Palo Alto Medical Foundation Research Institute, Palo Alto, CA 94301, USA.
Sutter Health Research, Development and Dissemination, Walnut Creek, CA 94596, USA.
Prev Med. 2017 Jul;100:180-193. doi: 10.1016/j.ypmed.2017.04.022. Epub 2017 Apr 25.
Moderate and severe obesity (BMI ≥35 kg/m) affect 15% of US adults, with a projected increase over the next two decades. This study reviews evidence of behavioral lifestyle interventions for weight loss in this population. We searched PubMed, PsychInfo, CINAHL®, and Scopus through February 2016 for experimental and quasi-experimental studies that tested a dietary and/or physical activity intervention with a behavioral modification component versus a comparator; and had ≥six-month follow-up and a weight-related primary outcome. Twelve studies representing 1862 participants (mean BMI 37.5-48.3, mean age 30-54 years) were included. Nine studies compared different behavioral interventions and three tested behavioral intervention(s) versus pharmacological or surgical treatments. Among the 25 behavioral interventions in the 12 studies, 18 reported percent of participants achieving clinically significant weight loss up to 12months (32-97% achieving 5% or 3-70% achieving 10%). Three studies measured other cardiometabolic risk factors, but showed no significant risk reduction. Seven interventions with greater effectiveness (i.e., at least 31% achieving ≥10% or 62% achieving ≥5% weight loss up to one year) included multiple components (diet, physical activity, and behavioral strategies), long duration (e.g., one year), and/or intensive contacts (e.g., inpatient stays for clinic-based interventions, weekly contacts for community-based ones). Evidence for the effectiveness of behavioral interventions versus pharmacological or surgical treatment was limited. Comprehensive and intensive behavioral interventions can result in clinically significant, albeit modest, weight loss in this obese subpopulation but may not result significant improvements in other cardiometabolic risk factors. More research on scalable and sustainable interventions is needed.
中度和重度肥胖（BMI≥35kg/m）影响了美国 15%的成年人，预计在未来二十年中还会有所增加。本研究综述了针对该人群的减肥行为生活方式干预的证据。我们通过 PubMed、PsychInfo、CINAHL®和 Scopus 检索了截至 2016 年 2 月的实验和准实验研究，这些研究测试了具有行为修正成分的饮食和/或体力活动干预与对照相比的效果；且随访时间至少为 6 个月，主要结局为体重相关。纳入了 12 项研究，共 1862 名参与者（平均 BMI 为 37.5-48.3，平均年龄 30-54 岁）。9 项研究比较了不同的行为干预，3 项研究测试了行为干预与药物或手术治疗的效果。在这 12 项研究中的 25 项行为干预中，有 18 项报告了达到临床显著减重的参与者比例，时间为 6 至 12 个月（32-97%达到 5%或 3-70%达到 10%）。有 3 项研究测量了其他心血管代谢风险因素，但没有显示出显著的风险降低。7 项更有效的干预措施（即至少 31%的人达到≥10%或 62%的人达到≥5%的体重减轻，持续一年）包括多种成分（饮食、体力活动和行为策略）、较长的时间（如一年）和/或密集的接触（如诊所为基础的干预措施的住院停留，社区为基础的干预措施的每周接触）。行为干预与药物或手术治疗的有效性的证据有限。综合和强化的行为干预措施可以在肥胖亚人群中导致临床显著但适度的体重减轻，但可能不会导致其他心血管代谢风险因素的显著改善。需要进一步研究可扩展和可持续的干预措施。
