Addressing Weight Bias Internalization to Improve Adolescent Weight Management Outcomes

项目摘要/摘要 体重偏向内化(WBI)，或自我导向的基于体重的污名，与许多 肥胖青少年的负面身心健康后果，包括负体重- 相关结果(例如，卡路里消耗增加，减肥效果较差)。流行率和 WBI作为压力源影响青少年体重相关结果的显着性与异质性 对青少年肥胖干预的反应突出了联合干预的潜在效用 体重指数和青少年肥胖在这一关键发育阶段促进改善体重管理结果 句号。这项K23奖项旨在填补我培训中的空白，并支持一项研究研究，该研究将提供Next 改善肥胖青少年健康的步骤。研究项目的第一阶段将采用 焦点小组和开放的试点试验，以开发和测试综合干预的可行性 采用循证青少年行为体重控制(BWC)治疗WBI。然后我将进行一次 小型随机对照试验，以检验新设计的WBI+BWC干预对WBI的影响和体重变化的机制 柱头应激导致体重增加，特别是应激的生理标志物(昼夜皮质醇)和炎症 (C-反应蛋白、白介素6)和失调的饮食行为(情绪化进食、失控、不健康 体重控制行为)。我假设《生物武器公约》结合对WBI的干预，将导致改善 在体重-耻辱压力诱导体重增加的机制中，反过来又促进了减肥效果的改善。 本研究对改善青少年体重指数、减少体重指数具有重要的临床意义 青少年因体重而蒙受耻辱的负面影响。进行这项研究并填补关键的空白 我的培训将有助于成为一名专注于肥胖行为治疗的独立调查员 在青少年时期，我将完成一项严格的、有针对性的培训计划。拟议的培训计划包括 发展以下方面的专门知识：1)开展随机对照试验，为青少年制定和测试《生物武器公约》干预措施；2)理论 以及基于体重的污名和WBI的概念模型；3)临床试验中机制的整合 关于生物标记物和失调的饮食行为；4)职业发展。这次培训将是 在Elissa Jelian博士的主要指导下进行，共同指导Rebecca Puhl博士，Stephanie 撰稿人：David Barker博士，David Barker博士。我将获得的技能直接映射到 建议的研究项目，并提供必要的知识和专业知识，以准备成功的R01 在授权期结束前提出申请。导师团队，结合严谨的学术和 由Miriam医院体重控制和糖尿病研究中心提供的培训环境和 布朗大学是实现这些培训和研究目标的理想环境。通过这件事 职业发展奖，我将把自己确立为一名致力于发展的独立调查员 采取新的干预措施，改善肥胖青少年的健康状况。

PROJECT SUMMARY/ABSTRACT Weight bias internalization (WBI), or self-directed weight-based stigma, has been associated with a number of negative physical and mental health consequences for adolescents with obesity, including negative weight- related outcomes (e.g., increased calorie consumption, poorer weight loss outcomes). The prevalence and salience of WBI as a stressor impacting weight-related outcomes in adolescents paired with the heterogeneous response to interventions for adolescents with obesity highlights the potential utility of combined intervention for WBI and obesity in youth to promote improved weight management outcomes during this critical developmental period. This K23 award is designed to fill gaps in my training and support a research study that will provide next steps in improving the health of adolescents with obesity. The first phase of the research project will employ focus groups and an open pilot trial to develop and test feasibility of an integrated intervention that combines treatment for WBI with an evidence-based adolescent behavioral weight control (BWC). I will then conduct a small RCT to test the effects of the newly designed WBI+BWC intervention on WBI and mechanisms of weight- stigma stress induced weight gain, specifically physiological markers of stress (diurnal cortisol) and inflammation (c-reactive protein, interleukin-6), and dysregulated eating behaviors (emotional eating, loss of control, unhealthy weight control behaviors). I hypothesize that BWC combined with intervention for WBI, will lead to improvements in mechanisms of weight-stigma stress induced weight gain, in turn promoting improved weight loss outcomes. This research project has significant clinical implications for the improvement of adolescent BWC and reduction of the negative effects of weight-based stigma in adolescents. To conduct this research and fill critical gaps in my training that will facilitate becoming an independent investigator focused on behavioral treatment of obesity in adolescents, I will complete a rigorous, targeted training program. The proposed training plan includes developing expertise in 1) conducting RCTs to develop and test BWC interventions for adolescents; 2) theoretical and conceptual models of weight-based stigma and WBI; 3) integration of mechanisms in clinical trials focused on biological markers and dysregulated eating behaviors; and 4) professional development. This training will be conducted under the primary mentorship of Dr. Elissa Jelalian, with co-mentors Drs. Rebecca Puhl, Stephanie Parade, Andrea Goldschmidt, and contributor Dr. David Barker. The skills I will acquire map directly onto the proposed research project and provide the knowledge and expertise necessary to prepare a successful R01 application by the end of the award period. The mentorship team, in combination with the rigorous academic and training environment provided by the Weight Control and Diabetes Research Center at The Miriam Hospital and Brown University, represent an ideal environment to accomplish these training and research goals. Through this Career Development Award, I will establish myself as an independent investigator dedicated to the development of novel interventions to improve health outcomes for adolescents with obesity.