Weight Control and Diabetes Research Center, The Miriam Hospital and Brown Medical School, Providence, Rhode Island, USA.
Diabetes Care. 2011 Oct;34(10):2152-7. doi: 10.2337/dc11-0874. Epub 2011 Aug 11.
Rates of severe obesity (BMI ≥40 kg/m(2)) are on the rise, and effective treatment options are needed. We examined the effect of an intensive lifestyle intervention (ILI) on weight loss, cardiovascular disease (CVD) risk, and program adherence in participants with type 2 diabetes who were severely obese compared with overweight (BMI 25 to <30 kg/m(2)), class I (BMI 30 to <35 kg/m(2)), and class II (BMI 35 to <40 kg/m(2)) obese participants.
Participants in the Action for Health in Diabetes (Look AHEAD) trial were randomly assigned to ILI or diabetes support and education (DSE). DSE participants received a less intense educational intervention, whereas ILI participants received an intensive behavioral treatment to increase physical activity (PA) and reduce caloric intake. This article focuses on the 2,503 ILI participants (age 58.6 ± 6.8 years).
At 1 year, severely obese participants in the ILI group lost -9.04 ± 7.6% of initial body weight, which was significantly greater (P < 0.05) than ILI participants who were overweight (-7.43 ± 5.6%) and comparable to class I (-8.72 ± 6.4%) and class II obese (-8.64 ± 7.4%) participants. All BMI groups had comparable improvements in fitness, PA, LDL cholesterol, triglycerides, blood pressure, fasting glucose, and HbA(1c) at 1 year. ILI treatment session attendance was excellent and did not differ among weight categories (severe obese 80% vs. others 83%; P = 0.43).
Severely obese participants in the ILI group had similar adherence, percentage of weight loss, and improvement in CVD risk compared with less obese participants. Behavioral weight loss programs should be considered an effective option for this population.
严重肥胖（BMI≥40kg/m²）的发病率正在上升，因此需要有效的治疗方法。我们研究了强化生活方式干预（ILI）对患有 2 型糖尿病且肥胖程度严重（BMI≥40kg/m²）的患者的体重减轻、心血管疾病（CVD）风险以及治疗方案的依从性的影响，与超重（BMI 25 至＜30kg/m²）、I 级肥胖（BMI 30 至＜35kg/m²）和 II 级肥胖（BMI 35 至＜40kg/m²）患者进行了比较。
行动研究糖尿病（Look AHEAD）试验中的参与者被随机分配到 ILI 或糖尿病支持和教育（DSE）组。DSE 组参与者接受了强度较低的教育干预，而 ILI 组参与者接受了强化行为治疗以增加体力活动（PA）和减少热量摄入。本文主要关注 2503 名 ILI 参与者（年龄 58.6±6.8 岁）。
在 1 年时，ILI 组中肥胖程度严重的参与者体重减轻了初始体重的 9.04±7.6%，这明显高于超重（7.43±5.6%）和 I 级肥胖（8.72±6.4%）和 II 级肥胖（8.64±7.4%）参与者（P＜0.05）。所有 BMI 组在 1 年时的健康状况、PA、LDL 胆固醇、甘油三酯、血压、空腹血糖和 HbA1c 都有类似的改善。ILI 治疗疗程的出勤率非常高，且不同体重类别之间没有差异（严重肥胖 80%与其他组 83%；P=0.43）。
ILI 组肥胖程度严重的参与者在治疗方案的依从性、体重减轻百分比和 CVD 风险改善方面与肥胖程度较轻的参与者相似。行为体重管理方案应被视为该人群的有效治疗方法。
