Using the Multiphase Optimization Strategy to Optimize a Culturally Tailored Online Behavioral Weight Loss Intervention for Sexual Minority Women

项目摘要 肥胖对性少数群体妇女的影响不成比例。这个K23的目标是改善肥胖 通过定制和优化基于证据的在线行为权重来治疗性少数女性 减肥计划，以加强减肥在这一组。这一目标与《生物多样性公约》中概述的研究优先事项一致， 美国国立卫生研究院对性和性别少数群体健康研究特别感兴趣的通知（NOT-MD-19-001）。 行为减肥计划是治疗轻度至中度肥胖的金标准。Rx减肥 是一个在线行为减肥计划（由K23导师共同开发），有效，低成本， 并且高度可扩展。然而，现有的研究和候选人的试点工作表明， 解决性少数女性中3个公认的减肥障碍对于最大限度地提高女性的健康至关重要。 行为减肥的相关性和有效性。此K23将定制Rx减肥，以解决 性少数女性的减肥障碍（即，少数民族压力，低社会支持，负面的身体形象） 并进行优化试验，以确定定制组件是否以及如何增强减肥效果 使用多阶段优化策略（MOST）的性少数女性的结果。制备 阶段（目标1）将涉及开发3种针对性少数女性体重的新型治疗成分 根据试点测试和定性访谈的反馈， 20性少数女性优化阶段（目标2）将涉及进行析因实验。88 性少数女性将接受12周的Rx减肥，并随机接受0-3个量身定制的 件.这些数据将用于确定新组分-单独和组合- 影响平均体重减轻和6个月时达到临床显著体重减轻的女性比例 (Aim 2A），并通过测试以下假设的机制来阐明定制的组分如何影响体重减轻： 行动（目标2B）。使平均重量损失增加≥2%或比例达到5+%的新型成分 体重减轻≥10%将保留在最终的肥胖治疗包中，以在未来的RCT中进行评价。 该项目建立在候选人先前在性少数群体妇女方面的工作基础上，将于 来自高素质和经验丰富的导师团队的指导。候选人的首要目标是 这一K23是建立应用文化剪裁和创新方法的技能（例如，技术- 基于治疗，MOST），以提高行为减肥的相关性，有效性和影响 性少数群体妇女的项目。K23提供的指导、培训和经验将 允许候选人获得这些技能，并利用这些技能开展独立的研究生涯 解决性少数群体妇女和其他得不到充分服务的群体中肥胖问题的技能。

PROJECT ABSTRACT Obesity disproportionately impacts sexual minority women. The goal of this K23 is to improve obesity treatments for sexual minority women by tailoring and optimizing an evidence-based online behavioral weight loss program to enhance weight loss in this group. This objective aligns with the research priorities outlined in NIH’s Notice of Special Interest in Research on the Health of Sexual and Gender Minorities (NOT-MD-19-001). Behavioral weight loss programs are the gold standard treatment for mild to moderate obesity. Rx Weight Loss is an online behavioral weight loss program (co-developed by mentors on this K23) that is effective, low-cost, and highly scalable. However, existing research and the Candidate’s pilot work suggest that tailoring treatment to address 3 well-established weight loss barriers in sexual minority women will be critical for maximizing the relevance and efficacy of behavioral weight loss for this group. This K23 will tailor Rx Weight Loss to address sexual minority women’s weight loss barriers (i.e., minority stress, low social support, negative body image) and conduct an optimization trial to identify whether and how tailored components enhance weight loss outcomes in sexual minority women using the Multiphase Optimization Strategy (MOST). The Preparation Phase (Aim 1) will involve developing 3 novel treatment components targeting sexual minority women’s weight loss barriers and refining the intervention based on pilot testing and feedback from qualitative interviews with 20 sexual minority women. The Optimization Phase (Aim 2) will involve conducting a factorial experiment. 88 sexual minority women will receive 12 weeks of Rx Weight Loss and randomization to receive 0-3 tailored components. This data will be used to determine whether novel components - alone and in combination - impact mean weight loss and the proportion of women achieving clinically significant weight loss at 6 months (Aim 2A) and to clarify how tailored components affect weight loss by testing hypothesized mechanisms of action (Aim 2B). Novel components that increase mean weight loss by ≥2% or the proportion achieving 5+% weight loss by ≥10% will be retained in a final obesity treatment package to evaluate in a future RCT. This project builds on the Candidate’s prior work in sexual minority women and will be completed with guidance from a highly qualified and experienced mentorship team. The Candidate’s overarching goal in this K23 is to establish skills in applying cultural tailoring and innovative methods (e.g., technology- based treatment, MOST) to improve the relevance, efficacy, and impact of behavioral weight loss programs for sexual minority women. The mentorship, training, and experience provided by the K23 will allow the Candidate to acquire these skills and to launch an independent research career leveraging these skills to address obesity disparities in sexual minority women and other underserved groups.