Hartmann-Boyce J, Johns D J, Jebb S A, Summerbell C, Aveyard P
Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, UK.
Obes Rev. 2014 Nov;15(11):920-32. doi: 10.1111/obr.12220. Epub 2014 Aug 11.
This systematic review and meta-analysis of effectiveness trials comparing multicomponent behavioural weight management programmes with controls in overweight and obese adults set out to determine the effectiveness of these interventions implemented in routine practice. To be included, interventions must have been multicomponent, delivered by the therapists who would deliver the intervention in routine practice and in that same context, and must be widely available or feasible to implement with little additional infrastructure or staffing. Searches of electronic databases were conducted, and augmented by screening reference lists and contacting experts (November 2012). Data were extracted by two reviewers, with mean difference between intervention and control for 12-month change in weight, blood pressure, lipids and glucose calculated using baseline observation carried forward. Data were also extracted on adverse events, quality of life and mood measures. Although there were many published efficacy trials, only eight effectiveness trials met the inclusion criteria. Pooled results from five study arms providing access to commercial weight management programmes detected significant weight loss at 12 months (mean difference -2.22 kg, 95% confidence interval [CI] -2.90 to -1.54). Results from two arms of a study testing a commercial programme providing meal replacements also detected significant weight loss (mean difference -6.83 kg, 95% CI -8.39 to -5.26). In contrast, pooled results from five interventions delivered by primary care teams showed no evidence of an effect on weight (mean difference -0.45 kg, 95% CI -1.34 to 0.43). One study testing an interactive web-based intervention detected a significant effect in favour of the intervention at 12 months, but the study was judged to be at high risk of bias and the effect did not persist at 18 months. Few studies reported other outcomes, limiting comparisons between interventions. Few trials have examined the effectiveness of behavioural weight loss programmes delivered in everyday contexts. These trials suggest that commercial interventions delivered in the community are effective for achieving weight loss. There is no evidence that interventions delivered within primary care settings by generalist primary care teams trained in weight management achieve meaningful weight loss.
本系统评价和荟萃分析对比了超重和肥胖成年人中多成分行为体重管理计划与对照组的有效性试验，旨在确定这些干预措施在常规实践中的有效性。纳入的干预措施必须是多成分的，由将在常规实践中实施干预的治疗师在相同背景下提供，并且必须广泛可用或在几乎不需要额外基础设施或人员配备的情况下即可实施。我们检索了电子数据库，并通过筛选参考文献列表和联系专家进行了补充（2012年11月）。由两名审阅者提取数据，使用结转的基线观察值计算干预组和对照组在体重、血压、血脂和血糖方面12个月变化的平均差异。还提取了不良事件、生活质量和情绪测量方面的数据。虽然有许多已发表的疗效试验，但只有八项有效性试验符合纳入标准。来自五个提供商业体重管理计划的研究组的汇总结果显示，12个月时体重显著减轻（平均差异-2.22千克，95%置信区间[CI]-2.90至-1.54）。一项测试提供代餐的商业计划的研究的两个组的结果也显示体重显著减轻（平均差异-6.83千克，95%CI-8.39至-5.26）。相比之下，初级保健团队实施的五项干预措施的汇总结果显示，没有证据表明对体重有影响（平均差异-0.45千克，95%CI-1.34至0.43）。一项测试基于网络的交互式干预措施的研究在12个月时检测到对干预措施有利的显著效果，但该研究被判定存在高偏倚风险，且该效果在18个月时未持续。很少有研究报告其他结果，限制了不同干预措施之间的比较。很少有试验研究在日常环境中实施的行为减肥计划的有效性。这些试验表明，在社区中实施的商业干预措施对实现体重减轻有效。没有证据表明，由接受过体重管理培训的全科初级保健团队在初级保健环境中实施的干预措施能实现有意义的体重减轻。
