McQuigg M, Brown J, Broom J, Laws R A, Reckless J P D, Noble P A, Kumar S, McCombie E L, Lean M E J, Lyons G F, Frost G S, Quinn M F, Barth J H, Haynes S M, Finer N, Ross H M, Hole D J
Diabetes Centre, Royal United Hospital, Bath, UK.
Eur J Clin Nutr. 2005 Aug;59 Suppl 1:S93-100; discussion S101. doi: 10.1038/sj.ejcn.1602180.
To improve the management of obese adults (18-75 y) in primary care.
Cohort study.
UK primary care.
Obese patients (body mass index > or =30 kg/m(2)) or BMI> or =28 kg/m(2) with obesity-related comorbidities in 80 general practices.
The model consists of four phases: (1) audit and project development, (2) practice training and support, (3) nurse-led patient intervention, and (4) evaluation. The intervention programme used evidence-based pathways, which included strategies to empower clinicians and patients. Weight Management Advisers who are specialist obesity dietitians facilitated programme implementation.
Proportion of practices trained and recruiting patients, and weight change at 12 months.
By March 2004, 58 of the 62 (93.5%) intervention practices had been trained, 47 (75.8%) practices were active in implementing the model and 1549 patients had been recruited. At 12 months, 33% of patients achieved a clinically meaningful weight loss of 5% or more. A total of 49% of patients were classed as 'completers' in that they attended the requisite number of appointments in 3, 6 and 12 months. 'Completers' achieved more successful weight loss with 40% achieving a weight loss of 5% or more at 12 months.
The Counterweight programme provides a promising model to improve the management of obesity in primary care.
改善基层医疗中肥胖成年人（18 - 75岁）的管理。
队列研究。
英国基层医疗。
80家普通诊所中体重指数≥30 kg/m²的肥胖患者或体重指数≥28 kg/m²且患有肥胖相关合并症的患者。
该模型包括四个阶段：（1）审核与项目开发，（2）诊所培训与支持，（3）护士主导的患者干预，以及（4）评估。干预项目采用循证路径，其中包括增强临床医生和患者能力的策略。由专业肥胖营养师担任的体重管理顾问协助项目实施。
接受培训并招募患者的诊所比例，以及12个月时的体重变化。
到2004年3月，62家干预诊所中有58家（93.5%）接受了培训，47家（75.8%）诊所积极实施该模型，共招募了1549名患者。12个月时，33%的患者实现了具有临床意义的体重减轻，即体重减轻5%或更多。共有49%的患者被归类为“完成者”，因为他们在3个月、6个月和12个月内参加了规定次数的预约。“完成者”的体重减轻更为成功，40%的人在12个月时体重减轻了5%或更多。
Counterweight项目为改善基层医疗中肥胖的管理提供了一个有前景的模型。
