Using Behavioral Economic Strategies to Address Obesity in Economically Disadvantaged Adults

肥胖是一种公共健康危机，来自经济困难背景的成年人中，超过85%的人 经历超重或肥胖以及相关的健康疾病。迄今为止，生活方式干预的目标是 这一高风险人群的体重下降幅度不大。因此，对这些弱势群体进行有效的干预 人口是迫切需要的。来自行为经济学的新证据表明，目标缺乏 目前的强化和偏见可能会改善来自弱势群体的成年人的治疗结果 背景。具体地说，贫穷的环境被证明几乎没有健康的来源 强化，这使得对强化的基本来源(例如，美味的食物)的反应更具抵抗力 去改变。此外，所有的人类都被证明对现在有偏见，或者说偏爱立即 奖励(美味的食物)胜过未来的奖励(改善健康)，研究表明， 弱势背景对当下的偏见更大(可能是由于生活需求、压力和 认知负荷)。解决肥胖症的这两个过程(缺乏强化和目前的偏见) 治疗可能独一无二地满足这一高危、服务不足的人群的需求，并导致减肥 成功。这项拟议的研究将测试移动健康行为经济学减肥干预的有效性 这解决了目前缺乏强化和偏见的问题。增援不足的问题将通过 小额货币增强剂在治疗开始时提供。增强剂将在初始阶段逐渐变细 疗程结束，最终结束。随着增强剂逐渐减少，参与者将接受插曲未来的培训 思考，这已被证明可以减少目前的偏见，并可能改善长期减肥 结果。这种双管齐下的分阶段方法首先解决了缺乏加固的问题，然后偏向于 现在是最重要的。在治疗开始时立即提供增援是必要的，以吸引参与者 马上就来。然后，由于参与者正在形成成功的减肥经验，这自然 提供自己的强化(改善情绪、健康、外表)，强化会逐渐减少。在此期间， EFT培训将开始。这一新的行为经济学mHealth干预将被比作mHealth 只有干预。这两种干预措施将主要通过移动平台提供，包括治疗 为这一人群量身定做的材料，并与之匹配以便于接触。因此，这两项干预的唯一途径是 不同之处在于BE mHealth中包含了行为经济学策略。我们的主要假设是 行为经济学干预将在12个月(治疗结束)产生明显更好的体重减轻。 调节因子(食物强化、目前的偏向)、调节因子(压力、韧性、肥胖环境)、 此外，还将探讨成本效益。如果有效，这种mHealth行为经济学干预将 是一种新的变革性干预方法，显著改善肥胖患者的治疗结果 高危、服务不足的人群。

Obesity is a public health crisis among adults from economically disadvantaged backgrounds, with over 85% experiencing overweight or obesity and associated health ailments. To date, lifestyle interventions targeting this high-risk group have produced modest weight losses. Thus, effective interventions for this vulnerable population are urgently needed. New evidence from behavioral economics suggests that targeting lack of reinforcement and bias for the present may improve treatment outcomes in adults from disadvantaged backgrounds. Specifically, impoverished environments have been shown to have few sources of healthy reinforcement, which makes responding to basic sources of reinforcement (e.g., palatable food) more resistant to change. Moreover, all humans have been shown to have bias for the present, or a preference for immediate rewards (palatable food) over future rewards (improved health), and studies suggest that individuals from disadvantaged backgrounds have even greater bias for the present (perhaps due to life demands, stress, and cognitive load). Addressing these two processes (lack of reinforcement and bias for the present) in obesity treatment may uniquely meet the needs of this high-risk, underserved population and result in weight loss success. The proposed study will test the efficacy of a mHealth behavioral economics weight loss intervention that addresses lack of reinforcement and bias for the present. Lack of reinforcement will be addressed with small monetary reinforcers delivered at the beginning of treatment. Reinforcers will taper during the initial treatment period and eventually end. As reinforcers taper, participants will be trained in Episodic Future Thinking, which has been shown to reduce bias for the present and may improve longer-term weight loss outcomes. This two-pronged, phased approach that first addresses lack of reinforcement and then bias for the present is essential. Providing reinforcement immediately at treatment start is necessary to engage participants straightaway. Then, as participants are developing success experiences with weight loss, which naturally provides its own reinforcement (improved mood, health, appearance), reinforcers will taper. During this time, EFT training will begin. This novel behavioral economics mHealth intervention will be compared to a mHealth only intervention. The two interventions will be delivered primarily via a mobile platform, include treatment material tailored to this population, and be matched for contact. Thus, the only way the two interventions will differ is in the inclusion of behavioral economics strategies in BE mHealth. Our primary hypothesis is that the behavioral economics intervention will yield significantly better weight losses at month 12 (treatment end). Mediators (food reinforcement, bias for the present), moderators (stress, resilience, obesogenic environment), and cost-effectiveness will also be explored. If effective, this mHealth behavioral economics intervention would be a new and transformative intervention approach that significantly improves obesity treatment outcomes in a high-risk, underserved population.