Engaging Self-Regulation Targets to Understand the Mechanisms of Behavior Change and Improve Mood and Weight Outcomes (ENGAGE-2)

Abstract

Obesity affects 36% of U.S. adults and increases lifetime risk for diabetes and cardiovascular disease. Similarly, depression affects 20% of women and 13% of men in the United States and is the leading cause of disability worldwide. Further, the two disorders have a bidirectional positive relationship. Proven behavioral interventions to treat obesity and depression exist; however, the underlying biological mechanisms remain unknown. This lack of understanding significantly hampers efforts to optimize the effectiveness of behavioral interventions and limits their dissemination and implementation into widespread practice to curtail the adverse consequences of obesity and depression and promote population health. Rapid advances in human neuroscience and behavioral science and integration of the two could provide unique opportunity to fill this gap.

This study leverages a recent two-year randomized controlled trial ("RAINBOW" target n=404; PI Dr. Jun Ma) of a first-ever integrated treatment for comorbid obesity and depression in primary care that uniquely combines two nationally recognized behavioral interventions.

In this study, we conduct a 2-phased project to identify, validate, and refine a set of assays to measure self-regulation targets; and to engage these targets to optimize behavioral treatment of obesity and depression.


In the first (UH2) phase of this study, from 2015 to 2018, our research team...

  • Conducted secondary data analysis and hold workshops and a symposium to finalize selection of self-regulation targets and assays for testing.
  • Leveraged the RAINBOW intervention to engage identified targets.
  • Verified target engagement across multiple domains (neural, physiological, behavioral, psychological), settings (laboratory, virtual, and naturalistic), and time points (0, 4 weeks, 6, 12 and 24 months).

Transitional milestones are to...

  • Establish assays that reliably and accurately measure the identified targets.
  • Demonstrate malleability of the self-regulation targets in response to th RAINBOW integrated treatment.
  • Identify self-regulation profiles that predict treatment response in health behaviors (medical regimen adherence, physical activity, diet) and outcomes (weight, depression).

In the UH3 phase, which begins in September 2018, we conduct a pilot randomized controlled trial in which an additional 100 obese and depressed adults will be randomized to intervention or wait-list control groups. Both groups will be assessed at baseline, 4 weeks, and 6 months. Intervention subjects will receive the first 4 weeks of the RAINBOW intervention, followed by target-guided tailoring of the intervention components to optimize target engagement and enhance behavioral change based on their individual self-regulation profile during the first 4 weeks. We will use the insights from intervention subjects to then further refine the tailoring strategies for the waitlist subjects.

This research will provide a toolkit of well-validated assays of self-regulation targets important for health behavior change, as well as target-guided personalization of intervention strategies, in the treatment of comorbid obesity and depression.

Given the widespread relevance of these disorders and the targeted health behaviors, this research will be a prototype for treating multiple chronic conditions with profound potential impacts on population health.

Principal investigator
Funding Agency

National Heart, Lung, and Blood Institute of the National Institutes of Health (Grant No. UH2HL132368 and UH3HL132368)

 

Co-Principal Investigator

Leanne Williams, PhD, of Stanford University

Start date
09/15/2015
End date
08/31/2020
Total award
$4,998,623
About this grant

The University of Illinois at Chicago is one of nine research institutions in the National Institutes of Health Common Fund’s Science of Behavior Change (SOBC) Research Network.

Related publications


Pines AR, Sacchet MD, Kullar M, Ma J, Williams LM. Multi-unit relations among neural, self-report, and behavioral correlates of emotion regulation in comorbid depression and obesity. Sci Rep. 2018;8(1):14032. Published 2018 Sep 19. doi:10.1038/s41598-018-32394-2

Williams LM, Pines A, Goldstein-Piekarski AN, Rosas LG, Kullar M, Sacchet MD, Gevaert O, Bailenson J, Lavori PW, Dagum P, Wandell B, Correa C, Greenleaf W, Suppes T, Perry LM, Smyth JM, Lewis MA, Venditti EM, Snowden M, Simmons JM, Ma J. The ENGAGE study: Integrating neuroimaging, virtual reality and smartphone sensing to understand self-regulation for managing depression and obesity in a precision medicine model. Behav Res Ther. 2018 Feb;101:58-70. doi: 10.1016/j.brat.2017.09.012.

Ma J, Rosas LG, Lv N. Precision Lifestyle Medicine: A New Frontier in the Science of Behavior Change and Population Health. Am J Prev Med. 2016 Mar;50(3):395-7. [See abstract.]

Ma J, Yank V, Lv N, Goldhaber-Fiebert JD, Lewis MA, Kramer MK, et al. Research aimed at improving both mood and weight (RAINBOW) in primary care: A type 1 hybrid design randomized controlled trial. Contemp Clin Trials. 2015 Jul;43:260-78. [PMID: 26096714] doi: 10.1016/j.cct.2015.06.010.