Novel approaches to dietary behavior change assessment and intervention.

摘要

It is well documented that individual risk for the leading causes of morbidity and mortality in the US, including coronary heart disease and obesity, can be reduced through changes in lifestyle including diet and exercise. Prior interventions to promote long-term changes in such lifestyle factors have met with limited success. Researchers have emphasized the importance of the development and testing of new, cost-effective interventions. Available evidence indicates that interventions based on well-accepted behavioral theories are most effective, however few to date have been based on such theory.; Impediments to the development of such interventions include a lack of in-depth understanding of the dietary behaviors most easily and effectively modified for disease risk reduction. Instruments that assess consumers' eating behaviors and identify target areas of change as well as the development and testing of innovative behaviorally-based interventions would advance the field.; This dissertation includes the systematic development and testing of the inter-rater, reliability and validity of a method to evaluate food intake behaviors called FIAT (F&barbelow;ood I&barbelow;ntake A&barbelow;ssessment T&barbelow;ool). Once developed and tested, the FIAT was applied to existing data collected from a 12-week pilot study of a computer-based, telephone administered, cost-efficient dietary behavior intervention (DietAid) to determine its impact on food behavior change. Information gained from this research component was then utilized to design a more sophisticated, behaviorally based intervention using the same computer-based, telephone administered approach. This new intervention was designed to promote weight maintenance among patients who have completed a clinical weight loss program for chronic disease risk management.; FIAT is a reliable and valid instrument for estimating food intake behavior. When FIAT was used to test the efficacy of DietAid, this low-intensity intervention resulted in significant changes in food intake and in blood lipids in the intervention group, and no similar changes were seen in the control group. DietAid was found to be an effective and cost-efficient dietary intervention. The design for the weight management intervention is complete and future work will include computer programming and formal testing of this system.