Svetkey Laura P, Stevens Victor J, Brantley Phillip J, Appel Lawrence J, Hollis Jack F, Loria Catherine M, Vollmer William M, Gullion Christina M, Funk Kristine, Smith Patti, Samuel-Hodge Carmen, Myers Valerie, Lien Lillian F, Laferriere Daniel, Kennedy Betty, Jerome Gerald J, Heinith Fran, Harsha David W, Evans Pamela, Erlinger Thomas P, Dalcin Arline T, Coughlin Janelle, Charleston Jeanne, Champagne Catherine M, Bauck Alan, Ard Jamy D, Aicher Kathleen
Division of Nephrology, Department of Medicine, Duke Hypertension Center and Sarah W. Stedman Nutrition and Metabolism Center, Duke University Medical Center, Durham, North Carolina 27710, USA.
JAMA. 2008 Mar 12;299(10):1139-48. doi: 10.1001/jama.299.10.1139.
Behavioral weight loss interventions achieve short-term success, but re-gain is common.
To compare 2 weight loss maintenance interventions with a self-directed control group.
DESIGN, SETTING, AND PARTICIPANTS: Two-phase trial in which 1032 overweight or obese adults (38% African American, 63% women) with hypertension, dyslipidemia, or both who had lost at least 4 kg during a 6-month weight loss program (phase 1) were randomized to a weight-loss maintenance intervention (phase 2). Enrollment at 4 academic centers occurred August 2003-July 2004 and randomization, February-December 2004. Data collection was completed in June 2007.
After the phase 1 weight-loss program, participants were randomized to one of the following groups for 30 months: monthly personal contact, unlimited access to an interactive technology-based intervention, or self-directed control. Main Outcome Changes in weight from randomization.
Mean entry weight was 96.7 kg. During the initial 6-month program, mean weight loss was 8.5 kg. After randomization, weight regain occurred. Participants in the personal-contact group regained less weight (4.0 kg) than those in the self-directed group (5.5 kg; mean difference at 30 months, -1.5 kg; 95% confidence interval [CI], -2.4 to -0.6 kg; P = .001). At 30 months, weight regain did not differ between the interactive technology-based (5.2 kg) and self-directed groups (5.5 kg; mean difference -0.3 kg; 95% CI, -1.2 to 0.6 kg; P = .51); however, weight regain was lower in the interactive technology-based than in the self-directed group at 18 months (mean difference, -1.1 kg; 95% CI, -1.9 to -0.4 kg; P = .003) and at 24 months (mean difference, -0.9 kg; 95% CI, -1.7 to -0.02 kg; P = .04). At 30 months, the difference between the personal-contact and interactive technology-based group was -1.2 kg (95% CI -2.1 to -0.3; P = .008). Effects did not differ significantly by sex, race, age, and body mass index subgroups. Overall, 71% of study participants remained below entry weight.
The majority of individuals who successfully completed an initial behavioral weight loss program maintained a weight below their initial level. Monthly brief personal contact provided modest benefit in sustaining weight loss, whereas an interactive technology-based intervention provided early but transient benefit.
clinicaltrials.gov Identifier: NCT00054925.
行为减肥干预措施能取得短期成功，但体重反弹很常见。
比较两种体重维持干预措施与一个自我指导对照组。
设计、场所和参与者：两阶段试验，1032名超重或肥胖成年人（38%为非裔美国人，63%为女性），患有高血压、血脂异常或两者皆有，在为期6个月的减肥计划（第一阶段）中体重减轻了至少4千克，被随机分配到体重维持干预组（第二阶段）。2003年8月至2004年7月在4个学术中心招募参与者，2004年2月至12月进行随机分组。2007年6月完成数据收集。
在第一阶段减肥计划结束后，参与者被随机分配到以下组之一，为期30个月：每月个人联系、无限制使用基于互动技术的干预措施或自我指导对照组。主要结局为随机分组后的体重变化。
平均初始体重为96.7千克。在最初的6个月计划中，平均体重减轻了8.5千克。随机分组后，体重出现反弹。个人联系组的参与者体重反弹比自我指导组少（4.0千克对5.5千克；30个月时的平均差异为-1.5千克；95%置信区间[CI]，-2.4至-0.6千克；P = 0.001）。在30个月时，基于互动技术的组（5.2千克）和自我指导组（5.5千克）之间的体重反弹没有差异（平均差异-0.3千克；95% CI，-1.2至0.6千克；P = 0.51）；然而，在18个月时（平均差异，-1.1千克；95% CI，-1.9至-0.4千克；P = 0.003）和24个月时（平均差异，-0.9千克；95% CI，-1.7至-0.02千克；P = 0.04），基于互动技术的组的体重反弹低于自我指导组。在30个月时，个人联系组和基于互动技术的组之间的差异为-1.2千克（95% CI -2.1至-0.3；P = 0.008）。按性别、种族、年龄和体重指数亚组划分，效果没有显著差异。总体而言，71%的研究参与者体重仍低于初始体重。
大多数成功完成初始行为减肥计划的个体体重维持在初始水平以下。每月简短的个人联系在维持体重减轻方面有适度益处，而基于互动技术的干预措施提供了早期但短暂的益处。
clinicaltrials.gov标识符：NCT00054925。
