Prevention & Promotion in the Treatment of Obesity
Condition: Obesity
MeSH terms: Obesity
Study type: Interventional

Summary: 
      Making healthy food choices requires sacrificing immediate pleasures of consuming high
      calorie foods in order to achieve long-term health goals. Two strategies to encourage such
      future thinking are 1) focusing on the long-term consequences of consuming unhealthy foods,
      and 2) focusing on the long-term benefits of avoiding these unhealthy foods. Two novel
      behavioral weight loss (BWL) interventions will be developed based on these strategies
      (PREVENT and PROMOTE) and compared to standard Internet-delivered BWL to test their
      feasibility and efficacy in changing food choice decision-making, reducing food cravings, and
      ultimate weight loss.
    

Detailed description: 
      Obesity is one of the most important public health issues today, contributing to many of the
      primary causes of morbidity and mortality in the United States. Still, treatment remains
      difficult and many people continually struggle to lose weight. Thus there is critical need
      for improvements in methods for treating obesity. One potential reason weight control is so
      difficult is the need to sacrifice immediate pleasures for long-term goals. This requires
      placing significant value on future outcomes, such as health.

      One strategy for doing so is to focus on the potential benefits of avoiding unhealthy
      choices. Health messaging studies suggest that messages focused on promoting long-term
      benefits of healthier choices may be effective in encouraging initiation of, or positive
      attitudes toward, healthy behaviors, however, longer-term effects of these messages have not
      been studied in the context of obesity. By contrast, behavioral economic work on Prospect
      Theory suggests focusing on preventing future negative consequences may be superior, and the
      threat of weight gain is a more powerful motivator than the benefit of weight loss. Although
      prevention strategies have been successfully employed in smoking cessation and anti-smoking
      campaigns, they are not typically used in obesity treatment. In promising preliminary
      neuroimaging work, the investigators identified increases in brain regions involved in
      inhibitory control and decreases in cravings when using this PREVENT strategy.

      The goal of this R03 is to test whether an intervention built upon the goal to PREVENT
      long-term consequences of weight gain versus an intervention built upon the goal to PROMOTE
      long-term benefits of weight loss is beneficial in altering valuation of health and taste in
      food choice decision-making, encouraging adherence, reducing food cravings and consumption,
      and ultimate weight loss, as compared to a standard behavioral weight loss program (BWL). A
      total of 90 overweight/obese men and women will be randomly assigned to either PREVENT,
      PROMOTE, or standard BWL. Each intervention will have one in-person training session wherein
      participants will learn key strategies of their assigned program, and the remaining 12 weekly
      lessons will be delivered via internet. Baseline and 3-month (post-treatment) assessments
      will include the food choice decision-making task featured in the parent K01 to measure
      valuation of health and taste, weight measurement, and measurement of food cravings and
      consumption. To address feasibility, adherence and engagement measures (i.e., lessons viewed,
      self-monitoring) will be collected during the internet program, and memory for lesson content
      will be assessed post-treatment. Individual difference measures will also be collected to
      provide preliminary data on factors that may influence success in each arm.

      This project tests innovative approaches in the clinical treatment of obesity and will
      provide new insights into the potential role of prevention versus promotion strategies for
      weight loss.
    

Intervention name(s): STANDARD; PREVENT; PROMOTE
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Standard Internet-delivered behavioral weight loss; enhanced standard Internet-delivered behavioral weight loss program; enhanced standard Internet-delivered behavioral weight loss program
Other intervention name(s): Standard Internet-delivered behavioral weight loss; PREVENT Internet-delivered behavioral weight loss; PROMOTE Internet-delivered behavioral weight loss
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment