Opt-IN: Optimizing INtensive Lifestyle Intervention for Weight Loss

描述(申请人提供)：肥胖是一个普遍存在的公共健康问题，但最有效的减肥治疗一直是面对面的密集生活方式干预(INLI)，成本太高，负担太大，无法推广。然而，最近，我们的顾问劳伦斯·阿佩尔进行的一项重要的比较有效性试验表明，通过网络授课和通过电话进行指导的技术支持的减肥INLI可能与亲自治疗一样有效。这些发现表明，开发比之前认为的更具资源效率的肥胖症治疗方法可能是可行的。我们建议应用一个创新的方法框架，多阶段优化战略(MOST)14，以改进远程提供的、技术支持的密集生活方式干预肥胖。与之前几乎所有治疗INLI的研究不同 作为捆绑的“治疗方案”，MOST在单个干预组件上实施有效的实验，以确定哪些可以减少、消除或替换以提高效率。然后，这些信息指导最佳、全面的一揽子治疗方案的组装，当与核心干预(CORE)相结合时，以最低的资源消耗和参与者负担实现目标结果。这项拟议的实验量化了五种实验性治疗成分对560名成年人6个月体重减轻的影响。这些组成部分是：1.指导电话的数量[24或12]；2.短信支持[是或否]；3.初级保健提供者(PCP)联系[是或否]；4.伙伴培训[是或否]；5.推荐的膳食替代[是或否])。通过作用于社会认知理论假设的行为改变的社会认知中介(自我效能、自我调节、支持性责任、促进)，选择了五个组成部分来促进对肥胖治疗的坚持。研究结果将被应用于建立一种新的选择加入干预措施，该干预措施只由主动组件组成，可用500美元或更少的费用实施。由于这样的干预措施既有效又可扩展，它将大大扩大覆盖范围，并在抗击肥胖方面取得重大进展。 与公共健康相关：最近的研究结果表明，通过使用技术和远程指导人们，可能会使肥胖治疗更有效，负担更少。Opt-In研究应用了一种新的研究方法来测试哪些治疗成分可以减少、消除或更换，以最大限度地减少消费者负担和资源利用，同时仍能实现减肥。。

DESCRIPTION (provided by applicant): Obesity is a pervasive public health problem, yet most effective weight loss treatments have been in-person Intensive Lifestyle Interventions (INLIs) that are too costly and burdensome to scale. Recently though, an important comparative effectiveness trial conducted by our consultant, Lawrence Appel demonstrated that a technology-supported weight loss INLI that delivered lessons via the web and coaching via telephone could be as effective as in-person treatment. Those findings suggest that it may be feasible to develop more resource- efficient obesity treatment than was previously believed possible. We propose to apply an innovative methodological framework, the Multiphase Optimization Strategy (MOST) 14, to improve a remotely delivered, technology-supported intensive lifestyle intervention for obesity. Unlike nearly all previous research which treats INLI as a bundled "treatment package," MOST implements efficient experimentation on individual intervention components to determine which could be reduced, eliminated, or replaced to improve efficiency. This information then guides assembly of an optimal, comprehensive treatment package that, when combined with a core intervention (CORE), achieves target outcomes with least resource consumption and participant burden. The proposed experiment quantifies the effects of five experimental treatment components on 6 month weight loss among 560 adults. The components are: 1. Number of coaching calls [24 or 12]; 2. Text Message support [yes or no]; 3. Primary Care Provider (PCP) contact [yes or no]; 4. Buddy training [yes or no]; 5. Meal replacements recommended [yes or no]). The five components were selected to foster adherence to obesity treatment by acting upon social cognitive mediators of behavior change that are posited by social-cognitive theory (self-efficacy, self-regulation, supportive accountability, facilitation). Findings will be applied to build a new Opt-IN intervention made up of only active components and implementable for $500 or less. Because such an intervention will be both effective and scalable, it will enjoy greatly increased reach and make significant progress in the fight against obesity. PUBLIC HEALTH RELEVANCE: Recent findings suggest that it may be possible to make obesity treatment more efficient and less burdensome by using technology and coaching people remotely. The Opt-IN study applies a new research method to test which treatment components can be reduced, eliminated, or replaced to minimize consumer burden and resource utilization, while still achieving weight loss. .