Teaching Novel Values-Based Skills to Improve Long-Term Weight Loss: A Randomized Trial Examining the Efficacy of a Weight Loss Maintenance Intervention Based on Acceptance and Commitment Therapy

项目总结/摘要 本提案适用于药物启动的临床试验R 01。肥胖是一个主要的公共卫生问题， 虽然短期的体重减轻是可以实现的，但个体通常会重新获得大部分失去的体重。 目前的方法已经调整了行为处方，并延长了治疗接触，以努力 解决这个问题，效果不大。该提案的调查人员已经制定并试行了一份简报， 基于接受和承诺疗法（ACT）的干预，重点是教授新内容 和技能，促进价值观的澄清和承诺;提供必要的动力，继续 控制体重的努力。在一项初步研究中，最近在行为减肥中体重下降≥5%的参与者（N=102） 程序被随机分配接受（一）5小时的ACT研讨会，5小时的研讨会的基础上自我， 调节（SR）或无车间对照条件（对照），所有组均接受3个月的随访 电子邮件联系。ACT组在24个月时的体重减轻（7.2%）大于SR组（4.2%; Cohen's d= 0.39）和对照（-1.1%; d= 0.73）。这些结果代表了改善减肥的潜在范式转变 维护对教学完全新的技能提供了简短的格式，在一个更大的学习 审判因此，拟议的R 01项目是一项随机对照临床试验，旨在比较 ACT干预和SR干预在30个月内维持体重减轻。所有参与者 将首先完成一个经过充分验证的在线减肥干预（研究的1-3个月）。的参与者 初始体重减轻≥4 kg的受试者将随机分配接受ACT或SR治疗，两种情况均适用 包括三次面对面的小组干预会议（共10小时）和每周电子邮件联系 6个月ACT干预将针对一个新的理论衍生干预目标，价值观- 始终如一的行为，这将有助于使减肥目标与个人价值观保持一致，并培养内在动力 继续努力控制体重。将在基线、体重减轻后/随机化前进行评估， 然后进行6、12、18、24和30个月随访（从随机化开始的月数）。我们假设ACT 组在30个月时将显示出显著更好的体重减轻维持（即较低的平均体重增加）， 该奖项的主要网站是体重控制和糖尿病研究中心 （妇女儿童权利中心）。WCDRC是Miriam医院行为和预防医学中心的一部分 在普罗维登斯，罗得岛，和精神病学和人类行为在阿尔珀特医疗部门 布朗大学学院。这项研究是重要的，因为它解决了减肥维持-一个关键的 治疗肥胖的障碍-研究结果可用于改善长期减肥结果 以及治疗超重和肥胖成年人的相关健康益处。

PROJECT SUMMARY/ABSTRACT This proposal is for an investigator-initiated clinical trial R01. Obesity is a major public health problem, and although short-term weight loss is achievable, individuals often regain the majority of weight that was lost. Current approaches have adjusted behavioral prescriptions and lengthened treatment contact in an effort to address this problem, with modest effect. The investigators of this proposal have developed and piloted a brief intervention based on Acceptance and Commitment Therapy (ACT) that focuses on teaching novel content and skills that promote values clarification and commitment; providing the needed motivation to continue with weight control efforts. In a pilot study, participants (N=102) who recently lost ≥5% in a behavioral weight loss program were randomly assigned to receive (a) 5-hour ACT workshop, a 5-hour workshop based on Self- Regulation (SR), or a no workshop control condition (Control), with all groups receiving 3 months of follow-up email contact. The ACT group had greater weight loss at 24 months (7.2%) relative to the SR (4.2%; Cohen’s d=.39) and Control (-1.1%; d=.73). These results represent a potential paradigm shift for improving weight loss maintenance towards teaching completely novel skills delivered in brief format, warranting study in a larger trial. Therefore, the proposed R01 project is a randomized controlled clinical trial to compare the efficacy of an ACT intervention and a SR intervention on weight loss maintenance over a 30-month period. All participants will first complete a well-validated online weight loss intervention (months 1-3 of the study). Participants who lose ≥4 kilograms of initial weight will then be randomly assigned to receive ACT or SR, with both conditions consisting of three face-to-face, group-based intervention meetings (10 hours total) and weekly email contact for 6 months. The ACT intervention will target a novel theoretically derived intervention target, values- consistent behavior, which will help align weight loss goals with personal values and foster internal motivation to continue with weight control efforts. Assessments will be at baseline, post-weight loss/pre-randomization, and then 6, 12, 18, 24, and 30-month follow-up (months from randomization). We hypothesize that the ACT group will show significantly better weight loss maintenance (i.e. lower mean weight gain) at 30 months as compared to SR. The primary site for this award is the Weight Control and Diabetes Research Center (WCDRC). The WCDRC is part of the Centers for Behavioral and Preventive Medicine at The Miriam Hospital in Providence, Rhode Island, and the Department of Psychiatry and Human Behavior at the Alpert Medical School of Brown University. This study is significant because it addresses weight loss maintenance – a critical barrier to treating obesity – and results of the study could be used to improve long-term weight loss outcomes and associated health benefits for treatment seeing overweight and obese adults.