Nanchahal Kiran, Power Tom, Holdsworth Elizabeth, Hession Michelle, Sorhaindo Annik, Griffiths Ulla, Townsend Joy, Thorogood Nicki, Haslam David, Kessel Anthony, Ebrahim Shah, Kenward Mike, Haines Andrew
London School of Hygiene & Tropical Medicine, London, UK.
BMJ Open. 2012 May 4;2(3). doi: 10.1136/bmjopen-2011-000793. Print 2012.
To evaluate effectiveness of a structured one-to-one behaviour change programme on weight loss in obese and overweight individuals.
Randomised controlled trial.
23 general practices in Camden, London.
381 adults with body mass index ≥25 kg/m(2) randomly assigned to intervention (n=191) or control (n=190) group.
A structured one-to-one programme, delivered over 14 visits during 12 months by trained advisors in three primary care centres compared with usual care in general practice.
Changes in weight, per cent body fat, waist circumference, blood pressure and heart rate between baseline and 12 months.
217/381 (57.0%) participants were assessed at 12 months: missing values were imputed. The difference in mean weight change between the intervention and control groups was not statistically significant (0.70 kg (0.67 to 2.17, p=0.35)), although a higher proportion of the intervention group (32.7%) than the control group (20.4%) lost 5% or more of their baseline weight (OR: 1.80 (1.02 to 3.18, p=0.04)). The intervention group achieved a lower mean heart rate (mean difference 3.68 beats per minute (0.31 to 7.04, p=0.03)) than the control group. Participants in the intervention group reported higher satisfaction and more positive experiences of their care compared with the control group.
Although there is no significant difference in mean weight loss between the intervention and control groups, trained non-specialist advisors can deliver a structured programme and achieve clinically beneficial weight loss in some patients in primary care. The intervention group also reported a higher level of satisfaction with the support received. Primary care interventions are unlikely to be sufficient to tackle the obesity epidemic and effective population-wide measures are also necessary.
Trial registrationClincaltrials.gov NCT00891943.
评估一项结构化一对一行为改变计划对肥胖和超重个体体重减轻的效果。
随机对照试验。
伦敦卡姆登的23家全科诊所。
381名体重指数≥25kg/m²的成年人，随机分为干预组（n = 191）或对照组（n = 190）。
一项结构化一对一计划，由三个初级保健中心的训练有素的顾问在12个月内进行14次家访，与全科诊所的常规护理相比。
基线和12个月之间体重、体脂百分比、腰围、血压和心率的变化。
381名参与者中有217名（57.0%）在12个月时接受了评估：缺失值进行了估算。干预组和对照组之间的平均体重变化差异无统计学意义（0.70kg（0.67至2.17，p = 0.35）），尽管干预组（32.7%）体重减轻达到或超过基线体重5%的比例高于对照组（20.4%）（比值比：1.80（1.02至3.18，p = 0.04））。干预组的平均心率低于对照组（平均差异为每分钟3.68次心跳（0.31至7.04，p = 0.03））。与对照组相比，干预组的参与者对其护理的满意度更高，体验更积极。
尽管干预组和对照组之间的平均体重减轻没有显著差异，但训练有素的非专科顾问可以实施结构化计划，并在初级保健中的一些患者中实现临床上有益的体重减轻。干预组对所获得支持的满意度也更高。初级保健干预措施不太可能足以应对肥胖流行，有效的全人群措施也很有必要。
Trial registrationClincaltrials.gov NCT00891943 。
