College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
Counterweight Ltd, London, UK.
J Hum Nutr Diet. 2019 Jun;32(3):329-337. doi: 10.1111/jhn.12611. Epub 2018 Nov 22.
Weight management including formula total diet replacement (TDR) is emerging as an effective intervention for severe and complex obesity, particularly with respect to type 2 diabetes (T2DM). However, no prospective audit and service evaluation of such programmes have been reported.
Following initial feasibility piloting, the Counterweight-Plus programme was commissioned across a variety of healthcare providers. The programme includes: Screening, TDR (formula low energy diet), food reintroduction and weight loss maintenance, all delivered by staff with 8 h of training, in-service mentoring, ongoing specialist support and access to medical consultant expertise. Anonymised data are returned centrally for clinical evaluation.
Up to December 2016, 288 patients commenced the programme. Mean (SD) baseline characteristics were: age 47.5 (12.7) years, weight 128.0 (32.0) kg, body mass index 45.7 (10.1) kg m , n = 76 (26.5%) were male and n = 99 (34.5%) had T2DM. On an intention-to-treat (ITT) basis, a loss of ≥15 kg at 12 months was achieved by 48 patients, representing 22.1% of all who started and 40% of those who maintained engagement. For complete cases, mean (95% confidence interval) weight loss was 13.3 (12.1-14.4) kg at 3 months, 16.0 (14.4-17.6) kg at 6 months and 14.2 (12.1-16.3) kg at 12 months (all P < 0.001), with losses to follow-up of 10.8%, 29.3% and 44.2%, respectively. Mean loss at 12 months by ITT analyses was: single imputation -10.5 (9.5) kg, last observation carried forward -10.9 (11.6) kg and baseline observation carried forward -7.9 (11.1) kg. The presence of diabetes had no significant impact on weight change outcomes.
This nonsurgical approach is effective for many individuals with severe and complex obesity, representing an option before considering surgery. The results are equally effective in terms of weight loss for people with T2DM.
体重管理包括配方全营养替代疗法（TDR），正在成为治疗严重和复杂肥胖症的有效干预手段，尤其是在 2 型糖尿病（T2DM）方面。然而，目前尚未有针对此类方案的前瞻性审核和服务评估。
在最初的可行性试验之后，Counterweight-Plus 方案已在各种医疗保健提供者中开展。该方案包括：筛查、TDR（配方低能量饮食）、重新引入食物和体重维持，所有这些均由接受过 8 小时培训、在职辅导、持续专业支持和获得医学顾问专业知识的工作人员提供。匿名数据集中返回以供临床评估。
截至 2016 年 12 月，共有 288 名患者开始了该方案。平均（SD）基线特征为：年龄 47.5（12.7）岁，体重 128.0（32.0）kg，体重指数 45.7（10.1）kg，n=76（26.5%）为男性，n=99（34.5%）患有 T2DM。基于意向治疗（ITT）分析，12 个月时≥15kg 的减重目标在 48 名患者中实现，占所有起始患者的 22.1%，占持续参与患者的 40%。对于完整病例，3 个月时平均（95%置信区间）体重减轻 13.3（12.1-14.4）kg，6 个月时 16.0（14.4-17.6）kg，12 个月时 14.2（12.1-16.3）kg（均 P<0.001），随访丢失率分别为 10.8%、29.3%和 44.2%。根据 ITT 分析，12 个月时的平均体重减轻量为：单值插补-10.5（9.5）kg，末次观察值结转-10.9（11.6）kg，基线观察值结转-7.9（11.1）kg。糖尿病的存在对体重变化结果没有显著影响。
对于许多严重和复杂肥胖症患者来说，这种非手术方法是有效的，是在考虑手术之前的一种选择。对于患有 T2DM 的患者，其减肥效果同样有效。
