Developing and evaluating behavioural interventions to reduce meat consumption

行为医学拟议的研究探讨了多组分电子干预的可行性和有效性，旨在提高超重和肥胖患者在初级保健中对膳食替代计划的依从性。更具体地说，该项目调查了将代餐计划与旨在帮助患者监测体重减轻和坚持该计划的电话应用程序相结合的干预措施是否会导致（1）更高的坚持饮食方案，（2）更高的体重减轻和（3）更大的改善与肥胖相关的发病率的生物标志物相比，干预功能代餐计划。如果被证明有效，这将是第一个在初级保健环境中的干预措施，它可能成功地有助于减少肥胖的健康和经济负担，几乎没有额外的成本。超重或肥胖一直与一些严重的健康状况有关，如II型糖尿病（1-4），冠心病（5-8），男性阳痿（9-12），乳腺癌（13-15）和结肠直肠癌（16-18）的风险增加，以及其他不良心理后果（19-21）。每年，肥胖导致全球损失3580万残疾调整生命年（22），预计到2050年，与肥胖相关疾病相关的NHS支出将达到每年229亿英镑（23）。由于对肥胖对健康影响的认识不够理想，并且由于这种情况的耻辱感（24-27），患者可能缺乏积极寻求专业医疗机构支持以使体重正常化的动机或感到尴尬。因此，初级保健实践的作用对于减少人口肥胖症的患病率具有根本重要性。这不仅是因为与其他商业选择相比，患者对初级保健干预的固有偏好（28，29），而且还因为超重和肥胖患者访问初级保健实践进行常规检查或因为（据说）体重无关的条件可以机会性地提供减肥干预。然而，对文献的系统回顾表明，迄今为止，初级保健干预措施尚未成功地使超重患者的BMI正常化（22）。这可能是因为此类干预措施采取了认知方法，假设人类行为是由理性选择决定的，而心理学研究一致表明人类行为受到环境和启发式方法的强烈影响（30-34）。因此，旨在增加患者对与超重相关的健康风险的知识的零星教育会议可能不足以促进肥胖社会中临床相关的体重减轻。相反，需要更实质性的干预措施，成功地帮助患者克服日常动机，意志和实际的饮食变化障碍。现代数字技术可能是发展这种干预措施的宝贵机会。因此，该项目的目的是设计一种多组分干预措施，采用数字技术，可以在初级保健实践中切实可行，并有效地提高患者对处方代餐计划的依从性，并在时间和成本经济的情况下实现临床相关的BMI降低。MRC技能优先级：跨学科技能（社会/临床界面）

Behavioural Medicine The proposed research explores the feasibility and effectiveness of a multicomponent e-intervention that aims to enhance adherence to meal replacement programmes among overweight and obese patients in primary care.More specifically, the project investigates whether an intervention combining meal replacement programmes with a phone application designed to help patients monitoring their weight loss and their adherence to the programme results in (1) higher adherence to the dietary regimen, (2) higher weight loss and (3) greater improvement of bio-markers associated with obesity-related morbidities compared to an intervention featuring meal replacement programmes only. If proven effective, this would be the first intervention within a primary care setting that may successfully contribute, at virtually no added cost, to the reduction of the health and economic burden of obesity.Being overweight or obese has been consistently associated with a number of severe health conditions such as type II diabetes(1-4), coronary heart disease(5-8), male impotence(9-12) and increased risk of breast(13-15) and colorectal cancer(16-18) alongside other adverse psychological outcomes(19-21). Every year obesity accounts for a worldwide loss of 35.8 million disability-adjusted life years(22) and the NHS expenditure associated with obesity related diseases is expected to reach 22.9 billion pounds per year by 2050(23). Because the awareness of the impact of obesity on health is suboptimal and due to the stigma attached to this condition(24-27), patients might lack the motivation or feel too embarrassed to actively seek the support of specialised healthcare institutions to normalise their weight. The role of primary care practices is therefore of fundamental importance to reduce the prevalence of obesity at population level. This is not only true because of patients' inherent preference for primary care interventions compared to other commercial options(28,29) but also because overweight and obese patients visiting primary care practices for routine check-ups or because of (supposedly) weight-unrelated conditions can opportunistically be offered weight loss interventions. Nevertheless, a systematic review of the literature indicated that, to date, primary care interventions have not been successful in normalising the BMI of overweight patients(22). This is possibly because such interventions took a cognitive approach, assuming that human behaviour is determined by rational choices, while psychological research consistently indicated that human behaviour is strongly influenced by environments and heuristics(30-34). Sporadic educational sessions aiming to increase patients' knowledge of the health risks associated with being overweight might therefore not be sufficient to foster clinically relevant weight loss in an obesogenic society. Instead more substantial interventions that successfully help patients with overcoming daily motivational, volitional and practical barriers to dietary changes are needed. Modern digital technology might be a valuable opportunity with which such interventions can be developed. The aim of this project is therefore to design a multicomponent intervention featuring digital technology that can feasibly be delivered in primary care practices and that is effective at increasing patients' adherence to prescribed meal replacement programmes and in achieving a clinically relevant BMI reduction while still being time and cost economic.MRC Skill Priority: Interdisciplinary skills (social/clinical interface)