A Randomized Trial Testing Lay Health Coaches for Obesity Treatment

描述（由申请人提供）：非专业健康教练在医疗保健访问之间提供支持和责任，以促进行为改变。有两种类型的非专业教练，同伴（2个人发起行为改变教练彼此）和导师（个人谁以前和成功地修改他们的行为教练病人刚刚开始改变他们的行为）。业余教练还没有接受过肥胖治疗的测试。唯一具有客观结果的试验是在糖尿病管理领域，结果表明同伴可能比导师更有效。同样，社会比较理论的研究结果表明，与“相似”目标的横向比较（例如，同龄人）可能比向上比较“更成功”的目标（例如，导师），因为与成功的目标进行比较可能会导致挫折感并阻碍表现。虽然是一个自然的配合，社会比较理论还没有被用来了解同伴和导师健康教练对健康结果的影响。此外，这两种类型的业余教练还没有直接比较在任何领域。 我们进行了一项为期6个月的试点研究，测试同伴和导师健康教练减肥。参与者接受了一个团体行为减肥计划（BWL），并被随机分配到同伴或导师健康教练。BWL治疗涉及减少接触时间表;每周一次，持续6周，每两周一次，持续6周，此后每月一次。在小组没有见面的几周里，参与者将他们一周的体重，卡路里和活动信息通过电子邮件发送给他们的教练并获得反馈。结果令人印象深刻。对指导方案的依从性非常好。与Mentor条件相比，Peer条件产生了上级体重减轻结局（-8.7 kg v.-5.3 kg）。此外，同伴参与者与他们的教练进行横向比较，而导师参与者进行向上比较，横向比较与更大的减肥结果相关。这些初步研究结果提供了强有力的证据表明：1）非专业健康教练对肥胖治疗是可行的，2）同伴健康教练可能会产生特别令人印象深刻的减肥效果，3）社会比较过程可能在同伴和导师健康教练治疗结果中发挥重要作用。 我们建议测试非专业健康教练的肥胖治疗。受试者将被随机分配至BWL+Peer、BWL+Mentor或BWL单独治疗组。BWL将涉及减少接触时间表;会议将每周为6周，每两周为6周，每月为其余9个月。在小组不开会的几周内，同伴和导师参与者将通过电子邮件向他们的教练发送他们的进度并收到反馈。我们假设，与BWL+Mentor和单独BWL相比，BWL+同伴教练在12个月时将产生上级体重减轻，并且同伴和Mentor组在社会比较方向上不同。如果这些假设得到支持，我们将探讨社会比较方向是否介导了同伴和导师研究组之间12个月的减肥结果。 该项目测试了一种新颖的，有理论基础的，可传播的肥胖治疗方法。如果成功，这种方法可以为目前的肥胖治疗工作提供大量信息。

DESCRIPTION (provided by applicant): Lay health coaches provide support and accountability between health care visits to promote behavior change. There are 2 types of lay coaches, Peers (2 individuals initiating behavior change coach one another) and Mentors (individuals who previously and successfully modified their behavior coach patients just starting to change their behavior). Lay coaches have not been tested for obesity treatment. The only trials with objective outcomes are in the area of diabetes management, and results suggest that Peers may be more effective than Mentors. Similarly, findings from Social Comparison Theory show that lateral comparisons with "similar" targets (e.g., Peers) may promote greater motivation and health behavior change than upward comparisons with "more successful" targets (e.g., Mentors), as comparisons with successful targets can induce frustration and hinder performance. Although a natural fit, Social Comparison Theory has not been used to understand the effects of Peer and Mentor Health Coaches on health outcomes. Moreover, the2types of lay coaches have not been directly compared in any area. We conducted a 6-month pilot study testing Peer and Mentor Health Coaches for weight loss. Participants received a group behavioral weight loss program (BWL) and were randomized to a Peer or Mentor Health Coach. BWL treatment involved a reduced contact schedule; sessions were weekly for 6-weeks, biweekly for 6-weeks, and monthly thereafter. On weeks that group did not meet, participants emailed their week's weight, calorie, and activity information to their coach and received feedback. Results were impressive. Compliance with the coaching protocol was excellent. The Peer condition yielded superior weight loss outcomes compared to the Mentor condition (-8.7kg v. -5.3kg). Moreover, Peer participants engaged in lateral comparisons with their coach whereas Mentor participants engaged in upward comparisons, and lateral comparisons were associated with greater weight loss outcomes. These preliminary findings provide strong evidence that 1) lay health coaches are feasible for obesity treatment, 2) Peer Health Coaches may yield particularly impressive weight losses, and 3) social comparison processes may play an important role in Peer and Mentor Health Coach Treatment outcomes. We propose to test lay health coaches for obesity treatment. Participants will be randomized to BWL+Peer, BWL+Mentor, or BWL alone. BWL will involve a reduced contact schedule; sessions will be weekly for 6-weeks, biweekly for 6-weeks, and monthly for the remaining 9-months. During weeks that group does not meet, Peer and Mentor participants will email their progress to their coach and receive feedback. We hypothesize that BWL+Peer Coach will yield superior weight losses at 12-months compared to BWL+Mentor and BWL alone and that Peer and Mentor arms will differ on social comparison direction. If these hypotheses are supported, we will explore whether social comparison direction mediates 12-month weight loss outcomes between the Peer and Mentor study arms. This project tests a novel, theoretically-grounded, disseminable approach to obesity treatment. If successful, this approach could substantially inform current obesity treatment efforts.