Teixeira Pedro J, Carraça Eliana V, Marques Marta M, Rutter Harry, Oppert Jean-Michel, De Bourdeaudhuij Ilse, Lakerveld Jeroen, Brug Johannes
Interdisciplinary Centre for the Study of Human Performance (CIPER), Faculty of Human Kinetics, University of Lisbon, Lisbon, Portugal.
European Centre on Health of Societies in Transition, London School of Hygiene and Tropical Medicine, London, UK.
BMC Med. 2015 Apr 16;13:84. doi: 10.1186/s12916-015-0323-6.
Relapse is high in lifestyle obesity interventions involving behavior and weight change. Identifying mediators of successful outcomes in these interventions is critical to improve effectiveness and to guide approaches to obesity treatment, including resource allocation. This article reviews the most consistent self-regulation mediators of medium- and long-term weight control, physical activity, and dietary intake in clinical and community behavior change interventions targeting overweight/obese adults.
A comprehensive search of peer-reviewed articles, published since 2000, was conducted on electronic databases (for example, MEDLINE) and journal reference lists. Experimental studies were eligible if they reported intervention effects on hypothesized mediators (self-regulatory and psychological mechanisms) and the association between these and the outcomes of interest (weight change, physical activity, and dietary intake). Quality and content of selected studies were analyzed and findings summarized. Studies with formal mediation analyses were reported separately.
Thirty-five studies were included testing 42 putative mediators. Ten studies used formal mediation analyses. Twenty-eight studies were randomized controlled trials, mainly aiming at weight loss or maintenance (n = 21). Targeted participants were obese (n = 26) or overweight individuals, aged between 25 to 44 years (n = 23), and 13 studies targeted women only. In terms of study quality, 13 trials were rated as "strong", 15 as "moderate", and 7 studies as "weak". In addition, methodological quality of formal mediation analyses was "medium". Identified mediators for medium-/long-term weight control were higher levels of autonomous motivation, self-efficacy/barriers, self-regulation skills (such as self-monitoring), flexible eating restraint, and positive body image. For physical activity, significant putative mediators were high autonomous motivation, self-efficacy, and use of self-regulation skills. For dietary intake, the evidence was much less clear, and no consistent mediators were identified.
This is the first systematic review of mediational psychological mechanisms of successful outcomes in obesity-related lifestyle change interventions. Despite limited evidence, higher autonomous motivation, self-efficacy, and self-regulation skills emerged as the best predictors of beneficial weight and physical activity outcomes; for weight control, positive body image and flexible eating restraint may additionally improve outcomes. These variables represent possible targets for future lifestyle interventions in overweight/obese populations.
在涉及行为和体重变化的生活方式肥胖干预中，复发率很高。确定这些干预措施成功结果的中介因素对于提高有效性和指导肥胖治疗方法（包括资源分配）至关重要。本文回顾了针对超重/肥胖成年人的临床和社区行为改变干预中，中长期体重控制、身体活动和饮食摄入方面最一致的自我调节中介因素。
对2000年以来发表的同行评审文章在电子数据库（如MEDLINE）和期刊参考文献列表中进行全面检索。如果实验研究报告了对假设中介因素（自我调节和心理机制）的干预效果以及这些因素与感兴趣的结果（体重变化、身体活动和饮食摄入）之间的关联，则该研究符合要求。对所选研究的质量和内容进行分析并总结研究结果。对进行了正式中介分析的研究单独报告。
纳入了35项研究，测试了42个假定的中介因素。10项研究使用了正式中介分析。28项研究为随机对照试验，主要旨在减肥或维持体重（n = 21）。目标参与者为肥胖者（n = 26）或超重个体，年龄在25至44岁之间（n = 23），13项研究仅针对女性。在研究质量方面，13项试验被评为“强”，15项为“中”，7项研究为“弱”。此外，正式中介分析的方法学质量为“中等”。确定的中长期体重控制中介因素为较高水平的自主动机、自我效能感/障碍、自我调节技能（如自我监测）、灵活的饮食限制和积极的身体形象。对于身体活动，重要的假定中介因素为高自主动机、自我效能感和自我调节技能的使用。对于饮食摄入，证据则不太明确，未确定一致的中介因素。
这是首次对肥胖相关生活方式改变干预成功结果的中介心理机制进行系统综述。尽管证据有限，但较高的自主动机、自我效能感和自我调节技能成为有益体重和身体活动结果的最佳预测因素；对于体重控制，积极的身体形象和灵活的饮食限制可能会额外改善结果。这些变量代表了未来超重/肥胖人群生活方式干预的可能目标。
