Novel and Scalable Internet Supplemented Weight Loss Treatment in Primary Care.

 描述(申请人提供)：超重和肥胖是大多数美国人面临的代价高昂且普遍存在的公共卫生问题。超重或肥胖与心脏病、中风、代谢综合征和其他致命后果有关。接受传统减肥治疗的障碍包括费用、时间和可获得性。干预的地方可能是个人的初级保健提供者预约。不幸的是，大多数初级保健提供者都很忙，可能没有时间或资源提供治疗。因此，重要的是设计和测试有效的减肥疗法，而不需要大量的培训或时间。因此，互联网具有广泛的公共卫生潜力。 广泛传播行为改变工具和减肥干预措施。通过结合临床医生对减肥的支持、使用在线程序和个性化反馈，基于互联网的治疗结果可以进一步改善。该应用程序的目的是通过测试一种可以在初级保健中心(PCCs)提供的容易获得的减肥治疗来解决超重和肥胖问题。第一个目标包括一种治疗方法，它结合了两种最近开发的减肥治疗方法，这两种治疗方法在K23资助的随机对照试验(RCT)中得到了相对于常规护理(UC)的初步经验支持。在这项拟议的研究中，患者将接受营养心理教育(NPC)和动机访谈(MIC)，并辅之以互联网，为期12周，以确定与这种概念上的协同组合(NPC+MIC)相关的结果。治疗将由医疗助理提供；这种提供方法的目的是增加对其他初级保健中心的普及性。患者将在基线、治疗后和3个月的随访时进行全面评估。联合测试MIC和NPC将非常重要，因为NPC+MIC可能会导致更多的重量和与体重相关的变化。然而，将这些治疗方法结合起来的可行性需要进行实证检验。这项研究将为初级保健办公室提供可扩展和潜在有效的减肥选择所需的经验信息。假设接受NPC+MIC治疗的患者体重显著减轻，代谢变量和情绪得到改善。第二个目的是将NPC+MIC的结果与完成的K23随机对照试验研究的结果进行比较，K23 RCT研究将UC与两种互联网补充治疗进行比较，NPC或MIC单独由医疗助理在初级保健中提供。目前的应用解决了治疗文献的局限性，包括免费和轻松访问的互联网支持、超重和肥胖患者、代谢综合征、暴饮暴食障碍患者、许多PCC可获得的治疗临床医生、治疗保真度评估以及治疗停止一段时间后的跟踪评估。在K23随机对照试验中，接受NPC+MIC的患者的结果被假设为明显好于那些仅接受NPC、仅接受MIC或UC的患者。

 DESCRIPTION (provided by applicant): Overweight and obesity are costly and prevalent public health problems facing the majority of Americans. Being overweight or obese is related to heart disease, stroke, metabolic syndrome, and other deadly consequences. Barriers to receiving traditional weight loss treatment with a therapist include cost, time, and accessibility.A place to intervene may be at individuals' primary care provider appointments. Unfortunately, most primary care providers are busy and may not have the time or resources to provide treatment. Therefore, it is important to design and test effective weight loss treatments that do not require extensive training or time. As such, the internet has extensive public health potential for widespread dissemination of behavior change tools and interventions for weight loss. Internet-based treatment outcomes can be further improved by incorporating clinician support for weight loss, the use of online programs, and individualized feedback. The purpose of this application is to address overweight and obesity by testing an easily accessible weight loss treatment that can be provided in primary care centers (PCCs). The first aim includes a treatment approach that combines two recently developed weight loss treatments that received initial empirical support relative to Usual Care (UC) in a K23-funded randomized controlled trial (RCT). In the proposed study, patients will receive both Nutrition Psychoeducation (NPC) and Motivational Interviewing (MIC), supplemented by the internet for 12 weeks, to determine outcomes associated with this conceptually synergistic combination (NPC+MIC). Treatment will be provided by medical assistants; this method of delivery is intended to increase generalizability to other PCCs. Patients will be comprehensively assessed at baseline, post treatment, and at 3-month follow-up. It will be important to test MIC and NPC combined, as NPC+MIC may lead to even more weight and weight-related changes. The feasibility, however, of combining these treatments requires empirical examination. The study will provide needed empirical information about a scalable and potentially effective weight loss option for primary care offices. Patients receiving NPC+MIC are hypothesized to experience significant weight loss and improvements in metabolic variables and mood. The second aim is to compare the NPC+MIC outcomes to those from the completed K23 RCT study that compared UC to two internet supplemented treatments, NPC or MIC alone, provided in primary care by medical assistants. The current application addresses limits of the treatment literature by including free and easily accessible internet support, patients who are overweight and obese, metabolic syndrome, patients with binge eating disorder, treatment clinicians available to many PCCs, assessment of treatment fidelity, and follow-up assessment after a period of treatment cessation. The outcomes for patients receiving NPC+MIC are hypothesized to be significantly better than for those who received NPC alone, MIC alone, or UC in the K23 RCT.