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

项目摘要/摘要 肥胖成人行为减肥干预面临的一个关键问题是减肥后体重回升的趋势。这在一定程度上是由于未能解决导致肥胖的一个重要子集的行为因素：暴饮暴食的驱动力(例如，为了心理缓解而进食，强迫进食)。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，使我成为一名针对暴饮暴食的专家，使用基于正念和激励的方法来促进健康饮食。注意进食(ME)成分可能是减肥计划的一个重要补充，以更直接地针对暴饮暴食的驱动力。动机访谈(MI)已经被确定为一种有效的治疗成分，有助于减肥，并可能有助于减少暴饮暴食的冲动。还没有研究考察MI与ME的结合，在这里被称为“留心动机”(MM)。与NCCIH关于通过综合健康干预促进症状管理科学的倡议一致，拟议的项目旨在1)确定和优化MM干预的特定目标，以减少暴饮暴食；2)在具有主动控制条件(一般数字正念)的RCT设计中对改进的MM干预进行试点测试。为此，我将研究超重成年人接受8周MM的初步研究数据。基于这些发现，以及来自焦点小组的数据和与专家团队的咨询，我将确定MM干预的哪些方面最能强化目标(暴饮暴食)，并优化这些组成部分。我将开发一种利用MI和ME组件的轻触式干预。我将研究在暴饮暴食的靶向机制(主要是自我效能、冲动控制)方面，哪些治疗成分(与主动对照相比)最有效。初步调查结果将为R级应用程序提供信息，该应用程序将评估充分供电的随机对照试验中的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疗法，并可能促进长期的新陈代谢健康。 在我作为一名在饮食行为方面拥有专业知识的临床健康心理学家的高级培训基础上，K23机制满足了我在以机制为重点的干预开发和评估方面的关键培训需求。培训计划包括课程作业、会议、阅读材料和定性研究，以填补这些空白。我在加州大学旧金山分校(Epel、Mason、Adler、Hartogensis、Le Grange和Garber博士)和加州大学旧金山分校以外(Wolever、Cassin和West博士)组建了一支出色的导师和顾问团队，他们在互补领域拥有专业知识。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，K23机制将为我提供作为一名独立临床研究人员成长的机会，并开发更好的循证策略。

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.