Experience Success: Virtual Reality Skills Training to Enhance e-Weight Loss

超重和肥胖是主要的健康问题，影响超过三分之二的美国成年人。商业上可获得的基于互联网的减肥计划目前在美国被数百万超重/肥胖个体使用，但减肥效果往往很差，这可能是因为这些产品总体上没有纳入已经研究了40多年的经验验证的行为减肥策略。同样，通过基于研究的在线减肥计划获得的减肥效果大约是通过面对面治疗获得的减肥效果的一半，这可能是因为缺乏（1）行为体重控制策略的“动手”培训，以及（2）来自小组领导和同伴的支持和指导，这两者都是传统面对面治疗的标志。该应用程序的目标是通过开发虚拟现实（VR）系统来改善商业互联网交付的行为肥胖治疗，该系统可以集成到现有的互联网体重控制程序中，例如Weight Watchers Online。VR系统将允许用户在文化敏感的虚拟教练的支持下，在受控的虚拟环境中体验学习，实施和掌握行为体重控制策略。VR系统 将：（a）提高对体重控制行为障碍的认识，（B）教授科普 （c）使用这些技能建立信心，（d）加强在现实世界中使用这些技能的承诺。VR系统的设计基于社会认知理论，该理论指出，健康行为是通过观察和模仿同伴和角色模型以及接受社会强化来学习的。申请人最近成功完成了第一阶段申请（1 R41 HL 114046 - 01），其中开发了一个原型VR减肥干预，旨在与现有的互联网提供的行为减肥计划相结合，并通过一个专注于社交饮食情况的VR“小插曲”进行了试点测试。虚拟教练将被用来引导用户通过小插曲，教导用户行为体重控制策略，并帮助用户科普使用行为体重控制策略的任何后果。这种互动的社会饮食“小插曲”产生了统计学上的显着改善自我报告的困难，控制饮食的社会情况下，知识，信心和承诺，使用经验验证的技能，控制饮食的社会情况。在这个第二阶段的应用中，我们建议完善在第一阶段创建和测试的社交饮食小插曲，并开发另外3个小插曲，涉及饮食，体力活动和久坐行为的其他挑战性情况（即，坐着的时间）。我们将对N = 125名参与者进行一项随机对照试验（RCT），以测试在流行的付费商业减肥计划（Weight Watchers Online）中获得的4个小插曲在6个月内改善减肥效果的功效。在第二阶段项目成功完成后，我们将向商业上可用的基于互联网的减肥计划提供商（如Weight Watchers，Inc.）销售带有4个小插曲的VR系统。(see支持信）。

DESCRIPTION (provided by applicant): Overweight and obesity are major health problems, affecting over two-thirds of US adults. Commercially available Internet-based weight loss programs are currently used by millions of overweight/obese individuals in the U.S, but weight losses are often poor, likely because these products on the whole do not incorporate empirically validated behavioral weight loss strategies that have been researched for over 40 years. Similarly, the weight losses obtained via research-based online weight loss programs are about half the size of those obtained via in-person treatment, likely because of the lack of (1) "hands-on" training in behavioral weight control strategies, and (2) support and guidance from group leaders and peers, both of which are hallmarks of traditional in-person treatment. The goal of this application is to improve commercial Internet -delivered behavioral obesity treatments by developing a virtual reality (VR) system that can be integrated into existing Internet weight control programs, such as Weight Watchers Online. The VR system will allow users to experience learning, implementing, and mastering behavioral weight control strategies in controlled virtual settings with the support of a culturally sensitive virtual coach. The VR system will: (a) increase awareness of barriers to weight control behaviors, (b) teach skills to cope with these barriers, (c) build confidence using these skills, and (d) increase commitment to using these skills in real-world situations. The design of the VR System is based on Social Cognitive Theory, which states that health behaviors are learned by observing and imitating peers and role models, and by receiving social reinforcement. A Phase I application (1R41HL114046- 01) was recently completed successfully by the applicants, in which a prototype VR weight loss intervention, designed for integration with existing Internet-delivered behavioral weight loss programs, was developed and pilot tested with a single VR "vignette" focused on social eating situations. A virtual coach will was used to lead the user through the vignette, teach the user behavioral weight control strategies, and help the user cope with any consequences of using behavioral weight control strategies. This interactive social eating "vignette" produced statistically significant improvements in self-reported difficulty controlling eating in social situations, and knowledge, confidence, and commitment for using empirically validated skills for controlling eating in social situations. In this Phase II application we propose to refine the socil eating vignette created and tested in Phase I, and develop an additional 3 vignettes pertaining to other challenging situations involving eating, physical activity, and sedentary behavior (i.e., time spent sitting). We will conduct a randomized controlled trial (RCT) with N = 125 participants to test the efficacy of the 4 vignettes for improving weight losses obtained in a popular paid commercial weight loss program (Weight Watchers Online) over 6 months. Upon successful completion of this Phase II project, we will market the VR system with 4 vignettes to providers of commercially available Internet-based weight loss programs such as Weight Watchers, Inc. (see included letter of support).