Preventing weight gain among those who decline behavioral weight loss treatment

项目摘要/摘要 肥胖治疗指南建议将全面的行为减肥治疗作为一线 为肥胖或超重并有体重相关疾病的成年人提供的方法。然而，广大的 大多数有资格接受这些减肥治疗的成年人不会主动开始治疗，即使在 免费的。对于拒绝减肥治疗的人，肥胖指南建议关注体重增加 预防。不幸的是，现有的预防体重增加的干预措施具有相同的特点 导致许多人从一开始就拒绝减肥治疗，比如专注于说教的会议 饮食和体力活动的处方发生了变化。在克服这些障碍的同时防止体重增加 参与体重管理干预的常见障碍，我们提出了一种干预措施，规定 自我称重，但不规定改变饮食或体力活动行为，也不要求参加 以说教为主的会议。自我称重促进体重管理的潜力得到了以下两方面的支持 自律理论与实证研究。促进自我称重可能会激活参与者的自我 调节技能，导致自发决定减少卡路里摄入量或增加体力活动，因此 防止体重进一步增加。拟议的干预还将为个人提供基于短信的 反馈，以促进持续的自我衡量，并鼓励参与以证据为基础的资源 在他们可能对使用这些资源更加开放的时候进行体重管理-例如，在经历了 体重略有增加。目前的提案将调查这一低负担的可行性和可接受性 自我称量干预，以便为一项完全有效、务实的随机对照试验做准备。我们会 招募60名肥胖或超重并有体重相关合并症的初级保健患者， 都拒绝参加一个全面的行为体重管理计划。参与者将是 他们被要求每天通过“智能”秤称体重，该秤将体重数据直接通过 蜂窝网络。每隔一周，参与者将收到提供简短反馈的短信 鼓励继续自我衡量。此外，如果观察到体重略有增加，参与者将收到短信 旨在让他们参与商业或社区循证体重管理的信息 资源。在单臂设计中，所有登记的参与者将接受为期12个月的干预，并将 在3个月和12个月完成评估，以评估干预和试验的可行性和可接受性 设计，体重将从参与者的电子健康记录(EHR)中获得。我们将评估我们的 成功满足试验可行性和干预可接受性结果的预先指定的指标，包括 干预登记、干预满意度和从参与者的 EHR。我们也会评估干预措施在推广定期自我称重和使用 循证体重管理资源。

PROJECT SUMMARY/ABSTRACT Obesity treatment guidelines recommend comprehensive behavioral weight loss treatments as the first line approach for adults with either obesity or overweight with a weight-related comorbidity. However, the vast majority of adults who are eligible for these weight loss treatments do not initiate them, even when offered at no cost. For individuals who decline weight loss treatment, obesity guidelines suggest a focus on weight gain prevention. Unfortunately, existing interventions to prevent weight gain have the same characteristics that cause many individuals to reject weight-loss treatments in the first place, such as didactic-focused meetings and prescriptions for dietary and physical activity change. To prevent weight gain while overcoming these common barriers to engaging in weight management interventions, we propose an intervention that prescribes self-weighing but does not prescribe changes in diet or physical activity behaviors or require attendance at didactic-focused meetings. The potential of self-weighing to promote weight management is supported both by self-regulatory theory and empirical research. Promoting self-weighing may activate participants’ self- regulatory skills, leading to spontaneous decisions to reduce calorie intake or increase physical activity, thus preventing further weight gain. The proposed intervention will also provide individuals with text message-based feedback to promote continued self-weighing and to motivate engagement with evidence-based resources for weight management at a time when they may be more open to using these resources—e.g., after experiencing a small weight gain. The current proposal will investigate the feasibility and acceptability of this low burden self-weighing intervention in order to prepare for a fully-powered, pragmatic randomized controlled trial. We will enroll 60 primary care patients with either obesity or overweight with a weight-related comorbidity and who have declined to participate in a comprehensive behavioral weight management program. Participants will be asked to weigh themselves daily via a “smart” scale that transmits weight data directly to the study team via the cellular network. Every-other week, participants will be sent text messages providing brief feedback encouraging continued self-weighing. Moreover, if a small weight gain is observed, participants will be sent text messages aiming to engage them in commercial or community-based evidence-based weight management resources. In a single-arm design, all enrolled participants will receive the intervention for 12 months and will complete assessments at 3 and 12 months to assess feasibility and acceptability of the intervention and trial design, while weight will be obtained from participants’ Electronic Health Records (EHR). We will evaluate our success in meeting pre-specified metrics for trial feasibility and intervention acceptability outcomes, including intervention enrollment, intervention satisfaction, and obtainment of weight data abstracted from participants’ EHRs. We will also evaluate the success of the intervention in promoting regular self-weighing and use of evidence-based weight management resources.