Damschroder Laura J, Lutes Lesley D, Kirsh Susan, Kim Hyungjin Myra, Gillon Leah, Holleman Robert G, Goodrich David E, Lowery Julie C, Richardson Caroline R
Veterans Affairs Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Department of Psychology, East Carolina University, Greenville, North Carolina.
Am J Prev Med. 2014 Nov;47(5):541-53. doi: 10.1016/j.amepre.2014.06.016. Epub 2014 Sep 10.
Weight-loss trials tend to recruit highly selective, non-representative samples. Effective weight-loss approaches are needed for real-world challenging populations.
To test whether a small-changes intervention, delivered in groups or via telephone, promotes greater weight loss than standard obesity treatment in a predominantly male, high-risk Veteran population. Data were collected in 2010-2012 and analyzed in 2013.
A three-arm, 12-month randomized pragmatic effectiveness trial.
SETTING/PARTICIPANTS: Four-hundred eighty-one overweight/obese participants from two Midwestern Veterans Affairs (VA) Medical Centers were randomly assigned to one of three programs: the 12-month Aspiring to Lifelong Health (ASPIRE) weight-loss program delivered (1) individually over the phone (ASPIRE-Phone) or (2) in-person group sessions (ASPIRE-Group); compared to (3) VA's standard weight-loss program (MOVE!).
Twenty-eight sessions with a non-clinician coach via telephone or in-person groups using a small-changes obesity treatment approach compared to a 15-30-session standard VA program.
Twelve-month change in weight (kilograms).
Participants in all three arms lost significant (p<0.01) weight at 12 months. Participants in the ASPIRE-Group arm lost significantly more weight at 12 months than those in the other two treatment arms (-2.8 kg, 95% CI=-3.8, -1.9, in ASPIRE-Group vs -1.4 kg, 95% CI=-2.4, -0.5, in ASPIRE-Phone and -1.4 kg, 95% CI=-2.3, -0.4) in MOVE!(®). ASPIRE-Group resulted in greater improvements in all other anthropometric measures compared to MOVE! at 12 months (p<0.05) and for all (p<0.05) but waist circumference (p=0.23) compared to ASPIRE-Phone.
Group-based delivery of the ASPIRE weight management program is more effective than MOVE! and the phone-based version of ASPIRE at promoting sustained weight loss in a predominantly male population with multiple comorbidities. The incremental benefits of group-based ASPIRE over the current MOVE! program could yield significant population-level benefits if implemented on a large scale.
减肥试验倾向于招募高度选择性的、不具代表性的样本。现实世界中具有挑战性的人群需要有效的减肥方法。
在以男性为主的高风险退伍军人人群中，测试通过小组或电话进行的小改变干预措施是否比标准肥胖治疗方法能促进更多的体重减轻。数据于2010 - 2012年收集，并于2013年进行分析。
一项三臂、为期12个月的随机实用有效性试验。
设置/参与者：来自两个中西部退伍军人事务（VA）医疗中心的481名超重/肥胖参与者被随机分配到三个项目之一：为期12个月的“立志终身健康（ASPIRE）”减肥项目，该项目（1）通过电话单独进行（ASPIRE - 电话组）或（2）进行面对面的小组课程（ASPIRE - 小组组）；与（3）VA的标准减肥项目（MOVE!）进行比较。
与为期15 - 30节的VA标准项目相比，通过电话或面对面小组与非临床教练进行28节课程，采用小改变肥胖治疗方法。
体重（千克）的12个月变化。
所有三个组的参与者在12个月时体重均显著减轻（p<0.01）。ASPIRE - 小组组的参与者在12个月时比其他两个治疗组的参与者体重减轻显著更多（ASPIRE - 小组组为 - 2.8千克，95%置信区间 = - 3.8， - 1.9；ASPIRE - 电话组为 - 1.4千克，95%置信区间 = - 2.4， - 0.5；MOVE!为 - 1.4千克，95%置信区间 = - 2.3， - 0.4）。与MOVE!相比，ASPIRE - 小组组在12个月时所有其他人体测量指标上有更大改善（p<0.05）；与ASPIRE - 电话组相比，除腰围外所有指标均有改善（p<0.05），腰围方面差异不显著（p = 0.23）。
在以男性为主且患有多种合并症的人群中，基于小组的ASPIRE体重管理项目在促进持续减肥方面比MOVE!以及基于电话的ASPIRE版本更有效。如果大规模实施，基于小组的ASPIRE相对于当前的MOVE!项目所带来的额外益处可能会产生显著的人群层面效益。
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