Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, Rhode Island, USA.
Obesity (Silver Spring). 2012 Feb;20(2):324-9. doi: 10.1038/oby.2011.124. Epub 2011 May 19.
Even though behavioral weight loss interventions are conducted in groups, a social contingency (SC) paradigm that capitalizes on the social reinforcement potential of the weight loss group has never been tested. We tested a weight loss intervention in which participation in the weight loss group was contingent upon meeting periodic weight goals. We hypothesized that making access to the group dependent upon weight loss would improve weight outcomes. Participants (N = 62; 84% female; 94% white; age = 51.9 ± 9.0; BMI = 34.7 ± 4.5) were randomized to 6-months of standard behavioral weight loss (SBWL) or to a behavioral program that included a SC paradigm. Both groups engaged in social cohesion activities. Participants in SC who did not meet weight goals did not attend group meetings; instead, they received individual treatment with a new interventionist and returned to group once their weight goals were met. SC did not improve overall weight loss outcomes (SC: -10.0 ± 4.9 kg, SBWL: -10.8 ± 6.4 kg, P = 0.63). Similarly, overall weight loss was not significantly different in the subgroup of participants in the SC and SBWL conditions who did not meet periodic weight loss goals (-7.3 ± 4.1 kg vs. -7.1 ± 3.5 kg, P = 0.90). Surprisingly, "successful" SC participants (who met their weight goals) actually lost less weight than "successful" SBWL participants (-12.4 ± 3.2 kg vs. -14.5 ± 4.7 kg, P = 0.02). Whereas contingency-based treatments have been tested for other health behaviors (e.g., substance abuse), this is the first study to test a SC intervention for weight loss. This approach did not improve overall weight loss outcomes. Our attempt to offer appropriate clinical care by providing individual treatment to SC participants when needed may have mitigated the effects of the SC paradigm.
尽管行为体重减轻干预是在小组中进行的，但从未测试过利用减肥小组的社会强化潜力的社会应急 (SC) 范式。我们测试了一种减肥干预措施，其中参加减肥小组取决于定期达到减肥目标。我们假设使获得小组的机会取决于减肥会改善减肥效果。参与者（N = 62；84%为女性；94%为白人；年龄= 51.9 ± 9.0；BMI = 34.7 ± 4.5）被随机分配到 6 个月的标准行为减肥 (SBWL) 或包括 SC 范式的行为计划。两组都进行了社会凝聚力活动。未达到体重目标的 SC 参与者不参加小组会议；相反，他们接受新干预者的个体治疗，一旦达到体重目标，就返回小组。SC 并没有改善总体减重效果（SC：-10.0 ± 4.9kg，SBWL：-10.8 ± 6.4kg，P = 0.63）。同样，在未达到定期体重减轻目标的 SC 和 SBWL 条件的参与者亚组中，总体减重也没有显着差异（-7.3 ± 4.1kg 与-7.1 ± 3.5kg，P = 0.90）。令人惊讶的是，“成功”的 SC 参与者（达到体重目标）实际上比“成功”的 SBWL 参与者体重减轻更少（-12.4 ± 3.2kg 与-14.5 ± 4.7kg，P = 0.02）。虽然已经针对其他健康行为（例如，药物滥用）测试了基于条件的治疗方法，但这是第一个测试减肥 SC 干预的研究。这种方法并没有改善总体减重效果。我们试图通过在需要时向 SC 参与者提供个体治疗来提供适当的临床护理，这可能减轻了 SC 范式的影响。
