Contingency Management for Promoting Weight Loss in University Students

描述（由申请人提供）：超重和肥胖率正在增加，特别是在18至29岁的人群中。据估计，25- 35%的美国大学生超重或肥胖。应急管理（CM）是一种行为干预，为积极的行为提供有形的奖励。CM在减少吸烟和药物使用以及增加治疗保留率和药物依从性方面具有显著疗效。目前的研究将评估24周CM干预对促进超重和肥胖大学生减肥的有效性。70名体重指数（BMI）为27.0-34.9的参与者将被随机分配到以下两种情况之一：（a）LEARN，一种手动指导的行为减肥计划（Brownell，2004），包括称重和支持性咨询，或（B）LEARN，包括称重和支持性咨询加CM。CM条件下的参与者每周将有机会赢得价值从1美元到100美元不等的奖品，其中他们至少减掉一磅。一旦他们失去了5%的基线体重，他们将有机会赢得减肥或维持体重的奖品。通过完成促进减肥的活动可以获得额外的机会。主要结果将是从治疗前到治疗后的绝对和比例体重减轻，以及达到临床显著体重减轻（>基线体重的5%）的参与者比例和进入较低风险BMI类别的比例。次要结果将包括研究中的保留时间，体力活动水平的增加和饮食营养质量的改善。还将评估CM干预对精神困扰和自我效能以及参与促进减肥活动的动机的影响。我们预测，在CM条件下的参与者将失去更多的体重比分配到没有CM的LEARN计划的参与者，更多的CM参与者将实现临床显着的体重减轻。我们还预测，与对照组参与者相比，CM条件下的参与者将在该计划中停留更长时间，身体活动增加更大，饮食质量改善更大，自我效能和动机水平提高更大。还将评估CM结果的调解人和主持人。如果在大学人群中有效促进减肥，CM可以帮助预防或延迟与肥胖相关的医疗问题的后期发展。公共卫生相关性：肥胖是一个严重和普遍的问题，对个人和社区造成身体、情感、社会和经济后果，年轻人的肥胖率正在上升。有证据表明，学生在大学期间体重增加不多，但数量可观。如果应急管理在促进减肥和健康的生活方式改变方面是有效的，这有助于在这个高风险时期减肥，它可以帮助预防肥胖的负面后果，并为整个成年期的更好的健康结果奠定基础。

DESCRIPTION (provided by applicant): Rates of overweight and obesity are increasing, particularly among individuals aged 18 to 29. An estimated 25- 35 percent of American college and university students are overweight or obese. Contingency Management (CM) is a behavioral intervention that provides tangible rewards for positive behaviors. CM has substantial evidence of efficacy in reducing smoking and drug use and increasing treatment retention and medication compliance. The current study will evaluate the efficacy of a 24-week CM intervention to promote weight loss in overweight and obese university students. Seventy participants with a body mass index (BMI) of 27.0-34.9 will be randomly assigned to one of two conditions: (a) LEARN, a manual guided behavioral weight loss program (Brownell, 2004), with weigh-ins and supportive counseling, or (b) LEARN with weigh-ins and supportive counseling plus CM. Participants in the CM condition will earn chances to win prizes ranging in value from $1 to $100 each week in which they lose at least one pound. Once they lose 5 percent of baseline body weight, they will earn chances to win prizes for weight loss or weight maintenance. Additional chances can be earned by completing activities that promote weight loss. The primary outcomes will be absolute and proportional weight loss from pre- to post-treatment, as well as proportion of participants achieving clinically significant weight loss (>5 percent of baseline weight) and proportion moving into a lower risk BMI category. Secondary outcomes will include length of retention in the study, increase in physical activity level, and improvement in nutritional quality of diet. Effects of the CM intervention on psychiatric distress and self-efficacy and motivation to engage in activities that promote weight loss will also be assessed. We predict that participants in the CM condition will lose more weight than participants assigned to the LEARN program without CM, and that more CM participants will achieve clinically significant weight loss. We also predict that participants in the CM condition will remain in the program longer, show larger increases in physical activity, show greater improvements in diet quality, and have greater increases in levels of self-efficacy and motivation than comparison group participants. Mediators and moderators of CM outcomes will also be evaluated. If efficacious in promoting weight loss in a college population, CM could help to prevent or delay later development of obesity-related medical problems. PUBLIC HEALTH RELEVANCE: Obesity is a serious and prevalent problem with physical, emotional, social, and financial consequences for individuals and the community, and rates of obesity are increasing among young adults. Evidence suggests that students gain modest but significant amounts of weight during the college years. If contingency management is effective in promoting weight loss and healthy lifestyle changes that contribute to weight loss during this high risk period, it could help to prevent the negative consequences of obesity and set the stage for better health outcomes throughout the adult lifespan.