Ecological Momentary Assessment of Behavioral and Psychosocial Predictors of Weight Loss Following Bariatric Surgery

 描述（由申请人提供）：减肥手术是产生显著和持久减肥的有力工具。然而，并不是所有的患者都能达到最初的减肥成功，许多患者早在手术后1-2年就恢复了体重。不完全由手术，人口统计学和医学因素解释的次优体重减轻模式导致更加重视患者行为，这些行为由临床指南证明，重点是适当的饮食和体育活动。然而，为这些指南提供信息的研究通常依赖于不精确的测量方法，或者不是针对减肥手术的。也很少有人了解 心理社会因素影响结果的机制。因此，需要：（a）使用创新策略测量被认为与手术结果相关的行为和心理社会因素（特别是指南中强调的那些），以最大限度地提高数据质量，（B）确定哪些行为和心理社会因素与结果相关，以及（c）探索心理社会因素如何直接和通过影响行为影响体重。我们的研究团队是第一个在生态瞬时评估（EMA）框架内采用创新的移动的健康（mHealth）技术来衡量术后6个月对推荐行为的依从性的人。我们建议在这项工作的基础上，使用EMA在更长的时间内测量行为，心理和环境因素，以了解它们如何预测手术后关键减肥阶段的成功和风险，即主动减肥（0-1年），体重稳定（1-2年）和初始维持（2-3年）。由NIH资助的多传感器PiLR HEALTH平台将把测量行为及其执行环境的客观传感器数据与通过智能手机实时收集的患者自然环境中的自我报告信息集成在一起。从2个ASMBS指定的卓越中心招募的参与者（N=200）将在术前和术后3、6、12、18、24、30个月完成为期12天的EMA方案，以评估推荐的行为[例如，进餐频率，PA]，具有与手术结果相关的最先证据的心理社会指标（例如，情绪/抑郁），以及关键环境因素（例如，食品环境的类型/质量）。还将在上述时间点和36个月时对受试者进行称重。沿着描述行为模式及其与减肥的关系，我们将测试因果模型，以了解复杂的行为、心理和环境因素系统如何影响减肥，并确定干预的最佳目标。这个项目有可能建立一个更复杂和有效的了解谁是减肥手术后不成功，为什么。这一新的理解将直接有助于改善（即，具体的、一致的和经过验证的）指南，用于推荐术前和术后行为，这可能会改善手术结果。增强的理解还将为最有可能改善手术结果的干预行为，心理社会和环境目标提供信息。

 DESCRIPTION (provided by applicant): Bariatric surgery is a powerful tool for producing significant and durable weight loss. Yet, not all patients achieve initial weight loss success and many patients have weight regain as early as 1-2 years post-surgery. Suboptimal weight loss patterns not fully explained by surgical, demographic, and medical factors has led to greater emphasis on patient behaviors evidenced by clinical guidelines that focus on appropriate eating and physical activity. However, research to inform such guidelines typically has relied on imprecise measures or not been specific to bariatric surgery. There is also little understanding of mechanisms by which psychosocial factors influence outcomes. Thus, there is a need to: (a) measure behaviors and psychosocial factors thought to be related to surgical outcomes (particularly those emphasized in guidelines) using innovative strategies to maximize data quality, (b) determine which behaviors and psychosocial factors are related to outcomes, and (c) explore how psychosocial factors influence weight both directly and via influences on behavior. Our research team was the first to employ innovative mobile health (mHealth) technology within an Ecological Momentary Assessment (EMA) framework to measure adherence to recommended behaviors at 6 months post-surgery. We propose to build on this work by using EMA to measure behavioral, psychosocial, and environmental factors over a much longer period to understand how they predict success and risk at key post-surgical weight loss phases-i.e. active weight loss (0-1 yrs), weight stabilization (1-2 yrs), and initial maintenance (2-3 yrs). An NIH-funded multi-sensor PiLR HEALTH platform will integrate objective sensor data measuring behaviors and the environments in which they are performed with self-report information collected via smartphone in real-time and in patients' natural environment. Participants (N=200) recruited from 2 ASMBS-designated centers of excellence will complete a 12-day EMA protocol pre-surgery and at 3, 6, 12, 18, 24, 30 months post-surgery to assess recommended behaviors [e.g., meal frequency, PA], psychosocial indicators with the most prior evidence of an association with surgical outcomes (e.g., mood/depression), and key environmental factors (e.g., type/quality of the food environment). Participants will also be weighed at the above time points and 36 months. Along with describing patterns in behaviors and their relation to weight loss, we will test causal models to understand how complex systems of behavioral, psychosocial, and environmental factors affect weight loss, and to identify optimal targets for intervention. This project has the potential to build a much more sophisticated and valid understanding of who is and is not successful after bariatric surgery and why. This new understanding will directly contribute to improved (i.e., specific, consistent, and validated) guidelines for recommended pre and postoperative behaviors, which could lead to improved surgical outcomes. The enhanced understanding will also inform behavioral, psychosocial, and environmental targets for intervention that are mostly likely to improve surgical outcomes.