Eaton Charles B, Hartman Sheri J, Perzanowski Elizabeth, Pan Guohui, Roberts Mary B, Risica Patricia M, Gans Kim M, Jakicic John M, Marcus Bess H
Alpert Medical School of Brown University, Providence, Rhode Island Department of Epidemiology, School of Public Health of Brown University, Providence, Rhode Island Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California Cancer Prevention and Control, UC San Diego Moores Cancer Center, La Jolla, California.
Ann Fam Med. 2016 Jul;14(4):311-9. doi: 10.1370/afm.1952.
The aim of the study was to test a tailored lifestyle intervention for helping obese primary care patients achieve weight loss and increase physical activity.
We conducted a 24-month randomized clinical trial in Rhode Island. Primary care physicians identified obese, sedentary patients motivated to lose weight and increase their moderate to vigorous physical activity. These patients were randomized to 1 of 2 experimental groups: enhanced intervention (EI) or standard intervention (SI). Both groups received 3 face-to-face weight loss meetings. The enhanced intervention group also received telephone counseling calls, individually tailored print materials, and DVDs focused on diet and physical activity. Active intervention occurred in year 1 with a tapered maintenance phase in year 2.
Two hundred eleven obese, sedentary patients were recruited from 24 primary care practices. Participants were 79% women and 16% minorities. They averaged 48.6 years of age, with a mean body mass index (BMI) of 37.8 kg/m(2), and 21.2 minutes/week of moderate to vigorous physical activity. Significantly more EI participants lost 5% of their baseline weight than SI participants (group by visit, P <.001). The difference was significant during active treatment at 6 months (37.2% EI vs 12.9% SI) and 12 months (47.8% vs 11.6%), but was no longer significant during the maintenance phase at 18 months (31.4% vs 26.7%,) or 24 months (33.3% vs 24.6%). The EI group reported significantly more minutes of moderate to vigorous physical activity over time than the SI group (group by visit, P = 0.04). The differences in minutes per week at 6 months was 95.7 for the EI group vs 68.3 minutes for the SI group; at 12 months, it was 126.1 vs 73.7; at 18 months, 103.7 vs 63.7, and at 24 months, 101.3 vs 75.4. Similar trends were found for absolute weight loss and the percentage reaching national guidelines for physical activity.
A home-based tailored lifestyle intervention in obese, sedentary primary care patients was effective in promoting weight loss and increasing moderate to vigorous physical activity, with the effects peaking at 12 months but waning at 24 months.
本研究旨在测试一种量身定制的生活方式干预措施，以帮助肥胖的初级保健患者实现体重减轻并增加身体活动。
我们在罗德岛进行了一项为期24个月的随机临床试验。初级保健医生识别出有减肥意愿且有动力增加中度至剧烈身体活动的肥胖久坐患者。这些患者被随机分为两个实验组之一：强化干预组（EI）或标准干预组（SI）。两组均接受3次面对面的减肥会议。强化干预组还接受电话咨询、个性化的印刷材料以及关注饮食和身体活动的DVD。积极干预在第1年进行，第2年为逐渐减少的维持阶段。
从24个初级保健机构招募了211名肥胖久坐患者。参与者中79%为女性，16%为少数族裔。他们的平均年龄为48.6岁，平均体重指数（BMI）为37.8kg/m²，每周进行中度至剧烈身体活动的时间平均为21.2分钟。与标准干预组参与者相比，显著更多的强化干预组参与者体重减轻了基线体重的5%（按访视分组，P<.001）。在6个月（强化干预组为37.2%，标准干预组为12.9%）和12个月（47.8%对11.6%）的积极治疗期间差异显著，但在18个月（31.4%对26.7%）或24个月（33.3%对24.6%）的维持阶段差异不再显著。随着时间的推移，强化干预组报告的中度至剧烈身体活动分钟数显著多于标准干预组（按访视分组，P = 0.04）。6个月时，强化干预组每周的分钟数差异为95.7，标准干预组为68.3分钟；12个月时，分别为126.1对73.7；18个月时，为103.7对63.7；24个月时，为101.3对75.4。在绝对体重减轻和达到身体活动国家指南的百分比方面也发现了类似趋势。
针对肥胖久坐的初级保健患者进行的基于家庭的量身定制生活方式干预在促进体重减轻和增加中度至剧烈身体活动方面是有效的，效果在12个月时达到峰值，但在24个月时减弱。
