一种预防超重和肥胖成年人长期体重增加的小幅度改变方法：一项随机对照试验。

A small change approach to prevent long-term weight gain in adults with overweight and obesity: a randomized controlled trial.

机构信息

School of Kinesiology and Health Studies (Ross, Latimer-Cheung) and Department of Medicine, Division of Endocrinology and Metabolism (Ross), Queen's University; Kingston Health Sciences Centre (Day), Kingston, Ont.; AdventHealth Orlando, Translational Research Institute (Brennan), Orlando, Fla.; University of Alabama at Birmingham, Department of Nutritional Sciences (Hill), Birmingham, Ala.

出版信息

CMAJ. 2022 Mar 7;194(9):E324-E331. doi: 10.1503/cmaj.211041.

DOI:10.1503/cmaj.211041

PMID:35256388

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9053990/

Abstract

BACKGROUND

Efforts to manage obesity through weight loss are often unsuccessful as most adults are not able to sustain the major changes in behaviour that are required to maintain weight loss long term. We sought to determine whether small changes in physical activity and diet prevent weight gain in adults with overweight and obesity.

METHODS

We randomized 320 sedentary adults with overweight or obesity to monitoring alone (MA, = 160) or a small change approach (SCA, = 160). In Phase I (2 yr), MA participants were asked to maintain their normal lifestyle and SCA participants were counselled to make small changes in diet and physical activity, namely a suggested increase in daily step count of 2000 steps with a decrease in energy intake of 100 kcal per day, with group and individual support. Phase II (1 yr) was a passive follow-up period. The difference in change in body weight between groups at 24 and 36 months from baseline was the primary outcome. Additional outcomes included waist circumference and cardiorespiratory fitness.

RESULTS

Overall, 268 participants (83.8%) completed the 2-year intervention, and 239 (74.7%) returned at the end of the follow-up period at 3 years. The difference in body weight change between the SCA and MA groups was significant at 3, 6, 12 and 15 months from baseline, but was no longer significant at 24 months (mean change 0.9 [standard error (SE) 0.5] kg v. -0.4 [SE 0.5] kg; difference -0.6, 95% confidence interval [CI] -1.9 to 0.8) or at 36 months (-1.2 [SE 0.8] v. -0.7 [SE 0.8] kg; difference -0.5, 95% CI -2.2 to 1.2). Changes in waist circumference and cardiorespiratory fitness were not significantly different between groups at 24 or 36 months (both > 0.1).

INTERPRETATION

The SCA did not prevent weight gain compared with monitoring alone at 2 or 3 years in adults with overweight or obesity. On average, we observed prevention of weight gain in both arms of the trial.

TRIAL REGISTRATION

ClinicalTrials.gov, no. NCT02027077.

摘要

背景

通过减肥来控制体重的努力往往是不成功的，因为大多数成年人无法长期维持保持体重减轻所需的重大行为改变。我们试图确定在超重和肥胖的成年人中，体力活动和饮食的微小变化是否可以预防体重增加。

方法

我们将 320 名久坐不动的超重或肥胖成年人随机分为单独监测组（MA，n=160）或小变化组（SCA，n=160）。在第 I 阶段（2 年），MA 组参与者被要求保持其正常生活方式，而 SCA 组参与者则被建议在饮食和体力活动方面进行小的改变，即每天增加 2000 步，每天减少 100 千卡的能量摄入，并接受小组和个人支持。第 II 阶段（1 年）为被动随访期。从基线开始，24 个月和 36 个月时两组体重变化的差异是主要结局。其他结局包括腰围和心肺适能。

结果

总体而言，268 名参与者（83.8%）完成了 2 年的干预，239 名参与者（74.7%）在 3 年的随访期末返回。从基线开始，SCA 组和 MA 组的体重变化差异在 3、6、12 和 15 个月时具有统计学意义，但在 24 个月时不再具有统计学意义（平均变化 0.9[标准误差（SE）0.5]kg v.-0.4[SE 0.5]kg；差异-0.6，95%置信区间[CI]-1.9 至 0.8）或在 36 个月时（-1.2[SE 0.8]v.-0.7[SE 0.8]kg；差异-0.5，95%CI-2.2 至 1.2）。在 24 或 36 个月时，两组之间的腰围和心肺适能变化均无显著差异（均>0.1）。