Obesity is one of the leading causes of preventable death. People with overweight and obesity are at a heightened risk for type 2 diabetes, cardiovascular disease and several types of cancer, among other diseases. With nearly 40 percent of American adults suffering from obesity per by the Centers for Disease Control and Prevention, obesity is a public health crisis.
To combat this growing epidemic, Tricia Leahey, an associate professor in the Department of Allied Health Sciences, designs weight loss interventions and tests weight management strategies informed by basic science to assist individuals with improving their health and preventing disease. As co-director of the UConn Weight Management Research Group, Leahey evaluates behavioral and lifestyle changes to determine the most efficacious and cost-effective treatments for at-risk populations. She is currently working on three research studies funded by the National Institutes of Health.
“We design and evaluate the efficacy of various obesity treatments at our lab in downtown Hartford,” says Leahey. “Given that there are health disparities related to obesity and associated diseases, we want to meet the needs of individuals most in need. Thus our, populations are from diverse racial and ethnic backgrounds and socioeconomic status.”
Adults from economically disadvantaged backgrounds experience rates of obesity far greater than the national average. Leahey’s most recent research initiative seeks to address the urgent health needs of this underserved population. She tailors interventions to meet specific challenges facing economically disadvantaged adults in obesogenic environments.
Poorer communities often lack access to nutritious foods and encounter an excess of unhealthy food options. These surroundings, combined with daily stress and life demands, do not encourage healthful diets. Additionally, as humans tend to favor immediate gratification over future rewards, bias for the present is an impediment for anyone attempting to alter their habits. Leahey is designing a year-long weight loss program that uses behavioral economic strategies and digital health technology to help individuals overcome these obstacles and change behaviors.
Leahey is developing an app from based on the National Diabetes Prevention Program. This allows participants with lower income, who are more likely to own a smartphone than a computer, to have dependable access to the content. To forestall data costs from discouraging participation, the app will be usable offline. Since there is a strong correlation between lower income and lower education, Leahey is also adapting the content for reading level, health numeracy and health literacy. The University of North Carolina at Chapel Hill is assisting with the technical aspects of creating the app.
“We’re essentially putting the intervention content in plain language for the app,” says Leahey. “In addition, we’re testing behavioral economic strategies. I’ve done work with very small incentives, a few dollars a week, for obesity treatment. If it’s delivered consistent with behavior change principles, you can get a large treatment effect for the cost.”
Some of the participants will receive compensation for practicing core weight management behaviors, including weighing yourself every day, tracking your food consumption and monitoring your exercise. If the activities are finished five of seven days per week, a monetary award is given, but the amount is randomized and varies in size.
Leahey’s previous research suggests that the introduction of monetary reinforcement will help motivate participants and sustain their engagement, yielding improved weight loss. As participants begin to lose weight and the program continues, monetary awards will taper off and be replaced by episodic future thinking.
Episodic future thinking involves envisioning a positive future event at your desired weight or fitness outcome. The mental task takes the focus away from the immediate temptations participants may struggle to surmount and encourages them to look towards eagerly anticipated events in their lives.
“For example, maybe getting home from work, before dinner, and seeing a bag of cookies on the counter is a real temptation,”says Leahey. “At that moment, someone is in a ‘hot’ state. At that moment, they will be pushed a picture or cue of that positive future event for which their health goal is important. We’re trying to have them stop and think about something that’s really important to them in the future that relates to weight management. It might be their son’s wedding in three months and the importance of feeling good, keeping up on the dance floor and wearing that blue dress. Or it might be going on a hike with family and being able to keep up.”
Leahey’s team works with each participant to develop specific, personal events. They incorporate all five senses to create a vivid description and then add a complementary photo into the app. Leahey is also adding an audio feature, so participants can hear themselves relating these scenarios, which can aid those with lower literacy. Participants choose times when they are most tempted to make unhealthy choices and then receive pre-programmed, daily notifications about these envisaged episodes, shifting their minds away from a present temptation to a future reward enjoyed with better health. In other words, steering the value from an immediate gratification towards the aspirational event.
“There are cognitive tasks, called delayed discounting, where we can measure people’s tendency to value longer-term rewards versus short-term rewards. The goal is for us to change that mechanism, so people are thinking longer-term and how their current behavior impacts on their future. The basic science literature shows that episodic future thinking shifts delayed discounting, but there is scant literature on whether episodic future thinking shifts delayed discounting in the clinical treatment of obesity,” says Leahey.
Studying delayed discounting is also part of Leahey’s second NIH-funded trial, which she conducts with Amy Gorin, a professor of psychological sciences, co-director of the Weight Management Research Group and director of the Institute for Collaboration on Health, Intervention and Policy. The study concentrates on averting weight regain and promoting physical activity outcomes after successful weight loss.
Leahey’s third NIH research study investigates the role peer support might play in successful weight loss maintenance. The project will be the first to test long-term continuous care provided by trained patients instead of medical professionals in obesity treatment.
“Our aim is to translate basic science to actual intervention,” says Leahey. “We want to find what is most effective for long-term behavior change, what is most cost-effective and then best use that information to help people in our communities.”
These projects are funded by NIH grants 1R01DK118957-01A1, 5R21NR018359-02 and 5R01DK111232-03.