Stevens June, Pratt Charlotte, Boyington Josephine, Nelson Cheryl, Truesdale Kimberly P, Ward Dianne S, Lytle Leslie, Sherwood Nancy E, Robinson Thomas N, Moore Shirley, Barkin Shari, Cheung Ying Kuen, Murray David M
Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, Maryland.
Am J Prev Med. 2017 Jan;52(1):115-124. doi: 10.1016/j.amepre.2016.09.011. Epub 2016 Oct 26.
The origins of obesity are complex and multifaceted. To be successful, an intervention aiming to prevent or treat obesity may need to address multiple layers of biological, social, and environmental influences.
NIH recognizes the importance of identifying effective strategies to combat obesity, particularly in high-risk and disadvantaged populations with heightened susceptibility to obesity and subsequent metabolic sequelae. To move this work forward, the National Heart, Lung, and Blood Institute, in collaboration with the NIH Office of Behavioral and Social Science Research and NIH Office of Disease Prevention convened a working group to inform research on multilevel obesity interventions in vulnerable populations. The working group reviewed relevant aspects of intervention planning, recruitment, retention, implementation, evaluation, and analysis, and then made recommendations.
Recruitment and retention techniques used in multilevel research must be culturally appropriate and suited to both individuals and organizations. Adequate time and resources for preliminary work are essential. Collaborative projects can benefit from complementary areas of expertise and shared investigations rigorously pretesting specific aspects of approaches. Study designs need to accommodate the social and environmental levels under study, and include appropriate attention given to statistical power. Projects should monitor implementation in the multiple venues and include a priori estimation of the magnitude of change expected within and across levels.
The complexity and challenges of delivering interventions at several levels of the social-ecologic model require careful planning and implementation, but hold promise for successful reduction of obesity in vulnerable populations.
肥胖的成因复杂且多方面。若要成功，旨在预防或治疗肥胖的干预措施可能需要应对生物、社会和环境等多层面的影响。
美国国立卫生研究院（NIH）认识到确定有效对抗肥胖策略的重要性，尤其是在对肥胖及后续代谢后遗症易感性较高的高危和弱势人群中。为推动这项工作，美国国立心肺血液研究所与NIH行为和社会科学研究办公室以及NIH疾病预防办公室联合召集了一个工作组，为弱势群体多层次肥胖干预研究提供信息。该工作组审查了干预计划、招募、留存、实施、评估和分析的相关方面，然后提出了建议。
多层次研究中使用的招募和留存技术必须符合文化背景，且适用于个人和组织。进行初步工作需要充足的时间和资源。合作项目可受益于专业知识的互补领域以及对方法特定方面进行严格预测试的共同调查。研究设计需要适应所研究的社会和环境层面，并适当关注统计功效。项目应监测在多个场所的实施情况，并对不同层面内和层面间预期的变化幅度进行先验估计。
在社会生态模型的多个层面实施干预措施的复杂性和挑战需要精心规划和实施，但有望成功减少弱势群体中的肥胖现象。
