Wee Christina C, Hamel Mary B, Davis Roger B, Phillips Russell S
Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
J Gen Intern Med. 2004 Dec;19(12):1206-11. doi: 10.1111/j.1525-1497.2004.40063.x.
Modest weight loss of 10% of baseline weight is beneficial and achievable for overweight and obese patients. However, whether primary care patients value modest weight loss is unclear.
To quantify the value patients place on modest weight loss.
Cross-sectional telephone survey.
Patients at a large hospital-based primary care practice.
Three hundred sixty-five primary care patients (60% response rate).
Utilities or value for weight loss estimated from willingness to risk death or trade time in exchange for losing different levels of weight (weight loss in pounds equivalent to a 5%, 10%, and 20% reduction in initial weight or to achieve a body mass index [BMI] of 25 kg/m2) using the standard gamble and time tradeoff formats.
Of respondents, 15% of overweight (BMI, 25 to 29.9 kg/m2) and 42% of obese patients (BMI > or = 30 kg/m2) believed they needed to lose more than 10% of their weight to derive any health benefits. However, 18% of overweight and 33% of obese patients were willing to risk death to lose 10% of their weight. Patients with higher BMI valued higher degrees of weight loss. Among the overall sample, the utilities derived using standard gamble were 0.95 for current weight, 0.96 for 5% weight loss, 0.97 for 10% weight loss, and 0.98 for 20% weight loss; among obese patients, utilities were 0.88, 0.91, 0.93, and 0.96, respectively. Utilities derived using time tradeoff were lower but correlated with utilities derived from standard gamble. Utilities did not vary by education, gender, race, having comorbidities, or smoking.
Many primary care patients value modest weight loss. The value placed on loss of 10% body weight among obese patients where utility improved from 0.88 to 0.93 is similar to recovery from major depression. Nevertheless, the majority of patients still do not highly value modest weight loss. Clinicians should emphasize the health benefits of modest weight loss when counseling about weight.
超重和肥胖患者减轻相当于基线体重10%的适度体重是有益的且可以实现的。然而，初级保健患者是否重视适度体重减轻尚不清楚。
量化患者对适度体重减轻的重视程度。
横断面电话调查。
一家大型医院的初级保健机构的患者。
365名初级保健患者（应答率60%）。
使用标准博弈和时间权衡法，根据为减轻不同程度体重（相当于初始体重减轻5%、10%和20%或达到体重指数[BMI]为25kg/m²的磅数减重）而冒死亡风险或交换时间的意愿，估计体重减轻的效用或价值。
在受访者中，15%的超重患者（BMI为25至29.9kg/m²）和42%的肥胖患者（BMI≥30kg/m²）认为他们需要减轻超过10%的体重才能获得任何健康益处。然而，18%的超重患者和33%的肥胖患者愿意冒死亡风险来减轻10%的体重。BMI较高的患者重视更高程度的体重减轻。在总体样本中，使用标准博弈得出的效用，当前体重为0.95，体重减轻5%为0.96，体重减轻10%为0.97，体重减轻20%为0.98；在肥胖患者中，效用分别为0.88、0.91、0.93和0.96。使用时间权衡得出的效用较低，但与标准博弈得出的效用相关。效用不因教育程度、性别、种族、有无合并症或吸烟情况而有所不同。
许多初级保健患者重视适度体重减轻。肥胖患者中，体重减轻10%的效用从0.88提高到0.93，这与从重度抑郁症中康复的效用相似。然而，大多数患者仍然不太重视适度体重减轻。临床医生在进行体重咨询时应强调适度体重减轻对健康的益处。
