Environmental and Acceptance-Based Innovations for Weight Loss Maintenance

描述（由申请人提供）：基于环境和接受的减肥维持创新肥胖是一种严重和普遍的健康问题，具有广泛的医学，社会心理和经济后果。虽然行为疗法（BT）是非手术治疗的金标准，但体重反弹通常在治疗结束后不久就开始了；几乎所有在这些项目中减掉的体重在治疗5年后都恢复了。有几个因素似乎使减肥维持具有挑战性，包括致肥性食物环境、食物的奖励价值、节省劳动力的设备和减少能量消耗的建筑环境。改善BT计划的一个有希望的方法是教参与者如何改变他们的个人饮食和体育活动环境，以便为理想的体重控制行为提供最大的支持。干预成分可包括改变家中可用食物的类型、营养成分、种类和份量；改变家中运动器材和久坐活动的可用性；增加饮食和运动选择的后果的显著性；并获得对环境变化的支持。改进BT项目的第二个创新方法是将接受和承诺疗法（ACT）的组成部分结合起来，以(A)增强参与者对行为改变的承诺，(b)建立痛苦容忍技能，(c)促进对体重相关行为和目标的正念意识。这样的技巧可以提高长期坚持饮食和体育活动建议（从而维持减肥）。我们期望在这些处理组件和环境处理组件之间会有协同作用和互补的性质。维持一个有利于控制体重的家庭环境需要承诺、痛苦容忍和意识，因为个人必须对环境的改变做出决定并维持这些改变。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，他们无法在任何有意义的程度上改变环境；基于接受的技能可以促进在这种具有挑战性的情况下做出健康的选择。作为综合方法的测试，参与者将被随机分配到三个条件中的一个：1)BT, 2) BT加改造家庭环境（BT+E），或3)BT加改造家庭环境和接受技能培训（BT+EA）。治疗将持续1年。参与者将从社区招募297名超重和肥胖者。30%的参与者将是少数民族。评估将在基线和第6、12（治疗结束）、18（即6个月随访）和24（即12个月随访）个月完成。本研究的主要目的是验证一种假设，即在12个月的随访中，BT+EA状态的参与者比BT状态的参与者保持更多的体重减轻。次要目标将比较BT+EA与BT+E、BT+E与BT的体重减轻情况，并检查饮食摄入量和身体活动作为结果。探索性目的将检验治疗结果的调解和调节。

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.