Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, St. Louis, Missouri; Department of Medicine, Washington University School of Medicine, Washington University in St. Louis, St. Louis, Missouri.
Center for Obesity Prevention and Policy Research, Brown School, Washington University in St. Louis, St. Louis, Missouri.
Am J Prev Med. 2018 Mar;54(3):341-351. doi: 10.1016/j.amepre.2017.12.012.
Clinical trials have demonstrated significant impact in reducing weight and incidence of type 2 diabetes mellitus. However, the intensity of these trials limits their scalability to real world settings. The purpose of this study was to embed a lifestyle intervention for overweight and obese mothers within the routine practice of a parent education, home visiting organization.
Pragmatic trial that used a stratified random design.
SETTING/PARTICIPANTS: Overweight or obese mothers of preschool children located across St. Louis, Missouri, enrolled in Parents As Teachers, a home visiting organization reaching women and children nationwide.
A lifestyle intervention derived from the Diabetes Prevention Program was embedded within Parents As Teachers entitled Healthy Eating and Active Living Taught at Home (HEALTH).
Outcomes included the proportion of women that achieved 5% weight loss at 24 months and improvements in clinical and behavioral outcomes at 12 and 24 months. Participants were enrolled from 2012 to 2014 and data analysis began in 2016.
Women in the usual care versus intervention group were significantly less likely to achieve 5% weight loss at 24 months (11% vs 26%, p=0.01). At 12 months, there was a 2.8-kg difference in weight between groups (p=0.0006), and by 24 months a 4.7-kg difference in weight (3.2 [SD=7.6] kg vs -1.5 [SD=8.3] kg, p=0.002); group differences in waist circumference were also evident by 12 months (2.1 [SD=8.4] cm vs -0.7 [SD=9.8] cm, p=0.04) and 24 months (3.8 [SD=10.6] cm vs -2.5 [SD=9.1] cm, p=0.005), as were improvements in behavioral outcomes. There was no difference in blood pressure between groups.
HEALTH achieved modest but clinically significant weight loss outcomes, and reduced weight gain in mothers of young children. The scalability of this embedded intervention offers the potential to reach mothers in Parents As Teachers programs nationally.
This study is registered at www.clinicaltrials.gov NCT01567033.
临床试验已证明其在减轻体重和降低 2 型糖尿病发病率方面具有显著影响。然而，这些试验的强度限制了它们在真实环境中的可扩展性。本研究的目的是将超重和肥胖母亲的生活方式干预措施嵌入到父母教育、家庭访问组织的常规实践中。
采用分层随机设计的实用试验。
地点/参与者：位于密苏里州圣路易斯市的学龄前超重或肥胖儿童的母亲，参加了全国范围内面向妇女和儿童的家庭访问组织“父母就是老师”。
从糖尿病预防计划中衍生出来的生活方式干预措施被嵌入到“父母就是老师”的一个项目中，该项目名为“在家教授健康饮食和积极生活”（HEALTH）。
结果包括在 24 个月时达到 5%体重减轻的女性比例，以及在 12 个月和 24 个月时改善临床和行为结果。参与者于 2012 年至 2014 年入组，数据分析于 2016 年开始。
在常规护理组与干预组相比，在 24 个月时达到 5%体重减轻的女性比例明显较低（11%比 26%，p=0.01）。在 12 个月时，两组体重差异为 2.8 公斤（p=0.0006），到 24 个月时体重差异为 4.7 公斤（3.2[SD=7.6]公斤比-1.5[SD=8.3]公斤，p=0.002）；12 个月时腰围的组间差异也很明显（2.1[SD=8.4]厘米比-0.7[SD=9.8]厘米，p=0.04），24 个月时也有差异（3.8[SD=10.6]厘米比-2.5[SD=9.1]厘米，p=0.005），行为结果也有所改善。两组间血压无差异。
HEALTH 实现了适度但具有临床意义的体重减轻结果，并减少了幼儿母亲的体重增加。这种嵌入式干预措施的可扩展性为在全国范围内的“父母就是老师”计划中接触到母亲提供了潜力。
本研究在 www.clinicaltrials.gov 上注册，编号为 NCT01567033。
