Understanding Success Factors for African Americans in Weight Loss Programs

描述(由申请人提供)：非裔美国人肥胖的高流行率和高于平均水平的严重程度是一个重大的公共卫生和临床问题。拟议研究的总体目标是，就如何提高非洲裔美国人，特别是女性的生活方式行为减肥计划的有效性提供亟需的见解，因为在临床上显著肥胖的女性远远超过非裔美国人男性或白人女性或男性。干预研究设计可以通过参考与接受各种治疗方法的非裔美国人的最佳体重结果相关的因素的经验信息来增强。该方法利用了来自三个临床试验和一个社区项目评估的数据集，这些数据由同一个研究小组进行，并使用了相同的行为咨询核心原则。拟议的分析将在已发表的单独研究的主要结果的基础上展开，并特别侧重于跨研究的汇集分析。随机临床试验的治疗和随访时间为11至24个月(取决于研究和参与者登记日期)。社区计划评估研究有10到20周的治疗(取决于计划实施地点和参与者选择)。这四项研究总共招募了近900名非裔美国人(约90%是女性)。在这些研究中汇集数据具有重大优势，包括总体样本量增加；感兴趣的子组样本量增加，例如基于性别、教育、年龄、婚姻状况、健康状况或肥胖初始水平；提供的治疗模式以及退出和参加治疗会议的差异；初始和长期随访的体重变化范围扩大；以及能够比较不同环境(研究诊所、初级保健做法和社区组织)的体重结果。具体目的是：1)根据参与模式和水平以及最初体重变化结果的模式来描述研究参与者的特征；2)描述能够实现并保持临床显著减肥的参与者的特征；3)描述在临床或心理社会结果方面改善最大的参与者，如腰围、血压和生活质量；以及4)比较不同治疗环境和方式下的体重变化和生活质量。其中两个或更多数据集中的潜在自变量反映了动机、自我效能感、压力、生活事件、生活质量、来自家人和朋友的社会支持、邻里环境变量、参与模式(感兴趣的同时作为预测和结果的因素)，以及对行为改变建议的遵守。研究结果将产生至少四篇描述成功因素的科学文章，并解决改善参加减肥计划的非裔美国人的留存、出勤率和减肥结果的潜在方法。 与公共健康相关：非洲裔美国人，特别是女性，患肥胖症和相关并发症的风险很高，但疗效试验的证据表明，标准的肥胖治疗方法在非裔美国人中不如白人有效。为了给更有效的计划的设计和实施提供信息，我们的研究小组在过去十年中对3项临床试验和一项基于社区的计划进行了拟议的二次数据分析，这将为与减肥计划成功相关的变量提供新的见解。

DESCRIPTION (provided by applicant): The high prevalence and above average severity of obesity in African Americans is of major public health and clinical concern. The overall objective of the proposed studies is to generate critically needed insights about ways to improve the effectiveness of lifestyle behavior weight loss programs in African Americans, particularly women, for whom levels of clinically significant obesity far exceed those in African American men or white women or men. Intervention study designs can be enhanced by reference to empirical information about factors found to be associated with the best weight outcomes in African Americans exposed to various treatment approaches. The approach takes advantage of data sets from three clinical trials and a community program evaluation, conducted by the same research group and using the same core principles of behavioral counseling. Proposed analysis will expand upon published main results of the separate studies and focus particularly on pooled analyses across studies. The randomized clinical trials had 11 to 24 months (depending on the study and on participant enrollment date) of treatment and follow up. The community program evaluation study had 10 to 20 weeks (depending on program delivery site and participant choice) of treatment. Together, the four studies enrolled nearly 900 African Americans (~90% women). There are major advantages to pooling data across these studies, including increased sample sizes overall; increased sample sizes for subgroups of interest, e.g., based on gender, education, age, marital status, health status, or initial level of obesity; variation in patterns of treatment offered and in drop out and attendance at treatment sessions; increased range of weight change for both initial and longer term follow up; and ability to compare weight outcomes in different settings (research clinic, primary care practices, and community organizations). Specific aims are to: 1) characterize study participants according to participation patterns and levels, and patterns of initial weight change outcomes; 2) characterize participants who are able to achieve and maintain clinically significant weight loss; 3) characterize participants with the largest improvements in clinical or psychosocial outcomes such as waist circumference, blood pressure and QoL; and 4) compare weight change and QoL across different treatment settings and modalities. Potential independent variables available in two or more of these data sets reflect motivation, self efficacy, stress, life events, quality of life, social support from family and friends, neighborhood context variables, participation patterns (of interest as both predictors and outcomes), and adherence to behavioral change recommendations. Findings will yield at least four scientific articles describing success factors and addressing potential ways to improve retention, attendance and weight loss outcomes in African Americans who enroll in weight loss programs. PUBLIC HEALTH RELEVANCE: African Americans, particularly women, are at high risk from obesity and related complications, but evidence from efficacy trials indicates that standard obesity treatment approaches are less effective in African Americans than in whites. To inform the design and implementation of more effective programs, the proposed secondary analysis of data from 3 clinical trials and one community-based program conducted by our research group within the last decade will provide new insights into variables related to success in weight loss programs.