Improving Obesity Self-care Among Mentally Ill Veterans

描述（由申请人提供） 研究项目描述：肥胖是退伍军人中一个不断升级的健康问题，与慢性疾病，残疾和早期死亡率的风险增加有关。与没有精神疾病的人相比，患有精神疾病的肥胖退伍军人在体重管理方面遇到更大的困难。心理变量对参与和维持肥胖自我护理习惯造成障碍。抑郁和焦虑症状的减少与成功的体重管理有关，这反过来又会改善健康状况。尽管高共存率和证据将心理健康症状的改善与改善参与和维持适当的体重管理联系起来，但大多数肥胖自我护理干预措施对改善共存的焦虑和抑郁症状的关注很少或根本没有。拟议的研究项目将：（1）检查心理障碍的参与，坚持和结果的证据为基础的体重管理计划（移动！）（2）将抑郁和焦虑的治疗整合到MOVE！以提高保留率、坚持和随后的体重减轻。我以前的研究，临床和指导经验使我独特地准备进行这项研究。候选人的近期和长期职业目标：我的总体职业目标是建立自己作为一个独立的康复研究人员与肥胖的退伍军人与共存的精神疾病之间的体重管理的专业知识。我的短期职业目标包括获得RR&D CDA-2奖，该奖项将提供所需的保护时间和临床，指导和研究经验，以促进发展成为一名独立的康复研究人员。我的长期研究目标是修改基于证据的体重管理策略，以改善身体健康结果，临床实践和政策，为肥胖的退伍军人提供最大的残疾风险。研究职业发展计划的关键要素：我将获得额外的教学和指导经验，以扩大我在开发和测试基于证据的肥胖自我护理行为干预方面的专业知识，使用临床试验方法将心理健康治疗纳入体重管理干预，了解如何在VA康复护理线和VA RR&D项目中整合基于证据的体重管理策略，并获得RR&D IIR优异奖，以实现研究独立。设施及其他资源：我很幸运地成为医学系的一名初级教员，在休斯顿护理质量和利用研究中心（COE）担任主要职务，在动脉粥样硬化和血管医学中担任次要职务，并成为Michael E. DeBakey VA医疗中心。每个设置都有自己独特的资源可供我使用。其中一些资源包括，电子图书馆访问，研究和职业发展教学法和讲习班，统计学家，一些高级NIH和VA调查员，赠款写作讲习班，以及各种软件包。

DESCRIPTION (provided by applicant) Description of the research project: Obesity is an escalating health problem among Veterans that is associated with increased risk of chronic disease, disability and early mortality rates. Obese Veterans with co-existing mental illness experience greater difficulties with weight management in comparison to those without mental illness. Psychological variables create barriers to engagement and maintenance of obesity self-care habits. Decreased symptoms of depression and anxiety have been associated with successful weight management which in turn can lead to improved health status. Despite the high coexistence rates and evidence linking improvements in mental health symptoms to improved engagement and maintenance of appropriate weight management, most obesity self-care interventions provide minimal to no attention to improving co-existing anxiety and depression symptoms. The proposed research projects will: (1) examine psychological barriers to participation, adherence and outcomes of an evidenced based weight management program (MOVE!) and (2) integrate depression and anxiety treatment into MOVE! to improve retention rates, adherence and subsequent weight loss. My previous research, clinical and mentorship experiences make me uniquely poised to conduct this study. Candidate's immediate and long-term career goals: My overall career aim is to establish myself as an independent rehabilitation researcher with expertise in weight management among obese Veterans with co-existing mental illnesses. My short term career goals include securing a RR&D CDA-2 award that will provide the needed protected time and clinical, mentoring and research experiences to advance develop into an independent rehabilitation researcher. My long-term research goals are to modify evidenced based weight management strategies to improve physical health outcomes, clinical practice, and policy for obese Veterans at the greatest risk for disability. Key elements of the research career development plan: I will receive additional didactic and mentorship experiences to expanding my expertise in developing and testing evidence based obesity self-care behavioral interventions, integrating mental health treatments into weight management interventions using clinical trial methodology, gaining an understanding how to integrate evidenced based weight management strategies in a VA rehabilitation care line and VA RR&D project, and secure an RR&D IIR Merit award to attain research independence. Facilities & Other Resources: I am fortunate to be a junior BCM faculty member in the department of medicine with a primary appointment in the Houston Center for Quality of Care and Utilization Studies (COE) and secondary appointment in Atheroscleorsis and Vascular Medicine and to be an MIRECC Investigator for the Michael E. DeBakey VA Medical Center. Each setting has its own unique resources that are available for my use. Some of these resources include, electronic library access, research and career development didactics and workshops, statisticians, several senior NIH and VA investigators, grant writing workshops, and a variety of software packages.