Evaluating environmental control (AVOID) and inhibitory control (RESIST) strategies to improve weight management outcomes

摘要 循证体重管理计划是有效的，当个人能够始终如一地坚持 建议。然而，很大一部分寻求治疗的个人并没有临床经验。 体重显著减轻。需要创新策略来优化体重管理中的行为改变 干预措施。拟议的随机对照试验测试了两种自我调节方法以改善 超重或肥胖者的有意减肥与饮食质量：(1)环境对照 策略(避免)和(2)冲动控制训练策略(抵抗)。具体来说，500名女性和男性(BMI 25-39.9公斤/平方米)将从锡达斯-西奈医疗中心医院和诊所网络招聘。 所有参与者都将参加为期12个月的体重管理计划(WW，前身为慧俪轻体) 将重点放在饮食、体力活动和心态技能上，并随机分为四组：(1)仅限WW，(2) WW+改善家庭食品环境和在线杂货配送(避免)，(3)WW+游戏化抑制 控制训练(抵抗)，(4)WW+回避+抵抗。基准、6个月和12个月的评估将是 由经验丰富的英语和西班牙语学习人员完成。目标1(成果)。(A)测试如何避免 和抵抗力影响减肥和腰围(主要)和饮食质量(次要)。H1a：避免 和/或抵抗剂(臂2、3、4)在6个月和12个月的时间点上比 WW独自一人。(B)测试避免和抵制对现有家庭成员饮食质量的潜在连锁反应 (主要)和重量(次要)。H1B：我们预测避免(手臂2和手臂4)将产生更多的饮食 家庭成员的变化比WW单独和抵抗(臂1和臂3)。目标2(机制)。测试 通过(A)比较抑制控制和抵抗的纵向变化来避免和抵抗的机制路径 研究对象之间的家庭食物环境；以及(B)抑制性控制和家庭食物环境 调节研究武器与人体测量和饮食结果之间的关系。H2：避免遗嘱 家居食物环境产生变化，抵抗力就会发挥抑制控制作用。目标3 (主持人)。审查(A)个人特征(年龄、性别、种族、社会经济地位、家庭 组成、体力活动、基线体重指数和执行功能)，以及(B)过程数据(频率 杂货店送货、外出就餐和外卖、冲动控制培训和使用WW应用程序)缓和了这种关系 研究武器与人体测量和饮食结果之间的关系。这些考虑因素对帮助 解释干预结果的异质性，并了解谁从避免和/或抵制中受益。

ABSTRACT Evidence-based weight management programs are effective when individuals are able to consistently adhere to recommendations. However, a large proportion of treatment-seeking individuals do not experience clinically significant weight loss. Innovative strategies are needed to optimize behavior change in weight management interventions. The proposed randomized controlled trial tests two self-regulatory approaches to improve intentional weight loss and diet quality in individuals with overweight or obesity: (1) an environmental control strategy (AVOID) and (2) an impulse control training strategy (RESIST). Specifically, 500 women and men (BMI between 25-39.9 kg/m2) will be recruited from the Cedars-Sinai Medical Center network of hospitals and clinics. All participants will be enrolled in a 12-month weight-management program (WW, formerly Weight Watchers©) focusing on diet, physical activity and mindset skills, and randomized to one of four study arms: (1) WW only, (2) WW + modification of home food environment and online grocery delivery (AVOID), (3) WW + gamified inhibitory control training (RESIST), (4) WW + AVOID + RESIST. Baseline, 6- and 12-month assessments will be completed by experienced, English and Spanish speaking study staff. Aim 1 (Outcomes). (a) Tests how AVOID and RESIST affect weight loss and waist circumference (primary) and diet quality (secondary). H1a: AVOID and/or RESIST (arms 2, 3, 4) will result in greater weight loss at 6-month and 12-month timepoints compared to WW alone. (b) Tests potential ripple effects of AVOID and RESIST on available household members' diet quality (primary) and weight (secondary). H1b: We predict that AVOID (arms 2 and 4) will produce greater dietary changes in household members than WW alone and RESIST (arms 1 and 3). Aim 2 (Mechanisms). Tests the mechanistic pathways of AVOID and RESIST by (a) comparing longitudinal changes in inhibitory control and home food environment across study arms; and (b) whether inhibitory control and the home food environment mediate the relationships between study arms and anthropometric and dietary outcomes. H2: AVOID will produce changes in the home food environment and RESIST will operate on inhibitory control. Aim 3 (Moderators). Examines how (a) individual characteristics (age, sex, ethnicity, socioeconomic status, household composition, physical activity, baseline BMI and executive functioning), and (b) process data (frequency of grocery delivery, dining out and take out, impulse control training and WW app use) moderate the relationship between study arms and anthropometric and dietary outcomes. These considerations are important to help explain heterogeneity in intervention outcomes and to understand who benefits from AVOID and/or RESIST.