Environmental Attributes and Weight Control: Study of Over 1.3 Million Veterans

描述（由申请人提供）：肥胖导致数百万美国人患上了使人衰弱的慢性健康状况，占美国所有医疗支出的近10%，保守地说，美国人与其他13个高收入国家的人之间的预期寿命差距占差距的30%。尽管在肥胖治疗方面投入了大量资金，但进展甚微。在那些尝试减肥的人中，只有不到一半的人成功地减掉了临床上显著的体重;很少有人保持减肥;目前总体上35.7%的成年肥胖率并没有下降。这些令人失望的结果促使研究人员和政策制定者考虑居住环境如何促进健康饮食和体育活动。尽管早期的研究很有希望，但对于环境因素对体重的影响还没有达成共识。为了解决这一差距，拟议研究的目的是估计居住环境属性（步行性，美学，娱乐场所，健康和不健康的食品供应，以及健康和不健康食品的价格）对BMI和其他饮食敏感和身体活动敏感的贡献。 测量成年人的代谢风险（血压、血糖和血脂）。具体目标是：（1）通过对超过130万退伍军人进行的回顾性10年纵向全国性研究，确定居住环境的特定属性，这些属性有助于个人保持更健康的BMI，BMI轨迹和代谢风险状态;以及（2）在超过20万参加MOVE的退伍军人中！体重管理计划和类似数量的匹配对照，确定居住环境的特定属性在多大程度上帮助个体在6个月时减轻体重，在18个月时保持体重减轻，并在更长时间（5年）内实现更健康的BMI轨迹。为了实现这些目标，我们将把退伍军人的健康数据与表征其居住环境属性的公共和专有数据联系起来，并采用面板数据统计模型，这些模型对广泛的潜在偏见和反向因果关系来源具有鲁棒性。我们将使用类似的模型与通过倾向评分分析得出的匹配对照组，以确定环境属性对MOVE！方案有效性。拟议的研究具有高度创新性，因为它采用了迄今为止任何研究中最大的样本和最广泛的地理覆盖面。我们将使用独特的电子健康数据存储，精确的居住位置信息以及详细和重复的环境属性测量，使我们能够捕捉环境和居住位置随时间的变化，以检查长达10年的时间对个人BMI和代谢风险的影响，包括确定环境属性是否会调节体重管理干预的有效性。这项研究意义重大，因为它将提供迄今为止最有力的证据 这是制定有效的公共卫生政策以消除肥胖症所必需的，因为它有可能从根本上改变体重管理干预方法。

DESCRIPTION (provided by applicant): Obesity contributes to the development of debilitating chronic health conditions in millions of Americans, underlies nearly 10 percent of all U.S. medical spending, and conservatively accounts for 30% of the gap in life expectancy between Americans and their counterparts in 13 other high-income countries. Despite tremendous investment in obesity treatment, little headway has been made. Of those who try, less than half succeed in losing a clinically significant amount of weight; few maintain weight loss; and adult obesity rates, currently 35.7% overall, have not declined. These disappointing outcomes challenge researchers and policymakers to consider how the residential environment can facilitate healthful eating and physical activity. Despite promising early research, there is no consensus about environmental contributors to body weight. To address this gap, the objective of the proposed study is to estimate the contributions of residential environment attributes (walkability, aesthetics, recreational places, healthy and unhealthy food availability, and prices for healthy and less healthy foods) to BMI and other diet-sensitive and physical activity-sensitive measures of metabolic risk (blood pressure, serum glucose, and lipids) among adults. Specific aims are: (1) Through a retrospective 10- year longitudinal nationwide study of over 1.3 million veterans, determine specific attributes of the residential environment that help individuals to maintain healthier BMI, BMI trajectory, and metabolic risk status; and (2) In over 200,000 veterans who participated in the MOVE! weight management program and a similar number of matched controls, determine the extent to which specific attributes of the residential environment help individuals lose weight at six months, maintain weight loss at 18 months, and achieve healthier BMI trajectory longer term (5 years). To achieve these aims, we will link data on veterans' health to public and proprietary data characterizing attributes of their residential environments and employ panel data statistical models that are robust to a broad class of potential sources of bias and reverse causality. We will use similar models with a matched control group derived through propensity score analysis to determine the moderating impact of environmental attributes on MOVE! program effectiveness. The proposed study is highly innovative because it draws on the largest sample and the broadest geographic coverage of any study to date. We will use unique electronic health data stores, information on precise residential location, and detailed and repeated measures of environmental attributes, allowing us to capture changes in the environment and residential location over time to examine effects on individuals' BMI and metabolic risk over periods up to 10 years, including determining whether environmental attributes moderate the effectiveness of a weight management intervention. This research is significant because it will provide the most robust evidence to date that is needed to formulate effective public health policies to eradicate obesity and because it has the potential to fundamentally transform weight management intervention approaches.