College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
Edward Hines Jr. Veterans Affairs Hospital, Hines, IL 60141, USA.
Int J Environ Res Public Health. 2018 Jan 26;15(2):211. doi: 10.3390/ijerph15020211.
This study examined whether community food environments altered the longer-term effects of a nationwide behavioral weight management program on body mass index (BMI). The sample was comprised of 98,871 male weight management program participants and 15,385 female participants, as well as 461,302 and 37,192 inverse propensity-score weighted matched male and female controls. We measured the community food environment by counting the number of supermarkets, convenience stores, and fast food restaurants within a 1-mile radius around each person's home address. We used difference-in-difference regression models with person and calendar time fixed effects to estimate MOVE! effects over time in sub-populations defined by community food environment attributes. Among men, after an initial decrease in BMI at 6 months, the effect of the program decreased over time, with BMI increasing incrementally at 12 months (0.098 kg/m², < 0.001), 18 months (0.069 kg/m², < 0.001), and 24 months (0.067 kg/m², < 0.001). Among women, the initial effects of the program decreased over time as well. Women had an incremental BMI change of 0.099 kg/m² at 12 months ( < 0.05) with non-significant incremental changes at 18 months and 24 months. We found little evidence that these longer-term effects of the weight management program differed depending on the community food environment. Physiological adaptations may overwhelm environmental influences on adherence to behavioral regimens in affecting longer-term weight loss outcomes.
本研究旨在探讨社区食品环境是否改变了全国性行为体重管理计划对体重指数（BMI）的长期影响。该样本包括 98871 名男性体重管理计划参与者和 15385 名女性参与者，以及 461302 名和 37192 名经逆概率倾向评分加权匹配的男性和女性对照者。我们通过计算每个人家庭住址周围 1 英里半径内的超市、便利店和快餐店的数量来衡量社区食品环境。我们使用个体和日历时间固定效应的差分法回归模型，根据社区食品环境属性来估计 MOVE！在亚人群中的随时间变化的效果。在男性中，BMI 在 6 个月时最初下降后，计划的效果随着时间的推移而逐渐减弱，12 个月（0.098kg/m²，<0.001）、18 个月（0.069kg/m²，<0.001）和 24 个月（0.067kg/m²，<0.001）时 BMI 逐渐增加。在女性中，计划的初始效果也随着时间的推移而逐渐减弱。女性在 12 个月时 BMI 增加了 0.099kg/m²（<0.05），18 个月和 24 个月时 BMI 呈非显著递增变化。我们发现几乎没有证据表明体重管理计划的这些长期效果取决于社区食品环境。生理适应可能会超过环境对行为方案依从性的影响，从而影响长期减肥效果。
