临床实践中减肥干预措施的效果比较。
Comparative effectiveness of weight-loss interventions in clinical practice.
机构信息
Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, Maryland, USA.
出版信息
N Engl J Med. 2011 Nov 24;365(21):1959-68. doi: 10.1056/NEJMoa1108660. Epub 2011 Nov 15.
BACKGROUND
Obesity and its cardiovascular complications are extremely common medical problems, but evidence on how to accomplish weight loss in clinical practice is sparse.
METHODS
We conducted a randomized, controlled trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients with at least one cardiovascular risk factor. Participants were recruited from six primary care practices; 63.6% were women, 41.0% were black, and the mean age was 54.0 years. One intervention provided patients with weight-loss support remotely--through the telephone, a study-specific Web site, and e-mail. The other intervention provided in-person support during group and individual sessions, along with the three remote means of support. There was also a control group in which weight loss was self-directed. Outcomes were compared between each intervention group and the control group and between the two intervention groups. For both interventions, primary care providers reinforced participation at routinely scheduled visits. The trial duration was 24 months.
RESULTS
At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) for all participants was 36.6, and the mean weight was 103.8 kg. At 24 months, the mean change in weight from baseline was -0.8 kg in the control group, -4.6 kg in the group receiving remote support only (P<0.001 for the comparison with the control group), and -5.1 kg in the group receiving in-person support (P<0.001 for the comparison with the control group). The percentage of participants who lost 5% or more of their initial weight was 18.8% in the control group, 38.2% in the group receiving remote support only, and 41.4% in the group receiving in-person support. The change in weight from baseline did not differ significantly between the two intervention groups.
CONCLUSIONS
In two behavioral interventions, one delivered with in-person support and the other delivered remotely, without face-to-face contact between participants and weight-loss coaches, obese patients achieved and sustained clinically significant weight loss over a period of 24 months. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT00783315.).
背景
肥胖及其心血管并发症是极其常见的医学问题，但在临床实践中实现减肥的证据却很少。
方法
我们进行了一项随机对照试验，以检查两种行为减肥干预措施对 415 名至少有一个心血管危险因素的肥胖患者的影响。参与者从六个初级保健诊所招募而来；63.6%为女性，41.0%为黑人，平均年龄为 54.0 岁。一种干预措施通过电话、特定的研究网站和电子邮件远程为患者提供减肥支持。另一种干预措施在小组和个人会议期间提供面对面的支持，同时提供三种远程支持方式。还有一个对照组，其中减肥是自我导向的。结果在每个干预组与对照组之间以及两个干预组之间进行比较。对于两种干预措施，初级保健提供者都在常规预约就诊时加强了参与。试验持续 24 个月。
结果
在基线时，所有参与者的平均体重指数（体重以千克为单位除以身高以米为单位的平方）为 36.6，平均体重为 103.8 公斤。24 个月时，对照组体重从基线的平均变化为-0.8 公斤，仅接受远程支持组为-4.6 公斤（与对照组相比，P<0.001），接受面对面支持组为-5.1 公斤（与对照组相比，P<0.001）。体重减轻 5%或更多初始体重的参与者百分比在对照组为 18.8%，仅接受远程支持组为 38.2%，接受面对面支持组为 41.4%。从基线到体重的变化在两个干预组之间没有显著差异。
结论
在两种行为干预措施中，一种通过面对面支持提供，另一种通过远程提供，而参与者和减肥教练之间没有面对面的接触，肥胖患者在 24 个月的时间内实现并维持了临床显著的体重减轻。（由美国国立心肺血液研究所和其他机构资助；ClinicalTrials.gov 编号，NCT00783315）。
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