Pennington Biomedical Research Center, Baton Rouge, Louisiana, USA.
Department of Biostatistics, University of Kansas Medical Center, Kansas City, Kansas, USA.
Obesity (Silver Spring). 2021 Dec;29(12):2044-2054. doi: 10.1002/oby.23292. Epub 2021 Oct 29.
The aim of this study was to report the results of five weight-loss interventions in primary care settings in underserved patients and to compare the level of pragmatism across the interventions using the Pragmatic Explanatory Continuum Indicator Summary (PRECIS-2) tool.
Data from 54 primary care clinics (2,210 patients) were pooled from the Promoting Successful Weight Loss in Primary Care in Louisiana (PROPEL) and Rural Engagement in Primary Care for Optimizing Weight Reduction (REPOWER) cluster-randomized trials. Clinics were randomized to one of five comparators: PROPEL usual care, PROPEL combination of in-clinic and telephone visits, REPOWER in-clinic individual visits, REPOWER in-clinic group visits, or REPOWER telephone group visits.
At 24 months, weight loss (kilograms) was -0.50 (95% CI: -1.77 to 0.76), -3.05 (-4.10 to -2.01), -4.30 (-5.35 to -3.26), -4.79 (-5.83 to -3.75), and -4.80 (-5.96 to -3.64) in the PROPEL usual care, REPOWER in-clinic individual visits, REPOWER telephone group visits, REPOWER in-clinic group visits, and PROPEL in-clinic and telephone visits arms, respectively. At 24 months, percentage of weight loss was -0.360 (-1.60 to 0.88), -3.00 (-4.02 to -1.98), -4.23 (-5.25 to -3.20), -4.67 (-5.69 to -3.65), and -4.69 (-5.82 to -3.56), respectively, in the five arms. The REPOWER in-clinic individual visits intervention was the most pragmatic and reflects the current Centers for Medicare and Medicaid Services funding model, although this intervention produced the least weight loss.
Clinically significant weight loss over 6 months in primary care settings is achievable using a variety of lifestyle-based treatment approaches. Longer-term weight-loss maintenance is more difficult to achieve.
本研究旨在报告在服务不足患者的初级保健环境中进行的五项减肥干预措施的结果，并使用实用解释连续性指标综合（PRECIS-2）工具比较各项干预措施的实用程度。
来自路易斯安那州初级保健中促进成功减肥（PROPEL）和农村初级保健参与以优化体重减轻（REPOWER）集群随机试验的 54 个初级保健诊所（2210 名患者）的数据被汇总。诊所被随机分配到以下五种对照之一：PROPEL 常规护理、PROPEL 门诊和电话访问相结合、REPOWER 门诊个体访问、REPOWER 门诊小组访问或 REPOWER 电话小组访问。
在 24 个月时，体重减轻（千克）分别为 -0.50（95%CI：-1.77 至 0.76）、-3.05（-4.10 至-2.01）、-4.30（-5.35 至-3.26）、-4.79（-5.83 至-3.75）和-4.80（-5.96 至-3.64），分别在 PROPEL 常规护理、REPOWER 门诊个体访问、REPOWER 电话小组访问、REPOWER 门诊小组访问和 PROPEL 门诊和电话访问组中。在 24 个月时，体重减轻百分比分别为-0.360（-1.60 至 0.88）、-3.00（-4.02 至-1.98）、-4.23（-5.25 至-3.20）、-4.67（-5.69 至-3.65）和-4.69（-5.82 至-3.56），分别在五个手臂中。REPOWER 门诊个体访问干预措施是最实用的，反映了当前医疗保险和医疗补助服务的资助模式，尽管该干预措施的体重减轻效果最小。
在初级保健环境中，通过各种基于生活方式的治疗方法，6 个月内实现有临床意义的体重减轻是可行的。长期维持体重减轻更为困难。
