Evaluating environmental control (AVOID) and inhibitory control (RESIST) strategies to improve weight management outcomes

摘要 当个人能够始终如一地坚持 建议.然而，很大一部分寻求治疗的个人没有临床经验， 体重显著下降。需要创新的策略来优化体重管理中的行为改变 干预措施。拟议的随机对照试验测试两种自我调节方法，以改善 超重或肥胖个体的有意减肥和饮食质量：（1）环境对照 策略（AVOID）和（2）冲动控制训练策略（RESIST）。具体而言，500名女性和男性（BMI） 25 - 39.9 kg/m2）将从Cedars-Sinai医疗中心的医院和诊所网络招募。 所有参与者将参加为期12个月的体重管理计划（WW，前身为Weight Watchers ©） 重点关注饮食、体力活动和心态技能，并随机分配至四个研究组之一：（1）仅WW，（2） WW+家庭食品环境和在线杂货配送（AVOID）的修改，（3）WW+游戏化抑制 控制训练（RESIST）;（4）WW + AVOID + RESIST。基线、6个月和12个月评估将 由经验丰富的英语和西班牙语学习人员完成。目标1（成果）。(a)测试如何避免 和RESIST影响体重减轻和腰围（主要）和饮食质量（次要）。H1a：避免 和/或RESIST（第2、3、4组）在6个月和12个月时间点的体重减轻幅度大于 WW独自一人(b)测试AVOID和RESIST对家庭成员饮食质量的潜在连锁反应 （主要）和重量（次要）。H1b：我们预测AVOID（第2组和第4组）将产生更大的饮食 家庭成员的变化比WW单独和RESIST（臂1和3）。目标2（机制）。测试 AVOID和RESIST的机制途径，通过（a）比较抑制控制和 （B）抑制性对照和家庭食物环境是否 调节研究臂与人体测量和饮食结果之间的关系。H2：避免意志 产生家庭食品环境的变化，RESIST将对抑制控制进行操作。目标3 （主持人）。研究如何（a）个人特征（年龄，性别，种族，社会经济地位，家庭 组成、身体活动、基线BMI和执行功能），和（B）过程数据（ 杂货店送货，外出就餐和外卖，冲动控制培训和WW应用程序使用）调节关系 研究组与人体测量和饮食结果之间的关系。这些注意事项对于帮助 解释干预结果的异质性，并了解谁受益于AVOID和/或RESIST。

ABSTRACT Evidence-based weight management programs are effective when individuals are able to consistently adhere to recommendations. However, a large proportion of treatment-seeking individuals do not experience clinically significant weight loss. Innovative strategies are needed to optimize behavior change in weight management interventions. The proposed randomized controlled trial tests two self-regulatory approaches to improve intentional weight loss and diet quality in individuals with overweight or obesity: (1) an environmental control strategy (AVOID) and (2) an impulse control training strategy (RESIST). Specifically, 500 women and men (BMI between 25-39.9 kg/m2) will be recruited from the Cedars-Sinai Medical Center network of hospitals and clinics. All participants will be enrolled in a 12-month weight-management program (WW, formerly Weight Watchers©) focusing on diet, physical activity and mindset skills, and randomized to one of four study arms: (1) WW only, (2) WW + modification of home food environment and online grocery delivery (AVOID), (3) WW + gamified inhibitory control training (RESIST), (4) WW + AVOID + RESIST. Baseline, 6- and 12-month assessments will be completed by experienced, English and Spanish speaking study staff. Aim 1 (Outcomes). (a) Tests how AVOID and RESIST affect weight loss and waist circumference (primary) and diet quality (secondary). H1a: AVOID and/or RESIST (arms 2, 3, 4) will result in greater weight loss at 6-month and 12-month timepoints compared to WW alone. (b) Tests potential ripple effects of AVOID and RESIST on available household members' diet quality (primary) and weight (secondary). H1b: We predict that AVOID (arms 2 and 4) will produce greater dietary changes in household members than WW alone and RESIST (arms 1 and 3). Aim 2 (Mechanisms). Tests the mechanistic pathways of AVOID and RESIST by (a) comparing longitudinal changes in inhibitory control and home food environment across study arms; and (b) whether inhibitory control and the home food environment mediate the relationships between study arms and anthropometric and dietary outcomes. H2: AVOID will produce changes in the home food environment and RESIST will operate on inhibitory control. Aim 3 (Moderators). Examines how (a) individual characteristics (age, sex, ethnicity, socioeconomic status, household composition, physical activity, baseline BMI and executive functioning), and (b) process data (frequency of grocery delivery, dining out and take out, impulse control training and WW app use) moderate the relationship between study arms and anthropometric and dietary outcomes. These considerations are important to help explain heterogeneity in intervention outcomes and to understand who benefits from AVOID and/or RESIST.