Aceves-Martins M, Robertson C, Cooper D, Avenell A, Stewart F, Aveyard P, de Bruin M
Health Services Research Unit (HSRU), University of Aberdeen, Aberdeen, UK.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
J Hum Nutr Diet. 2020 Jun;33(3):351-372. doi: 10.1111/jhn.12732. Epub 2020 Feb 6.
The aim of this project was to systematically review UK evidence on the effectiveness of long-term (≥12 months) weight management services (WMSs) for weight loss and weight maintenance for adults (≥16 years) with severe obesity (body mass index ≥35 kg m ), who would generally be eligible for Tier 3 services.
Four data sources were searched from 1999 to October 2018.
Our searches identified 20 studies, mostly noncomparative studies: 10 primary care interventions, nine in secondary care specialist weight management clinics and one commercial setting intervention. A programme including a phase of low energy formula diet (810-833 kcal day ) showed the largest mean (SD) weight change at 12 months of -12.4 (11.4) kg for complete cases, with 25.3% dropout. Limitations or differences in evaluation and reporting (particularly for denominators), unclear dropout rates, and differences between participant groups in terms of comorbidities and psychological characteristics, made comparisons between WMSs and inferences challenging.
There is a persistent and clear need for guidance on long-term weight data collection and reporting methods to allow comparisons across studies and services for participants with severe obesity. Data could also include quality of life, clinical outcomes, adverse events, costs and economic outcomes. A randomised trial comparison of National Health Service Tier 3 services with commercial WMSs would be of value.
本项目的目的是系统回顾英国关于长期（≥12个月）体重管理服务（WMS）对重度肥胖（体重指数≥35kg/m²）的成年人（≥16岁）减肥和维持体重效果的证据，这些人通常符合三级服务的条件。
检索了1999年至2018年10月的四个数据源。
我们的检索共识别出20项研究，大多为非对照研究：10项初级保健干预研究、9项二级保健专科体重管理诊所研究和1项商业机构干预研究。一项包括低能量配方饮食阶段（810 - 833千卡/天）的项目显示，在12个月时，完整病例的平均（标准差）体重变化最大，为-12.4（11.4）千克，脱落率为25.3%。评估和报告方面的局限性或差异（特别是分母方面）、不明的脱落率以及参与者群体在合并症和心理特征方面的差异，使得不同体重管理服务之间的比较和推断具有挑战性。
对于长期体重数据收集和报告方法，持续且迫切需要相关指导，以便对重度肥胖参与者的各项研究和服务进行比较。数据还可包括生活质量、临床结局、不良事件、成本和经济结局。将国民医疗服务体系三级服务与商业体重管理服务进行随机对照试验比较将很有价值。
