This application brings together a strong interdisciplinary team of scientists at the UCSF Center for Obesity Assessment, Study and Treatment (COAST) with researchers at Kaiser-Permanente to test novel interventions based on the physiology by which stress and reward from palatable food influence eating behaviors and abdominal fat deposition. This type of eating is typically non-homeostatic (not meeting caloric deficit). We plan to reduce this type of intake through proof-of-concept and intervention strategies tailored for obese lower income women prior to pregnancy, a critical period for intervention, which may affect gestational weight gain, postpartum weight retention, and offspring weight. Our translational approach draws from the psychology of eating and behavior change, and neuroscience of stress, appetite and reward, to test whether modulating the reward and stress response systems reduces abdominal obesity and weight. In Phase 1 &2, we will develop and compare two distinct interventions that target diet, activity, and stress but with different conceptual bases: (1): Developmental Skills Training (DST) designed to curb addictions through promoting self-regulation of emotions and eating behavior. (2);Mindfulness and Diet (MIND) aimed to reduce stress and improve awareness of hunger-satiety cues and automatic eating patterns through mindfulness and mindful eating. Preliminary data on each intervention are promising. We will also test an indirect measure of endogenous opioid tone that may provide insight into mechanisms of weight loss. Pilot research has shown that response to a naltrexone """"""""opioid probe"""""""" is linked to indices of non-homeostatic eating and predicts weight loss. We will test the utility of this opioid probe to determine if it changes during treatment and predicts change in eating and abdominal fat. In Phase 2, we will randomize 80 obese women intending to become pregnant to a 3 month proof-of-concept trial of DST and MIND, to compare relative effects on proposed mechanisms (stress, opioid tone), and feasibility. In Phase 3, we will refine and test the efficacy of the most successful intervention then randomize 120 pre-pregnant obese women to the selected intervention or active control condition (diet and exercise alone). These efforts will produce promising intervention strategies for curbing obesity in women during their reproductive years. All phases will be informed by input from a Scientific Advisory panel and Data Safety and Monitoring Board. Accomplishing the aims of this proposal will expand current understanding of the mechanisms that lead to sustained weight reduction, and will inform further study of alternative strategies for obesity intervention.

Public Health Relevance

The proposed research develops new obesity interventions based on the science of how stress influences the rewarding value of food, and promotes compulsive eating. We will test promising interventions, with women intending to become pregnant that will result in a new prevention programs that are more effective for sustained weight loss maintenance than what is currently available. This program could have a broad public health impact by improving maternal heath and potentially benefiting the next generation.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project--Cooperative Agreements (U01)
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Special Emphasis Panel (ZHL1-CSR-H (S1))
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Czajkowski, Susan
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University of California San Francisco
Schools of Medicine
San Francisco
United States
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Felder, Jennifer N; Laraia, Barbara; Coleman-Phox, Kimberly et al. (2017) Poor Sleep Quality, Psychological Distress, and the Buffering Effect of Mindfulness Training During Pregnancy. Behav Sleep Med :1-15
Bush, Nicole R; Jones-Mason, Karen; Coccia, Michael et al. (2017) Effects of pre- and postnatal maternal stress on infant temperament and autonomic nervous system reactivity and regulation in a diverse, low-income population. Dev Psychopathol 29:1553-1571
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Congdon, Jayme L; Adler, Nancy E; Epel, Elissa S et al. (2016) A Prospective Investigation of Prenatal Mood and Childbirth Perceptions in an Ethnically Diverse, Low-Income Sample. Birth 43:159-66
Mason, Ashley E; Laraia, Barbara; Daubenmier, Jennifer et al. (2015) Putting the brakes on the ""drive to eat"": Pilot effects of naltrexone and reward-based eating on food cravings among obese women. Eat Behav 19:53-6
Mason, Ashley E; Lustig, Robert H; Brown, Rashida R et al. (2015) Acute responses to opioidergic blockade as a biomarker of hedonic eating among obese women enrolled in a mindfulness-based weight loss intervention trial. Appetite 91:311-320
Czajkowski, Susan M; Powell, Lynda H; Adler, Nancy et al. (2015) From ideas to efficacy: The ORBIT model for developing behavioral treatments for chronic diseases. Health Psychol 34:971-82
Thomas, Melanie; Vieten, Cassandra; Adler, Nancy et al. (2014) Potential for a stress reduction intervention to promote healthy gestational weight gain: focus groups with low-income pregnant women. Womens Health Issues 24:e305-11

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