Hickson M, Macqueen C, Frost G
Nutrition and Dietetic Research Group, Imperial College Healthcare NHS Trust, London, UK.
J Hum Nutr Diet. 2009 Feb;22(1):72-6. doi: 10.1111/j.1365-277X.2008.00927.x.
With increasing rates of obesity, the effectiveness of weight reduction programmes come under increasing scrutiny. This nonrandomized study aimed to review the effectiveness of two weight loss clinics in terms of percent and rate of weight loss, and attendance.
Data were collected on consecutive obese patients, attending either an intensive weight management clinic (IWMC) or a general dietetic outpatient clinic. The IWMC had a structured approach with six once-a-month appointments, a signed agreement to attend, an initial screening of readiness to change and consistent advice from one dietitian. The general clinic was less structured, had more ad hoc follow up and did not guarantee one dietitian.
Seventy percent of patients referred were female [mean (SD) age 48 (14.2) years]. Thirty-three percent (103/313) of all patients referred did not book an appointment. Of those attending with a body mass index > or = 32 kg m(-2), 55% were seen in the general and 45% in the intensive clinic, but only 19% and 53%, respectively, completed the programmes. The total amount and rate of weight loss did not differ significantly between clinics. However, analysis using the last recorded weight revealed a median weight reduction of 1.8% (interquartile range = -5.6-0) at the median rate of -0.4 kg month(-1) (-1-0) in the intensive clinic, compared to no overall weight loss in the general clinic (P < or = 0.001).
A more structured approach and initial screening of readiness to change is likely to achieve better weight loss results and therefore will comprise a better use of dietetic time than including obese patients in general clinics.
随着肥胖率的不断上升，减肥计划的有效性受到越来越多的审视。这项非随机研究旨在从体重减轻的百分比、速率及就诊率方面评估两家减肥诊所的有效性。
收集连续就诊的肥胖患者的数据，这些患者分别前往强化体重管理诊所（IWMC）或普通营养门诊就诊。IWMC采用结构化方法，每月安排6次就诊，患者需签署就诊协议，进行初始的改变意愿筛查，并由同一位营养师提供持续的建议。普通诊所的结构没那么严谨，随访较为随意，且不能保证由同一位营养师负责。
转诊患者中有70%为女性[平均（标准差）年龄48（14.2）岁]。所有转诊患者中有33%（103/313）未预约就诊。在体重指数≥32 kg/m²的就诊患者中，55%在普通诊所就诊，45%在强化诊所就诊，但分别只有19%和53%完成了整个疗程。两家诊所的总体体重减轻量和速率没有显著差异。然而，根据最后记录的体重进行分析发现，强化诊所的体重中位数下降了1.8%（四分位间距=-5.6-0），体重下降的中位数速率为-0.4 kg/月（-1-0），而普通诊所总体体重没有减轻（P≤0.001）。
相较于将肥胖患者纳入普通诊所，采用更结构化的方法并进行初始的改变意愿筛查可能会取得更好的减肥效果，从而能更有效地利用营养师的时间。
