Martin L F
Department of Surgery, Louisiana State University School of Medicine, New Orleans 70112, USA.
Obes Surg. 1999 Jun;9(3):235-43. doi: 10.1381/096089299765553098.
To determine prospectively the characteristics of obese patients allowed to select either a medically supervised weight-reduction treatment program or a surgical treatment program, both offered at the same location.
This was a cohort study at a university medical center where patients, who self-referred themselves for weight loss treatments, were introduced to two different programs before they were allowed to start either program. Four hundred forty-three patients with a mean body mass index (BMI) of 45.6 +/- 0.5 (85 men, 358 women) self-selected either a combined supplemented fast with behavior modification (DIET, n = 208) or gastric bypass surgery (SURG, n = 235). Three hundred forty of these patients had private insurance (PI,) and 103 were receiving Medicaid/Medicare (publicly funded, PF). Each patient completed a semistructured psychiatric interview, obesity questionnaire, Profile of Mood Status (POMS), Beck Depression Inventory (BDI), Minnesota Multiphasic Personality Inventory (MMPI), and Hollingshead Index.
Three distinct groups of patients emerged on the basis of their insurance reimbursement patterns (employed versus disabled or indigent) and biopsychosocial factors. The disabled and/or indigent group receiving PF usually chose SURG (n = 89) because their insurance program covered it, but 14 disabled patients receiving Medicare chose DIET (together labeled the PF:DS group). The PI patients were divided into two groups: SURG (PI:S), n = 146, and DIET (PI: D), n = 194, respectively, based on their program selection. These three groups differed significantly in their biopsychosocial patterns. The PF:DS subjects appeared to have the strongest degree of biologic influence, followed by the PI:S and PI:D subjects. The pattern of social influences was consistent with the pattern of biologic influences and the selection bias created in forming the PF and PI groups. The pattern of psychologic influences, however, did not appear to follow the pattern of biologic and social influences. PF:DS had the strongest psychologic loading, but PI:D had a stronger degree of psychopathologic impairment than PI:S.
The significant differences in the biopsychosocial characteristics of these three groups of obese patients need to be considered by policy-makers when they design and review treatment studies and decide what treatment programs should be offered in medical insurance programs.
前瞻性地确定在同一地点提供的医学监督下的减重治疗方案或手术治疗方案中，肥胖患者的特征。
这是一项在大学医学中心进行的队列研究，自我推荐进行减肥治疗的患者在开始任何一种方案之前，都会被介绍两种不同的方案。443名平均体重指数（BMI）为45.6±0.5的患者（85名男性，358名女性）自行选择了联合补充禁食与行为矫正（饮食组，n = 208）或胃旁路手术（手术组，n = 235）。其中340名患者有私人保险（PI），103名接受医疗补助/医疗保险（公共资助，PF）。每位患者完成了半结构化的精神病学访谈、肥胖问卷、情绪状态量表（POMS）、贝克抑郁量表（BDI）、明尼苏达多相人格调查表（MMPI）和霍林斯黑德指数。
根据保险报销模式（就业与残疾或贫困）和生物心理社会因素，出现了三组不同的患者。接受PF的残疾和/或贫困组通常选择手术治疗（n = 89），因为他们的保险计划涵盖了该治疗，但14名接受医疗保险的残疾患者选择了饮食治疗（统称为PF：DS组）。PI患者根据其方案选择分为两组：手术组（PI：S），n = 146，和饮食组（PI：D），n = 194。这三组在生物心理社会模式上有显著差异。PF：DS组似乎具有最强程度的生物学影响，其次是PI：S组和PI：D组。社会影响模式与生物学影响模式以及在形成PF和PI组时产生的选择偏差一致。然而，心理影响模式似乎并不遵循生物学和社会影响模式。PF：DS组具有最强的心理负荷，但PI：D组的心理病理损害程度比PI：S组更强。
政策制定者在设计和审查治疗研究以及决定医疗保险计划应提供哪些治疗方案时，需要考虑这三组肥胖患者在生物心理社会特征方面的显著差异。
