MRC Human Nutrition Research, Cambridge, UK.
Lancet. 2011 Oct 22;378(9801):1485-92. doi: 10.1016/S0140-6736(11)61344-5. Epub 2011 Sep 7.
The increasing prevalence of overweight and obesity needs effective approaches for weight loss in primary care and community settings. We compared weight loss with standard treatment in primary care with that achieved after referral by the primary care team to a commercial provider in the community.
In this parallel group, non-blinded, randomised controlled trial, 772 overweight and obese adults were recruited by primary care practices in Australia, Germany, and the UK. Participants were randomly assigned with a computer-generated simple randomisation sequence to receive either 12 months of standard care as defined by national treatment guidelines, or 12 months of free membership to a commercial programme (Weight Watchers), and followed up for 12 months. The primary outcome was weight change over 12 months. Analysis was by intention to treat (last observation carried forward [LOCF] and baseline observation carried forward [BOCF]) and in the population who completed the 12-month assessment. This trial is registered, number ISRCTN85485463.
377 participants were assigned to the commercial programme, of whom 230 (61%) completed the 12-month assessment; and 395 were assigned to standard care, of whom 214 (54%) completed the 12-month assessment. In all analyses, participants in the commercial programme group lost twice as much weight as did those in the standard care group. Mean weight change at 12 months was -5·06 kg (SE 0·31) for those in the commercial programme versus -2·25 kg (0·21) for those receiving standard care (adjusted difference -2·77 kg, 95% CI -3·50 to -2·03) with LOCF; -4·06 kg (0·31) versus -1·77 kg (0·19; adjusted difference -2·29 kg, -2·99 to -1·58) with BOCF; and -6·65 kg (0·43) versus -3·26 kg (0·33; adjusted difference -3·16 kg, -4·23 to -2·11) for those who completed the 12-month assessment. Participants reported no adverse events related to trial participation.
Referral by a primary health-care professional to a commercial weight loss programme that provides regular weighing, advice about diet and physical activity, motivation, and group support can offer a clinically useful early intervention for weight management in overweight and obese people that can be delivered at large scale.
Weight Watchers International, through a grant to the UK Medical Research Council.
超重和肥胖的患病率不断上升，这需要在初级保健和社区环境中采取有效的减肥方法。我们比较了初级保健团队将患者转介给社区商业供应商后，患者的体重减轻情况与接受标准治疗的患者的体重减轻情况。
在这项平行组、非盲、随机对照试验中，澳大利亚、德国和英国的初级保健机构招募了 772 名超重和肥胖成年人。参与者通过计算机生成的简单随机序列随机分配，接受 12 个月的标准治疗（根据国家治疗指南定义）或 12 个月的免费会员资格加入商业计划（Weight Watchers），并随访 12 个月。主要结局是 12 个月内体重变化。分析采用意向治疗（最后观察值结转[LOCF]和基线观察值结转[BOCF]）和完成 12 个月评估的人群。这项试验已注册，编号 ISRCTN85485463。
377 名参与者被分配到商业计划组，其中 230 名（61%）完成了 12 个月的评估；395 名参与者被分配到标准护理组，其中 214 名（54%）完成了 12 个月的评估。在所有分析中，商业计划组参与者的体重减轻量是标准护理组参与者的两倍。12 个月时的平均体重变化为商业计划组-5.06 公斤（SE 0.31），标准护理组-2.25 公斤（0.21）（调整差异-2.77 公斤，95%CI-3.50 至-2.03），采用 LOCF；-4.06 公斤（0.31）与-1.77 公斤（0.19）（调整差异-2.29 公斤，-2.99 至-1.58），采用 BOCF；以及-6.65 公斤（0.43）与-3.26 公斤（0.33）（调整差异-3.16 公斤，-4.23 至-2.11），采用完成 12 个月评估的参与者。参与者报告没有与试验参与相关的不良事件。
初级保健专业人员将患者转介给提供定期称重、饮食和身体活动建议、动机和小组支持的商业减肥计划，可以为超重和肥胖人群提供一种具有临床意义的早期体重管理干预措施，并且可以大规模实施。
Weight Watchers International 通过向英国医学研究理事会的赠款提供资金。
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