Brown T J, O'Malley C, Blackshaw J, Coulton V, Tedstone A, Summerbell C, Ells L J
School of Health and Social Care, Teesside University, Middlesbrough, UK.
FUSE, Centre for Translational Research in Public Health, North East England, UK.
Clin Obes. 2017 Oct;7(5):260-272. doi: 10.1111/cob.12204. Epub 2017 Jul 10.
Specialist weight management services provide a treatment option for severe obesity. The objective of the study is to review the characteristics, impact and practice implications of specialist weight management services for adults in the UK. Systematic review: EMBASE, MEDLINE and PsycINFO were searched from January 2005 to March 2016 with supplementary searches. Adults with a body mass index of ≥40 kg m , or ≥35 kg m with comorbidity or ≥30 kg m with type 2 diabetes and any study of multicomponent interventions, in any UK or Ireland setting, delivered by a specialist multidisciplinary team are the inclusion criteria. Fourteen studies in a variety of settings were included: 1 randomized controlled trial, 3 controlled and 10 observational studies. Mean baseline body mass index and age ranged from 40 to 54 kg m and from 40 to 58 years. The studies were heterogeneous making comparisons of service characteristics difficult. Multidisciplinary team composition and eligibility criteria varied; dropout rates were high (43-62%). Statistically significant reduction in mean body mass index over time ranged from -1.4 to -3.1 kg m and mean weight changes ranged from -2.2 to -12.4 kg. Completers achieving at least 5% reduction of initial body weight ranged from 32 to 51%. There was evidence for improved outcomes in diabetics. Specialist weight management services can demonstrate clinically significant weight loss and have an important role in supporting adults to manage severe and often complex forms of obesity. This review highlights important variations in provision and strongly indicates the need for further research into effective approaches to support severely obese adults.
专业体重管理服务为重度肥胖提供了一种治疗选择。本研究的目的是回顾英国针对成年人的专业体重管理服务的特点、影响及实践意义。系统评价：检索了2005年1月至2016年3月的EMBASE、MEDLINE和PsycINFO数据库，并进行了补充检索。纳入标准为：体重指数≥40kg/m²，或合并症时体重指数≥35kg/m²，或2型糖尿病患者体重指数≥30kg/m²，且在英国或爱尔兰的任何环境下，由专业多学科团队提供的任何多组分干预研究。纳入了各种环境下的14项研究：1项随机对照试验、3项对照研究和10项观察性研究。平均基线体重指数和年龄范围分别为40至54kg/m²和40至58岁。这些研究具有异质性，难以对服务特征进行比较。多学科团队组成和资格标准各不相同；脱落率很高（43%-62%）。随着时间的推移，平均体重指数的统计学显著降低范围为-1.4至-3.1kg/m²，平均体重变化范围为-2.2至-12.4kg。初始体重至少减轻5%的完成者比例范围为32%至51%。有证据表明糖尿病患者的结局有所改善。专业体重管理服务可实现临床上显著的体重减轻，在支持成年人管理重度且通常复杂的肥胖形式方面发挥重要作用。本综述强调了服务提供方面的重要差异，并强烈表明需要进一步研究支持重度肥胖成年人的有效方法。
