Teixeira P J, Going S B, Houtkooper L B, Cussler E C, Metcalfe L L, Blew R M, Sardinha L B, Lohman T G
Department of Exercise and Health, Faculty of Human Movement, Technical University of Lisbon, Lisbon, Portugal.
Int J Obes Relat Metab Disord. 2004 Sep;28(9):1124-33. doi: 10.1038/sj.ijo.0802727.
OBJECTIVE: This study analyzed baseline behavioral and psychosocial differences between successful and nonsuccessful participants in a behavioral weight management program. Success was defined by commonly used health-related criteria (5% weight loss). Noncompletion was also used as a marker of a failed attempt at weight control. SUBJECTS: A total of 158 healthy overweight and obese women (age, 48.0+/-4.5 y; BMI, 31.0+/-3.8 kg/m(2); body fat, 44.5+/-5.3%). INTERVENTION: Subjects participated in a 16-week lifestyle weight loss program consisting of group-based behavior therapy to improve diet and increase physical activity, and were followed for 1 y after treatment. METHODS: At baseline, all women completed a comprehensive behavioral and psychosocial battery assessing dieting/weight history, dietary intake and eating behaviors, exercise, self-efficacy, outcome evaluations, body image, and other variables considered relevant for weight management. Participants who maintained a weight loss of 5% or more at 16 months (or 10% or more of initial fat mass) were classified as successful. Nonsuccessful participants were those who dropped out and completers who had not lost weight at follow-up. RESULTS: Of all participants, 30% (n=47) did not complete initial treatment and/or missed follow-up assessments (noncompleters). Noncompletion was independently associated with more previous weight loss attempts, poorer quality of life, more stringent weight outcome evaluations, and lower reported carbohydrate intake at baseline. In logistic regression, completion status was predicted correctly in 84% of all cases (chi(2)=45.5, P<0.001), using baseline information only. Additional predictors of attrition were initial weight, exercise minutes, fiber intake, binge eating, psychological health, and body image. A large variation in weight loss/maintenance results was observed (range: 37.2 kg for 16-month weight change). Independent baseline predictors of success at 16 months were more moderate weight outcome evaluations, lower level of previous dieting, higher exercise self-efficacy, and smaller waist-to-hip ratio. Success status at follow-up was predicted correctly in 74% of all starting cases (chi(2)=33.6, P<0.001). CONCLUSION: Psychosocial and behavioral variables (eg, dieting history, dietary intake, outcome evaluations, exercise self-efficacy, and quality of life) may be useful as pretreatment predictors of success level and/or attrition in previously overweight and mildly obese women who volunteer for behavioral weight control programs. These factors can be used in developing readiness profiles for weight management, a potentially important tool to address the issue of low success/completion rates in the current management of obesity.
目的:本研究分析了行为体重管理项目中成功与未成功参与者之间的基线行为和心理社会差异。成功的定义采用常用的与健康相关的标准(体重减轻5%)。未完成项目也被用作体重控制尝试失败的一个标志。 对象:共有158名健康的超重和肥胖女性(年龄48.0±4.5岁;体重指数31.0±3.8kg/m²;体脂44.5±5.3%)。 干预措施:受试者参加了一个为期16周的生活方式减肥项目,该项目包括基于小组的行为疗法以改善饮食和增加身体活动,并在治疗后随访1年。 方法:在基线时,所有女性完成了一套全面的行为和心理社会测评,评估节食/体重史、饮食摄入和饮食行为、运动、自我效能感、结果评估、身体形象以及其他与体重管理相关的变量。在16个月时体重减轻5%或更多(或初始脂肪量的10%或更多)的参与者被归类为成功。未成功的参与者是那些退出的人以及随访时体重未减轻的完成者。 结果:在所有参与者中,30%(n = 47)未完成初始治疗和/或错过随访评估(未完成者)。未完成与更多先前的减肥尝试、较差的生活质量、更严格的体重结果评估以及基线时较低的碳水化合物摄入量独立相关。在逻辑回归分析中,仅使用基线信息,在所有病例中84%正确预测了完成状态(χ² = 45.5,P < 0.001)。损耗的其他预测因素包括初始体重、运动分钟数、纤维摄入量、暴饮暴食、心理健康和身体形象。观察到体重减轻/维持结果存在很大差异(范围:16个月体重变化为37.2kg)。16个月成功的独立基线预测因素是更适度的体重结果评估、较低的先前节食水平、较高的运动自我效能感和较小的腰臀比。在所有起始病例中74%正确预测了随访时的成功状态(χ² = 33.6,P < 0.001)。 结论:心理社会和行为变量(如节食史、饮食摄入、结果评估、运动自我效能感和生活质量)可能作为志愿参加行为体重控制项目的先前超重和轻度肥胖女性成功水平和/或损耗的预处理预测指标有用。这些因素可用于制定体重管理的准备情况概况,这是解决当前肥胖管理中低成功率/完成率问题的一个潜在重要工具。
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