Opt-IN: Optimizing INtensive Lifestyle Intervention for Weight Loss

描述（由申请人提供）：肥胖是一个普遍的公共卫生问题，但最有效的减肥治疗是面对面的强化生活方式干预（INLI），成本太高，负担太重，无法扩展。最近，我们的顾问进行了一项重要的比较有效性试验，劳伦斯阿佩尔证明，通过网络提供课程和通过电话进行辅导的技术支持的减肥INLI可以与面对面治疗一样有效。这些发现表明，开发比以前认为可能的更节省资源的肥胖治疗方法可能是可行的。我们建议应用创新的方法框架，多阶段优化策略（MOST）14，以改善远程交付，技术支持的密集的生活方式干预肥胖。不像几乎所有以前的研究， 作为一个捆绑的“一揽子治疗方案”，社会变革管理计划对各个干预组成部分进行有效的试验，以确定哪些可以减少、取消或取代，以提高效率。然后，这些信息指导最佳综合治疗方案的组装，当与核心干预（CORE）相结合时，以最少的资源消耗和参与者负担实现目标结果。所提出的实验量化了五种实验治疗组分对560名成年人6个月体重减轻的影响。这些组件是：1.教练电话的数量[24或12]; 2.文本消息支持[是或否]; 3.初级保健提供者（PCP）联系人[是或否]; 4.伙伴培训[是或否]; 5.推荐的膳食替代品[是或否]）。选择这五个组成部分，通过作用于社会认知理论（自我效能、自我调节、支持性责任、促进）所假设的行为改变的社会认知介质，来促进对肥胖治疗的坚持。研究结果将被应用于建立一个新的Opt-IN干预措施，只由活性成分组成，可实施500美元或更少。因为这样的干预措施将是有效的和可扩展的，它将大大增加覆盖面，并在对抗肥胖方面取得重大进展。

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.