Maintenance After Initiation of Nutrition TrAINing (MAINTAIN)

描述(由申请人提供)： 肥胖是美国可预防的死亡的第二大原因，并与多种疾病有关。对于肥胖的人来说，减肥可以改善血压、血脂异常、血糖和关节炎症状，减少几种疾病的药物使用，提高身体功能，并提高与健康相关的生活质量。尽管有这些好处，大多数实现减肥的患者在一年内又恢复了大部分体重，而且几乎没有找到有效的行为体重维持干预措施。因此，迫切需要有效的干预措施来促进减肥维持。理论和实证研究表明，行为维持是一种与最初的行为改变不同的心理过程和行为技能。少数几个测试减肥维持干预措施的试验没有考虑到这种区别，这可能部分解释了他们有限的发现。目前的研究将评估理论上知情的维护干预。如果有效，这种干预可以减少未来去诊所治疗肥胖症及其许多相关疾病的需要，并可以作为重新设计这一举措的模式！程序。这项为期3.5年的研究包括一项双臂随机对照试验。在磨合阶段，330名年龄为75岁、体重指数为30公斤/平方米的退伍军人将参加为期4个月的集体强化减肥计划。在4个月结束时减重至少4公斤的参与者(n~230)将随机接受(A)常规护理(n~115)14个月或(B)理论上知情的维持干预(n~115)10个月，然后4个月不进行干预接触以检查可持续性。维护干预将包括面对面的小组访问，过渡到个性化的电话呼叫，与干预者的联系频率将随着时间的推移而逐渐减少。结果将在随机化时以及随机化后3、6、10和14个月进行评估。我们的假设是，在研究期间，维持干预将导致至少3.5公斤的体重减轻，卡路里摄入量和体力活动得到更大改善，而且与通常的护理相比，它将具有成本效益。

DESCRIPTION (provided by applicant): Obesity is the second leading cause of preventable deaths in the United States and is associated with a wide range of diseases. In people who are obese, weight loss improves blood pressure, dyslipidemia, glycemia, and arthritis symptoms; reduces medication use for several disease processes; increases physical functioning; and enhances health-related quality of life. Despite these benefits, most patients who achieve weight loss regain much of this weight within a year, and few effective behavioral weight maintenance interventions have been identified. Thus, there is a dire need for effective interventions that can promote weight loss maintenance. Theoretical and empirical studies indicate that behavior maintenance is a distinct state that involves different psychological processes and behavioral skills than initial behavior change. The few trials that have tested weight loss maintenance interventions have not taken this distinction into account, which may partially explain their modest findings. The current study will evaluate a theoretically informed maintenance intervention. If effective, this intervention could reduce the need for future clinic visits to treat obesity and its many associated illnesses and could serve as a model for redesigning the MOVE! program. This 3.5-year study involves a two-arm randomized, controlled trial. During the run-in phase, 330 veterans aged d 75 with BMI e30 kg/m2 will participate in a 4-month, intensive, group-based weight loss program. Participants who lose at least 4 kg by the end of 4 months (n~230) will be randomized to receive (a) usual care (n~115) for 14 months or (b) a theoretically-informed maintenance intervention (n~115) for 10 months, followed by 4 months of no intervention contact to examine sustainability. The maintenance intervention will involve in-person group visits that transition to individualized telephone calls, and the frequency of contact with the interventionist will gradually taper over time. Outcomes will be assessed at the time of randomization and at 3, 6, 10, and 14 months post-randomization. Our hypotheses are that the maintenance intervention will result in at least 3.5 kg greater weight loss and greater improvements in caloric intake and physical activity over the study period, and that it will be cost-effective, compared to usual care.