Designing a mobile intervention for dysregulated eating and weight gain prevention in adolescents

项目总结/摘要 儿童超重和肥胖仍然是主要的公共卫生问题。饮食失控（Loss of Control） 暴饮暴食是两种肥胖相关的表型，影响约30%的超重/肥胖青少年， 影响体重控制治疗效果。很少有得到医疗支助的干预措施， 这些行为来促进青少年的体重调节。认知行为疗法（CBT） 对饮食失调有很好的效果，但对体重的影响往往不大。重要的是，CBT未能 充分解决自我调节的发展变化，这可能会限制CBT技能的利用， 最需要它们的时刻和背景。此外，CBT是昂贵的，时间密集的， 对大多数青少年来说是难以接近的。数字干预措施克服了许多这些障碍，因此可能是一种 实现参与和规模的最佳形式，特别是考虑到技术在 青少年。我们的团队测试了唯一针对饮食和体重失调的数字CBT干预措施 在超重/肥胖的青少年中，虽然对体重和饮食的影响是有希望的，但改善了 设计和更新的交付模式（即，需要智能手机）来加强参与和临床 结果。为了实现最佳参与和效力，这些干预措施应围绕 发展适当的理论模型，并根据用户的需求和偏好。在当前 根据这一建议，我们将采用以用户为中心的设计方法，设计和测试一种新的基于CBT的数字 干预，增加内容和功能，以改善自我调节，预防体重增加， 青少年饮食失调干预将解决行为，生理，情感， 影响饮食和体重控制的环境过程，受自我调节理论的影响， 以造型设计工作为指导，确保内容和功能符合青少年的需要， 是谁的意思。第一阶段将涉及设计活动与青少年谁有或有风险， 超重/肥胖和报告饮食失调，以了解所需的包装/介绍，特点， 和参与的障碍/促进因素。研究活动将包括需求评估和迭代 原型设计、可用性测试和数字干预的改进。第二阶段将是多站点 单组开放试验，涉及50名超重/肥胖或有超重/肥胖风险的青少年， 和/或暴饮暴食，以调查干预的可行性和初步疗效，以及推定的治疗 机制和目标。该研究的结果将直接为设计一个更大的，有足够动力的 随机对照试验，将有助于推进科学和临床的最佳治疗的理解 针对有饮食和体重相关问题的青少年的策略。此外，该项目具有明显的潜力， 通过制定相关的、可获得的和可扩展的干预措施， 青少年成人肥胖和饮食失调的高风险，以及相关的不良健康状况。

PROJECT SUMMARY/ABSTRACT Pediatric overweight and obesity continue to be major public health issues. Loss of control (LOC) eating and overeating are two obesity-related phenotypes affecting ~30% of adolescents with overweight/obesity that may undermine weight control treatment outcome. There are very few empirically-supported interventions targeting these behaviors to promote weight regulation in adolescents. Cognitive-behavioral therapy (CBT) has promising effects on dysregulated eating, but effects on weight are often modest. Importantly, CBT fails to adequately address developmental changes in self-regulation, which may limit CBT skill utilization in the moments and contexts in which they are needed most. Moreover, CBT is costly, time intensive, and inaccessible to most teens. Digital interventions overcome many of these barriers and hence may be an optimal format for achieving engagement and scale, especially given the ubiquity of technology usage in adolescents. Our group has tested the only digital CBT interventions targeting dysregulated eating and weight in adolescents with overweight/obesity, and while effects on weight and LOC eating were promising, improved design and updated delivery modes (i.e., Smartphone) are needed to strengthen engagement and clinical outcomes. To achieve optimal engagement and efficacy, such interventions should be built around developmentally appropriate theoretical models and informed by user needs and preferences. In the current proposal, we will apply user-centered design methods to design and test a novel CBT-based digital intervention, augmented with content and features to improve self-regulation, for weight gain prevention and dysregulated eating in adolescents. The intervention will address behavioral, physiological, affective, and environmental processes that impact eating and weight control, informed by self-regulation theories, and will be guided by formative design work to ensure that content and features meet the needs of adolescents for whom it is intended. The first phase will involve design activities with adolescents who have or are at risk for overweight/obesity and report dysregulated eating, to understand desired packaging/presentation, features, and barriers/facilitators to engagement. Research activities will include a needs assessment and iterative prototyping, usability testing, and refinement of the digital intervention. The second phase will be a multisite single arm open trial involving 50 adolescents who have or are at risk for overweight/obesity and report LOC and/or overeating to investigate intervention feasibility and preliminary efficacy, as well as putative treatment mechanisms and targets. Results of the study will directly inform design of a larger, adequately-powered randomized controlled trial and will help advance scientific and clinical understanding of optimal treatment strategies for adolescents with eating- and weight-related problems. Further, the project has clear potential to significantly impact public health via development of a relevant, accessible, and scalable intervention for adolescents at high risk for adult obesity and eating disorders, and related adverse health conditions.