Nanchahal Kiran, Townsend Joy, Letley Louise, Haslam David, Wellings Kaye, Haines Andy
London School of Hygiene and Tropical Medicine, London.
Br J Gen Pract. 2009 May;59(562):e157-66. doi: 10.3399/bjgp09X420617.
There is a paucity of randomised controlled trials of weight management in primary care.
To ascertain the feasibility of a full trial of a nurse-led weight-management programme in general practice.
Factorial randomised control trial.
Primary care, UK.
A total of 123 adults (80.3% women, mean age 47.2 years) with body mass index > or =27 kg/m(2), recruited from eight practices, were randomised to receive structured lifestyle support (n = 30), structured lifestyle support plus pedometer (n = 31), usual care (n = 31), or usual care plus pedometer (n = 31) for a 12-week period.
A total of 103 participants were successfully followed up. The adjusted mean difference in weight in structured support compared to usual care groups was -2.63 kg (95% confidence interval [CI] = -4.06 to -1.20 kg), and for pedometer compared to no pedometer groups it was -0.11 kg (95% CI = -1.52 to 1.30 kg). One in three participants in the structured-support groups (17/50, 34.0%) lost 5% or more of their initial weight, compared to less than one in five (10/53, 18.9%) in usual-care groups; provision of a pedometer made little difference (14/48, 29.2% pedometer; 13/55, 23.6% no pedometer). Difference in waist circumference change between structured-support and usual-care groups was -1.80 cm (95% CI = -3.39 to -0.20 cm), and between the pedometer and no pedometer groups it was -0.84 cm (95% CI = -2.42 to 0.73 cm). When asked about their experience of study participation, most participants found structured support helpful.
The structured lifestyle support package could make substantial contributions to improving weight-management services. A trial of the intervention in general practice is feasible and practicable.
基层医疗中体重管理的随机对照试验较少。
确定在全科医疗中全面开展由护士主导的体重管理项目的可行性。
析因随机对照试验。
英国基层医疗。
从8家医疗机构招募了123名体重指数≥27kg/m²的成年人（80.3%为女性，平均年龄47.2岁），随机分为四组，分别接受为期12周的结构化生活方式支持（n = 30）、结构化生活方式支持加计步器（n = 31）、常规护理（n = 31）或常规护理加计步器（n = 31）。
共成功随访了103名参与者。与常规护理组相比，结构化支持组体重的调整后平均差异为-2.63kg（95%置信区间[CI]=-4.06至-1.20kg）；与未使用计步器组相比，使用计步器组体重的调整后平均差异为-0.11kg（95%CI=-1.52至1.30kg）。结构化支持组中三分之一的参与者（17/50，34.0%）体重减轻了初始体重的5%或更多，而常规护理组中不到五分之一（10/53，18.9%）；提供计步器的效果不明显（使用计步器组为14/48，29.2%；未使用计步器组为13/55，23.6%）。结构化支持组与常规护理组腰围变化的差异为-1.80cm（95%CI=-3.39至-0.20cm），使用计步器组与未使用计步器组腰围变化的差异为-0.84cm（95%CI=-2.42至0.73cm）。当被问及参与研究的体验时，大多数参与者认为结构化支持很有帮助。
结构化生活方式支持方案可为改善体重管理服务做出重大贡献。在全科医疗中进行该干预措施的试验是可行且切实可行的。
