Enhancing Effectiveness of a Dissonance-Based Obesity Prevention Program

提高基于失调的肥胖预防计划的有效性

• 批准号: 10102523
• 负责人: ERIC M STICE
• 金额: $ 40.82万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-11-01 至 2023-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10102523
• 关键词: Enhancing; Effectiveness; Dissonance; Based; Obesity

ABSTRACT Prevention is key for combating obesity, but few programs have prevented future increases in BMI and onset of overweight/obesity, particularly during late adolescence when youth often assume responsibility for dietary intake and exercise choices. One exception is a brief 6-hr dissonance-based program (Project Health) wherein participants make small lasting incremental lifestyle changes to dietary intake and exercise to reach energy balance, and discuss costs of obesity, an unhealthy diet, and sedentary behavior, and benefits of leanness, a healthy diet, and exercise, which prompts them to align their attitudes with their publically displayed behavior. These activities promote internalization of health goals and executive control over lifestyle behaviors. Late adolescents randomized to Project Health showed less increases in BMI and a 41% and 43% reduction in overweight/obesity onset over 2-yr follow-up compared to a version of the program lacking dissonance- induction activities and an obesity education condition. Project Health appears to be the first program to produce these key obesity prevention effects relative to an alternative intervention, but it is critical to increase effects. A dissonance-based prevention program was more effective when implemented in single- versus mixed-sex groups, theoretically because it promoted greater participation in dissonance-inducing discussions. Aim 1a is to test whether the weight gain prevention effects will be larger when Project Health is implemented in single-sex groups; we will randomize 450 17-20 year olds to complete Project Health in female, male, or mixed-sex groups, assessing outcomes at pretest, posttest, and 6, 12, 24, and 36-month follow-ups. Aim 1b is to test whether greater participation in dissonance-inducing discussions and group cohesion mediate the effect of condition on any superior weight gain prevention effects. Adolescents who show greater fMRI-assessed reward and attention region responsivity to food images exhibit elevated future weight gain, implying that reducing this responsivity may reduce future weight gain. In a pilot trial, late adolescents who completed go/no- go, stop-signal, and respond-signal computer training in which they repeatedly inhibit responses to high-calorie foods and respond to low-calorie foods, and dot-probe and visual-search computer tasks that train attention away from high-calorie foods and to low-calorie foods, showed a greater reduction in reward and attention region responsivity to, palatability rating of, and willingness to pay for, high-calorie foods, suggesting reduced valuation and attentional bias, as well as greater fat loss over 1-yr follow-up versus controls who completed the training with non-food images. Aim 2a is to test whether adding food response and attention training to Project Health will produce larger weight gain prevention effects. Participants in the 3 conditions will be randomized to complete response and attention training for 25-mins after each of the 6-sessions with either food or non-food images. Aim 2b is to test whether reduced palatability ratings of, willingness to pay, and attentional bias for high-calorie foods mediate the effect of training condition on any superior weight gain prevention effects.

抽象的 预防是对抗肥胖的关键，但很少有项目能够阻止未来体重指数的增加和发病率的增加 超重/肥胖，特别是在青春期后期，此时年轻人经常承担饮食责任 摄入量和运动选择。一个例外是一项为期 6 小时的简短的不和谐计划（Project Health），其中 参与者对饮食摄入和锻炼进行小的、持久的增量生活方式改变以获取能量 平衡，并讨论肥胖、不健康饮食和久坐行为的成本，以及瘦身的好处， 健康的饮食和锻炼，促使他们将自己的态度与公开表现的行为保持一致。 这些活动促进健康目标的内化和对生活方式行为的执行控制。晚的 随机参加 Project Health 的青少年的 BMI 增幅较小，且体重指数分别下降 41% 和 43% 与缺乏失调的计划版本相比，在两年的随访中出现超重/肥胖—— 诱导活动和肥胖教育条件。健康计划似乎是第一个 与替代干预措施相比，产生这些关键的肥胖预防效果，但关键是要增加 影响。基于失调的预防计划在单人实施时比在单人实施时更有效。 混合性别群体，理论上是因为它促进了更多人参与引起不和谐的讨论。 目标1a是测试实施健康计划后，预防体重增加的效果是否会更大 在单一性别群体中；我们将随机抽取 450 名 17-20 岁的人来完成项目健康项目，其中女性、男性或 混合性别组，评估测试前、测试后以及 6、12、24 和 36 个月随访的结果。目标 1b 是 测试更多地参与引起不和谐的讨论和群体凝聚力是否会调节效果 条件对任何优越的体重增加预防效果的影响。经评估表现出更好功能磁共振成像的青少年 奖励和注意区域对食物图像的反应表现出未来体重增加的增加，这意味着 降低这种反应性可能会减少未来的体重增加。在一项试点试验中，完成 go/no- 的晚期青少年 走、停止信号和响应信号计算机训练，在这些训练中，它们反复抑制对高热量的反应 食物并对低热量食物做出反应，以及训练注意力的点探测和视觉搜索计算机任务 远离高热量食物和低热量食物，奖励和注意力明显减少 该地区对高热量食品的反应度、适口性评级以及支付意愿，表明减少 评估和注意力偏差，以及与完成该研究的对照组相比，一年随访期间脂肪减少量更大 使用非食物图像进行训练。目标 2a 是测试是否在项目中添加食物反应和注意力训练 健康就会产生较大的预防体重增加的效果。符合 3 种情况的参与者将被随机分配到 6 次训练后，每次进行 25 分钟的完整反应和注意力训练，食物或非食物均可 图像。目标 2b 是测试是否会降低适口性评级、支付意愿和注意力偏差 高热量食物可以调节训练条件对体重增加预防效果的影响。