Environmental and Acceptance-Based Innovations for Weight Loss Maintenance

描述(由申请人提供)：基于环境和接受度的减肥维持创新肥胖是一种严重和普遍的健康问题，具有广泛的医疗、心理和经济后果。虽然行为疗法(BT)是非手术方法中的黄金标准，但体重恢复通常在治疗结束后不久开始；这些计划中几乎所有减轻的体重都在治疗后5年恢复。有几个因素似乎使减肥的维持具有挑战性，包括肥胖的食物环境，食物的回报价值，以及节省劳动力的设备和减少能源消耗的建筑环境。改进BT计划的一个有希望的方法是教参与者如何修改他们的个人食物和身体活动环境，以便为理想的体重控制行为提供最大的支持。干预措施可包括改变家庭食物的类型、营养成分、种类和份量；改变家庭运动器材和久坐不动的活动的可用性；增加饮食和运动选择后果的突出程度；以及获得对环境变化的支持。改进BT项目的第二种创新方法是纳入接受与承诺疗法(ACT)的组成部分，以(A)增强参与者对行为改变的承诺，(B)培养承受痛苦的技能，以及(C)促进对与体重相关的行为和目标的意识。这些技能应该会提高长期遵守饮食和体力活动建议(从而保持减肥)的能力。我们预计，这些处理组成部分和环境处理组成部分之间将产生协同作用，并具有互补性。维持一个有利于体重控制的家庭环境需要承诺、耐受性和意识，因为个人必须做出关于环境修改的决定并保持这些修改。此外，家庭环境方法也有局限性，因为个人将继续遇到许多具有挑战性的情况，在这些情况下，他们无法对环境进行任何有意义的修改；基于接受的技能可能会在这种具有挑战性的情况下促进健康的选择。作为组合方法的测试，参与者将被随机分配到三种条件之一：1)BT，2)BT+修改家庭环境(BT+E)，或3)BT+修改家庭环境和接受技能培训(BT+EA)。治疗将持续一年。参与者将是从社区招募的297名超重和肥胖个人。30%的参与者将是少数民族。评估将在基线和6个月、12个月(治疗结束)、18个月(即6个月后续行动)和24个月(即12个月后续行动)时完成。这项研究的主要目的是检验这样一种假设，即在12个月的随访中，处于BT+EA状态的参与者将比处于BT状态的参与者保持更多的体重减轻。二级目标将比较BT+EA与BT+E、BT+E与BT的减肥效果，并检查饮食摄入量和体力活动作为结果。探索性目标将检查治疗结果的调解和缓和。

DESCRIPTION (provided by applicant): Environmental and Acceptance-Based Innovations for Weight Loss Maintenance Obesity is a serious and prevalent health problem with widespread medical, psychosocial and economic consequences. Although behavior therapy (BT) is the gold standard among non-surgical approaches, weight regain usually begins shortly after treatment ends; nearly all of weight lost in these programs is regained by 5 years after treatment. Several factors appear to make weight loss maintenance challenging including the obesogenic food environment, the rewarding value of food, and labor-saving devices and a built environment that reduce energy expenditure. One promising way of improving BT programs is to teach participants how to modify their personal food and physical activity environment so that it provides maximal support for desirable weight control behaviors. Intervention components can include modifying the type, nutritional composition, variety, and portion size of food available at home; modifying the availability of exercise equipment and sedentary activities in the home; increasing the saliency of the consequences of eating and exercise choices; and obtaining support for environmental changes. A second innovative way of improving BT programs is to incorporate components of Acceptance and Commitment Therapy (ACT) in order to (a) bolster participants' commitment to behavior change, (b) build distress tolerance skills, and (c) promote mindful awareness of weight-related behaviors and goals. Such skills should improve long-term adherence to dietary and physical activity recommendations (and therefore weight loss maintenance). We expect that there will be a synergy and a complementary nature between these treatment components and the environmental treatment components. Maintaining a home environment that facilitates weight control requires commitment, distress tolerance, and awareness, because individuals must make decisions about environmental modifications and maintain these modifications. Additionally, there are limits to the home environment approach because individuals will continue to encounter many challenging situations in which they cannot modify the environment to any meaningful extent; acceptance-based skills may promote healthy choices in such challenging situations. As a test of the combined approach, participants will be randomly assigned to one of three conditions: 1)BT, 2) BT plus modifying the home environment (BT+E), or 3) BT plus modifying the home environment and training in acceptance-based skills (BT+EA). Treatment will last 1 year. Participants will be 297 overweight and obese individuals recruited from the community. Thirty percent of participants will be ethnic minorities. Assessments will be completed at baseline and Months 6, 12 (end of treatment), 18 (i.e., 6-month follow-up), and 24 (i.e., 12- month follow-up). The primary aim of the study is to test the hypothesis that participants in the BT+EA condition will maintain more weight loss than those in the BT condition at 12-month follow-up. Secondary aims will compare weight loss in BT+EA vs. BT+E, and BT+E vs. BT, and examine dietary intake and physical activity as outcomes. Exploratory aims will examine mediation and moderation of treatment outcome.