Addressing Body Image in Weight Management: An Overlooked Risk Factor for Poor Treatment Outcome Among Women

项目摘要 这一以患者为导向的职业发展奖(K23)旨在促进KayLoni医生的发展 作为一名独立的临床研究科学家，奥尔森专注于开发干预措施来解决 导致个体在行为体重管理中的变异性和不良结果。超重和肥胖 仍然是对公共健康的主要威胁，并对美国的医疗保健成本做出了重大贡献。 标准行为体重管理(SBT)有助于临床上显著减轻许多人的体重 但治疗结果存在差异。高度关注体重和形状(WSC)与较少相关 女性在行为体重管理中的体重减轻。对这种关系的一个潜在解释是 WSC高的人对体重/身材有更多的负面想法，这会导致 暴饮暴食。因此，我们建议使用肥胖相关行为干预试验指南 改进经验支持的WSC疗法(Body Project：BP)以提高成年女性的适宜性 对超重或肥胖的患者，可提高治疗效果。该协议将使用以下工具迭代改进 探索性序贯混合方法更有力地针对超重或肥胖女性的WSC 肥胖和确保目标样本的可接受性(目标1)。修订后的议定书将在 随机先导试验，以评估联合SBT的疗效(目标2)。在试点试验中，60名患有 超重或肥胖那些报告WSC高并想要减肥的人将被招募。他们将被随机化 接受为期四周的WSC干预(改良BP)或为期四周、仅接受教育的对照条件。全 参与者随后将接受为期24周的SBT。WSC和体重将在基线、4周和 在减肥24周后。EMA将用于评估负体重/形状相关的治疗效果 在整个治疗过程中出现思想和暴饮暴食的情况。为了进行这个项目，申请者需要完成一份 严格、有针对性的培训计划，以获得项目成功所必需的关键技能，并为 作为肥胖研究人员的独立申请者。增长的关键领域包括1)行为 干预发展，2)肥胖污名是WSC的贡献者，3)生态瞬时评估，4) 先进的量化方法来评估治疗结果、调节和调节因素，以及5) 职业发展。这项培训将在Rena Wing博士的主要指导下进行， 共同导师拉尼·埃尔维博士、丽贝卡·普尔、格雷厄姆·托马斯、希拉·邓西格和撰稿人梅根·布特林博士。 所获得的技能直接映射到建议项目的要素上，但也使申请者能够扩展 她在创新方向上的研究计划。该指导团队与基础设施相结合 和通过Miriam医院和体重控制和糖尿病研究中心提供的资源， 代表理想的环境来完成申请者的培训目标，促进职业发展 并确立申请人作为独立临床肥胖症研究人员的自主权。

Project Summary This Patient-Oriented Career Development Award (K23) is designed to promote the development of Dr. KayLoni Olson as an independent, clinical research scientist focused on developing interventions to address factors that contribute to individual variability and poor outcomes in behavioral weight management. Overweight and obesity remain a major threat to public health and contribute significantly to health care costs in the United States. Standard behavioral weight management (SBT) facilitates clinically significant weight loss for many individuals but there is variability in treatment outcome. High weight and shape concern (WSC) is associated with less weight loss among women in behavioral weight management. One potential explanation for this relationship is that individuals with High WSC have more frequent negative thoughts about weight/shape which lead to overeating episodes. We therefore propose to use the Obesity-Related Behavioral Intervention Trials guidelines to refine an empirically-supported WSC treatment (the Body Project: BP) to increase suitability for adult women with overweight or obesity and enhance treatment effects. The protocol will be iteratively refined using exploratory sequential mixed methodology to more powerfully target WSC among women with overweight or obesity and to ensure acceptability to the target sample (Aim 1). The revised protocol will be tested in a randomized pilot trial to evaluate effects when combined with SBT (Aim 2). For the pilot trial, 60 women with overweight or obesity who report High WSC and want to lose weight will be recruited. They will be randomized to either a four-week WSC intervention (modified-BP) or a four-week, education-only control condition. All participants will then receive 24-week SBT. WSC and body weight will be assessed at baseline, 4 weeks, and after 24 weeks of weight loss. EMA will be utilized to evaluate treatment effects on negative weight/shape-related thoughts and overeating episodes throughout treatment. To conduct this project the applicant will complete a rigorous, targeted training program to acquire key skills necessary for the success of the project and to prepare the applicant for independence as an obesity researcher. Key areas for growth including 1) behavioral intervention development, 2) obesity stigma as a contributor to WSC, 3) ecological momentary assessment, 4) advanced quantitative methods to assess treatment outcomes, moderating and mediating factors, and 5) professional development. This training will be conducted under the primary mentorship of Dr. Rena Wing, with co-mentors Drs. Rani Elwy, Rebecca Puhl, Graham Thomas, Shira Dunsiger, and contributor Dr. Meghan Butryn. The skills acquired map directly onto elements of the proposed project but also position the applicant to expand her program of research in innovative directions. This mentorship team, in combination with the infrastructure and resources available through The Miriam Hospital and the Weight Control and Diabetes Research Center, represent the ideal environment to accomplish the applicant’s training goals, foster professional development and establish the applicant’s autonomy as an independent clinical obesity researcher.