Innovative Technology to Improve Patient Adherence to Weight Loss Recommendations

描述(由申请人提供)：本申请涉及广泛的挑战领域(06)-支持技术和特定挑战主题06-OD(OBSSR)-101*使用新技术来提高或衡量遵从性。超重/肥胖是一个主要的健康问题，影响着超过三分之二的美国人，增加了发病率和死亡率，每年的医疗费用超过750亿美元。尽管许多美国人表示他们正在努力减肥，但他们对减肥养生法的坚持性往往很差。需要能够提高超重/肥胖个人的依从性和减肥效果的计划。医生在激励患者改善健康行为方面发挥着重要作用，最近的研究表明，让医生建议患者减肥，然后将患者推荐给有效的计划，可以产生最佳的行为改变和维护。然而，问题是，医生目前对此类转诊的选择有限。该领域面临的挑战是制定一项计划，让医生可以将他们的超重/肥胖患者推荐给他们。该计划必须是低成本的，易于获得，并且必须促进对减肥方案的坚持，从而改善减肥结果。这项挑战奖助金申请的目标是开发和测试一个创新的基于网络的计划，该计划将提供一种可访问的有效方法，以提高对减肥临床建议的依从性。如果有效，该计划将为医生和他们的患者提供一个杰出的资源，并因此可能产生重要的临床和公共卫生影响。我们建议基于我们之前的研究开发一个项目，该项目使用创新的互联网技术来提供一个低成本、易于传播的项目，该项目抓住了有效的行为减肥计划的两个关键要素-即关键行为体重控制策略的培训和增加参与者的责任感。由医生推荐减肥的患者将被提供一个为期12周的计划，他们可以在方便的时候在电脑上查看。该计划将使用基于网络的交互式多媒体方法来展示行为技能，并提供一个基于网络的表格来提交自我监测和体重数据；为了最大限度地提高患者的责任感，该计划将包括一个自动反馈系统，供参与者评论他们迄今的减肥情况以及他们在几个行为减肥领域的表现，并根据个人的特点和表现提出建议。有关患者进展的定期报告也将发送给转诊医生。我们将在一项随机试验中对250名患者进行测试，这些患者由他们的医生推荐，他们将被随机分配到互联网教育(控制)组(N=125)或创新技术计划(N=125)。两组的参与者都将接受为期12周的基本减肥教育或创新技术计划的互联网计划，并在3个月计划的开始和结束时以及3个月的随访时进行称重。主要的假设是，在为期12周的计划中，被分配到创新技术计划的患者比对照组的患者平均体重减轻更多。第二个假设是，与对照组相比，创新技术组在12周内坚持得更好(通过登录网站和自我报告的饮食和活动变化来评估)，并在6个月内实现更好的减肥效果。拟议的项目解决了严重的肥胖问题，并使用创新技术来提高对行为减肥策略的坚持。如果该计划有效，它将为医生提供一个出色的资源，供他们的患者使用，因此将产生巨大的临床影响。拟议的项目解决了严重的肥胖问题，并使用创新技术来提高对行为减肥策略的坚持。如果该计划有效，它将为医生提供一个出色的资源，供他们的患者使用，因此将产生巨大的临床影响。

DESCRIPTION (provided by applicant): This application addresses broad Challenge Area (06)-Enabling Technologies and Specific Challenge Topic 06-OD(OBSSR)-101* Using new technologies to improve or measure adherence. Overweight/obesity is a major health problem that affects over two-thirds of Americans, increases morbidity and mortality and has annual medical costs exceeding $75 billion. Although many Americans indicate that they are trying to lose weight, adherence to weight loss regimens is often poor. Programs are needed that can improve adherence and weight loss for overweight/obese individuals. Physicians play an important role in motivating patients to improve health behaviors and recent reviews suggest that having physicians advise patients to lose weight and then referring patients to an effective program produces the best behavior change and maintenance. The problem, however, is that physicians currently have limited options for such referrals. The challenge for the field is to develop a program to which physicians can refer their overweight/obese patients. The program must be low cost, easily accessible, and must promote adherence to the weight loss regimen and consequently improve weight loss outcomes. The goal of this Challenge Grant application is to develop and test an innovative web-based program that would provide an accessible and effective approach to enhancing adherence to clinical recommendations for weight loss. If effective, the program would provide an outstanding resource for physicians and their patients and could consequently have important clinical and public health impact. We propose to develop a program based on our prior research that uses innovative Internet technology to provide a low cost, easily disseminated program that captures two critical elements of effective behavioral weight loss programs-namely, training in key behavioral weight control strategies and increased participant accountability. Patients, referred by their physician for weight loss, will be offered a 12 week program that they can view at their convenience on their computer. The program will use Web-based interactive multi-media approaches for presentation of the behavioral skills and provide a Web-based form for submission of self- monitoring and weight data; to maximize patient accountability, the program will include a system of automated feedback for participants, which comments on their weight loss to date and their performance within several behavioral weight-loss domains, with suggestions tailored to the characteristics and performance of the individual. Periodic reports on the patients' progress will also be sent to the referring physician. We will test this program in a randomized trial with 250 patients referred by their physicians who will be randomly assigned to either Internet Education (Control) (N=125) or to the Innovative Technology program (N=125). Participants in both groups will receive a 12 week Internet program of either basic weight loss education or the Innovative Technology program and will be weighed at the start and end of the 3 month program and at 3 month follow- up. The primary hypothesis is that patients who are assigned to the Innovative Technology program will achieve larger average weight losses than those in the control group over the 12-week program. Secondary hypotheses are that the Innovative technology group will adhere better over the 12-weeks (assessed by log-ins to the web site and self-reported changes in diet and activity) and achieve better weight losses at 6 months than the control group. The proposed project addresses the significant problem of obesity and uses innovative technology to improve adherence to a behavioral weight loss strategies. If the program is effective, it would provide an outstanding resource for physicians to use with their patients and thus would have tremendous clinical impact. The proposed project addresses the significant problem of obesity and uses innovative technology to improve adherence to a behavioral weight loss strategies. If the program is effective, it would provide an outstanding resource for physicians to use with their patients and thus would have tremendous clinical impact.