndrome, making it a crucial behavioral target. The objective of this K23 Mentored Patient-Oriented Research Career Development application is to provide me with high-level training to become an expert in targeting overeating drive, using mindfulness-based and motivational approaches to promote healthy eating. Mindful eating (ME) components may be an important addition to weight loss programs to more directly target overeating drive. Motivational interviewing (MI) is already established as an effective treatment component to help with weight loss and may help reduce overeating drive. No studies have examined MI in combination with ME, herein referred to as ‘Mindful Motivation’ (MM). Congruent with NCCIH’s initiative on advancing the science of symptom management through integrative health interventions, the proposed project aims to 1) identify and optimize specific targets of MM interventions that may reduce overeating drive and 2) pilot test the refined MM intervention in an RCT design with an active control condition (general digital mindfulness). To this end, I will examine pilot study data in which adults with overweight receive 8-weeks of MM. Based on these findings, along with data from focus groups and consultation with a team of experts, I will identify which aspects of the MM intervention most strengthened the target (overeating drive) and optimize these components. I will develop a light touch intervention utilizing both MI and ME components. I will examine which treatment components are most effective (in comparison to the active control) in targeting mechanisms of overeating drive (primarily self- efficacy, impulse control). Preliminary findings will inform an R-level application that evaluates the MM intervention in an adequately powered RCT. This research will help develop mindfulness-based treatments most suitable for adults with overweight and overeating drive, and may promote long-term metabolic health. Building on my advanced training as a clinical health psychologist with expertise in eating behavior, the K23 mechanism addresses my critical training needs in mechanism-focused intervention development and evaluation. The training plan includes coursework, meetings, readings, and qualitative research to fill these gaps. I have assembled an outstanding team of mentors and advisors at UCSF (Drs. Epel, Mason, Adler, Hartogensis, Le Grange, and Garber) and outside of UCSF (Drs. Wolever, Cassin and West) with expertise in complementary areas. As my long-term career goal is to develop and disseminate integrative interventions to improve the health of individuals with obesity, the K23 mechanism will provide me with opportunities to grow as an independent clinical researcher, and develop better evidence-based strategies.