An Integrated Lifestyle Intervention to Promote Cardiometabolic Health among Emerging Adult Women - PROJECT ABSTRACT Emerging adulthood (18-25 years of age) represents a critical developmental window for lifestyle intervention given high rates of obesity, proinflammatory behaviors (e.g., dysregulated sleep, intake of highly processed foods, declines in physical activity), life stressors, and psychological symptoms—all of which serve to perpetuate chronic low-level inflammation, thereby increasing risk for cardiometabolic disease and many cancers. Despite this, few behavioral obesity management interventions have developed specifically for emerging adults (EA). Those that do exist have produced modest treatment effects, with EA women experiencing considerably less benefit than EA men. EA women are also at disproportionate risk for psychological dysregulation in the form of depressive symptoms and psychological stress. Further, our preliminary data suggest that exposure to life events, insufficient sleep, perceived stress, and depressive symptoms interfere with weight loss treatment response in this population. Importantly, this does not appear to be driven by differences in self-regulation behaviors; rather, we posit that the cognitive processing required for effective self-regulation is disrupted by inflammatory cytokine activity. Extant behavioral weight loss programs are insufficient to address this underlying behavioral/psychological dysregulation, and do not promote behavior change through the lens of inflammation. Thus, a new intervention model is needed to optimize clinical impact in this high-risk population. Our overarching hypothesis is that explicitly targeting psychological functioning and proinflammatory behaviors could not only enhance weight loss outcomes, but also confer greater improvements in inflammation and cardiometabolic health among EA women than those achieved by weight loss alone. We developed and tested an integrated lifestyle intervention (ILI) in a single arm proof-of-concept trial and observed clinically and statistically significant improvements in depression, anxiety, perceived stress, as well as weight. ILI consisted of BWL content adapted to meet the needs of EAs with an increased focus on changing discrete behaviors linked to inflammation in the absence of calorie goals, all intertwined with training in empirically-supported strategies to improve psychological function (e.g., cognitive restructuring, distress tolerance). Building upon these promising results, we propose a pilot randomized clinical trial of ILI compared to our developmentally adapted behavioral weight loss (BWL). We will recruit 32 EA women age 18-25 with BMI 25-50kg/m2 and randomize them to ILI or BWL. All participants will receive digital tools to facilitate self-monitoring and contact schedule will be identical between arms—the initial 4-month program will consist of group sessions via Zoom (8 weekly, 4 bi-weekly) with weekly tailored e-coaching, followed by monthly boosters through 12 months. Assessments will occur at 0, 4, 8 and 12 months to assess the preliminary efficacy of ILI to improve adiposity (Aim 1) and biomarkers of inflammation and cardiometabolic risk (Aim 2), and to explore putative psychological mechanisms of action (Aim 3).
