Acceptance-based behavioral treatment for obesity: Maintenance and Mechanisms.

描述（由申请人提供）：肥胖症已变得如此普遍，现在被认为是一种国家和全球流行病。药物、手术和环境干预的局限性表明，迫切需要行为方案。然而，标准的行为治疗在长期内效果甚微，大多数参与者最终会恢复他们失去的体重。体重反弹可以追溯到参与者在遵循推荐的饮食和体育活动处方方面的困难，这似乎与不可改变的生物驱动力和内部（例如，悲伤、焦虑、渴望）和外部（例如，美味的食物和省力的设备的存在）提示。在我们的实验室中，我们发现抵抗这些暗示的能力得到了提高痛苦耐受力的干预措施的支持（例如，对负面影响的耐受性，对食物的渴望），对内部状态的当下意识以及这些如何影响行为（即，元认知意识），以及对个人价值的清晰度。特别是，我们已经表明，接受为基础的行为干预，其中包括这些策略，有希望控制体重。我们的NIH资助的试点研究表明，对于那些报告抑郁水平较高，对食物的心理反应以及内部和外部暗示饮食的参与者，基于接受的策略对减肥的影响特别强烈。拟议项目的主要目标是评估ABT相对于金标准的长期疗效 肥胖症的行为治疗次要目标是在主动干预期间和治疗后体重减轻维持阶段测试两种治疗的假设作用机制。基于我们最近的工作，使用基于实验室的行为测量和重复管理，生态瞬时评估（EMA），以更好地了解采用和保持健康行为选择的挑战，我们将使用这两种测量策略来最准确地捕捉因果途径，以在当下饮食和体力活动失误。EMA提供了相当大的优势，回顾性自我报告，这是受不准确和偏见。我们还旨在评估适度的假设，说明ABT的优越性将特别明显，对于那些有更大的情绪障碍，对食物环境的敏感性，以及内部和外部disinhibited饮食。我们的目标是实现更长期的目标，即利用证据最大限度地提高干预措施的有效性，将患者与治疗类型相匹配，并开发实时干预措施，旨在纠正自然发生的有问题的饮食和身体活动决策。因此，我们将随机分配200名超重参与者参加24次ABT或SBT，为期一年。将对所有受试者进行随访，直至基线后36个月。EMA和基于实验室的行为评估将允许更有效地测量调节和介导途径，包括内部状态之间的关系及其对行为的影响，以及这些关联如何受到治疗的影响。 公共卫生相关性：肥胖是美国的主要死亡原因，治疗肥胖是国家卫生优先事项。该项目的主要目标是评估创新减肥干预的有效性。 这种干预将帮助参与者学习 以可持续的方式改变他们的饮食和锻炼行为的技能。

DESCRIPTION (provided by applicant): Obesity has become so prevalent it is now considered a national and global epidemic. The limitations of pharmacologic, surgical and environmental interventions point to the critical need for behavioral programs. However, standard behavioral treatments are only minimally effective in the long term, with most participants eventually gaining back their lost weight. Weight regain can be traced to participants' difficulty following recommended diet and physical activity prescriptions, which appears tied to immutable biological drives and internal (e.g., sadness, anxiety, cravings) and external (e.g., presence of delicious foods and labor- saving devices) cues. In our lab we have found that the ability to resist these cues is bolstered by interventions that increase distress tolerance (e.g., tolerance of negative effect, food cravings), present-moment awareness of internal states and how these may be affecting behavior (i.e., metacognitive awareness), and clarity about one's personal values. In particular, we have shown that acceptance-based behavioral interventions, which incorporate these strategies, have promise for weight control. Our NIH-funded pilot study demonstrated an especially strong effect of acceptance-based strategies on weight loss for participants who reported higher levels of depression, psychological responsivity to food, and internally and externally-cued eating. The primary goal of the proposed project is to evaluate the longer-term efficacy of ABT in relation to gold standard behavioral treatment for obesity. A secondary goal is to test hypothesized mechanisms of action of the two treatments, both during active intervention and during the post-treatment weight loss maintenance phase. Building on our recent work using lab-based behavioral measures and repeatedly-administered, ecological momentary assessment (EMA) to better understand the challenges of adopting and maintaining healthful behavior choices, we will use both these measurement strategies to most accurately capture causal pathways to in-the-moment eating and physical activity lapses. EMA offers considerable advantages over retrospective self-reports which are subject to inaccuracies and biases. We also aim to evaluate moderation hypotheses stating that the superiority of ABT will be especially pronounced for those with greater mood disturbance, sensitivity to the food environment, and internal and external disinhibited eating. Our aims work towards longer-range goals of using evidence to maximize the most effective components of interventions, matching patients to treatment type, and developing real-time interventions aimed at correcting problematic eating and physical activity decisions as they occur naturalistically. Accordingly, we will randomly assign 200 overweight participants to 24 sessions of ABT or SBT, delivered over one year. All participants will be followed until 36 months post-baseline. EMA and lab-based behavioral assessments will allow more valid measurement of moderating and mediating pathways including the relationship between internal states and their impact on behavior, and how these associations are affected by treatment. PUBLIC HEALTH RELEVANCE: Obesity is a leading cause of death in the U.S, and efforts to treat it are a national health priority. The primary goal of the proposed project is to evaluate th efficacy of an innovative weight loss intervention. This intervention will help participants learn skills for changing their diet and exercise behaviors in sustainable ways.