Br J Gen Pract. 2008 Aug;58(553):548-54. doi: 10.3399/bjgp08X319710.
Evaluation for obesity management in primary care is limited, and successful outcomes are from intensive clinical trials in hospital settings.
To determine to what extent measures of success seen in intensive clinical trials can be achieved in routine primary care. Primary outcome measures were weight change and percentage of patients achieving >or=5% loss at 12 and 24 months.
Prospective evaluation of a new continuous improvement model for weight management in primary care.
Primary care, UK.
Primary care practice nurses from 65 UK general practices delivered interventions to 1906 patients with body mass index (BMI)>or=30 kg/m2 or>or=28 kg/m2 with obesity-related comorbidities.
Mean baseline weight was 101.2 kg (BMI 37.1 kg/m2); 25% of patients had BMI>or=40 kg/m2 and 74% had >or=1 major obesity-related comorbidity. At final data capture 1419 patients were in the programme for >or=12 months, and 825 for >or=24 months. Mean weight change in those who attended and had data at 12 months (n=642) was -3.0 kg (95% CI=-3.5 to -2.4 kg) and at 24 months (n=357) was -2.3 kg (95% CI=-3.2 to -1.4 kg). Among attenders at specific time-points, 30.7% had maintained weight loss of >or=5% at 12 months, and 31.9% at 24 months. A total of 761 (54%) of all 1419 patients who had been enrolled in the programme for >12 months provided data at or beyond 12 months.
This intervention achieves and maintains clinically valuable weight loss within routine primary care.
基层医疗中肥胖管理的评估有限，成功案例多来自医院环境下的强化临床试验。
确定在常规基层医疗中能在多大程度上实现强化临床试验中所见的成功指标。主要结局指标为体重变化以及在12个月和24个月时体重减轻≥5%的患者百分比。
对基层医疗中体重管理的新持续改进模型进行前瞻性评估。
英国基层医疗。
来自英国65家全科诊所的基层医疗执业护士对1906名体重指数（BMI）≥30kg/m²或≥28kg/m²且患有肥胖相关合并症的患者进行干预。
平均基线体重为101.2kg（BMI 37.1kg/m²）；25%的患者BMI≥40kg/m²，74%的患者患有≥1种主要的肥胖相关合并症。在最终数据收集时，1419名患者参与项目≥12个月，825名患者参与项目≥24个月。在12个月时参与且有数据的患者（n = 642）平均体重变化为-3.0kg（95%CI = -3.5至-2.4kg），在24个月时（n = 357）为-2.3kg（95%CI = -3.2至-1.4kg）。在特定时间点参与的患者中，30.7%在12个月时体重减轻维持≥5%，在24个月时为31.9%。在参与项目≥12个月的所有1419名患者中，共有761名（54%）在12个月及以后提供了数据。
该干预措施在常规基层医疗中实现并维持了具有临床价值的体重减轻。
