Pacific Northwest Evidence-based Practice Center, Department of Medical Informatics and Clinical Epidemiology, and Departments of Family Medicine and Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon (A.G.C.).
Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California (H.D.N.).
Ann Intern Med. 2022 Sep;175(9):1275-1284. doi: 10.7326/M22-0160. Epub 2022 Aug 2.
Despite high prevalence rates of obesity in the United States, no clinical guidelines exist for obesity prevention in midlife women who commonly experience weight gain.
To evaluate evidence on the effectiveness and harms of behavioral interventions to reduce weight gain and improve health outcomes for women aged 40 to 60 years without obesity.
English-language searches of Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews (inception to 26 October 2021); ClinicalTrials.gov (October 2021); and reference lists of studies and reviews.
Randomized controlled trials (RCTs) enrolling predominantly midlife women comparing behavioral interventions to prevent weight gain with control groups and reporting health outcomes and potential harms.
Dual extraction and quality assessment of individual studies.
Seven RCTs in 12 publications ( = 51 638) were included. Four RCTs showed statistically significant favorable differences in weight change for counseling interventions versus control groups (mean difference of weight change, -0.87 to -2.5 kg), whereas 1 trial of counseling and 2 trials of exercise showed no differences; 1 of 2 RCTs reported improved quality-of-life measures. Interventions did not increase measures of depression or stress in 1 trial; self-reported falls (37% vs. 29%; < 0.001) and injuries (19% vs. 14%; = 0.03) were higher with exercise counseling in 1 trial.
Trials were generally small, heterogeneous, and lacked data on harms, long-term health outcomes, and specific patient populations.
Counseling interventions to prevent weight gain in women during midlife may result in modest differences in weight change without causing important harms. More research is needed to determine optimal content, frequency, length, and number of sessions required and should include additional patient populations.
Health Resources and Services Administration.
尽管美国肥胖症的患病率很高，但对于中年女性（她们通常会体重增加），目前尚无针对肥胖预防的临床指南。
评估针对体重增加和改善 40 至 60 岁无肥胖症女性健康结局的行为干预措施的有效性和危害的证据。
Ovid MEDLINE、Cochrane 对照试验中心注册库和 Cochrane 系统评价数据库（从建库至 2021 年 10 月 26 日）、ClinicalTrials.gov（2021 年 10 月）以及研究和综述的参考文献列表。
纳入比较行为干预措施与对照组预防体重增加的、以中年女性为主要参与者的随机对照试验（RCT），并报告健康结局和潜在危害。
对单独研究进行双重提取和质量评估。
纳入 12 篇出版物中的 7 项 RCT（n = 51638）。4 项 RCT 显示，与对照组相比，咨询干预在体重变化方面具有统计学意义上的有利差异（体重变化的平均差值，-0.87 至-2.5 kg），而 1 项咨询试验和 2 项运动试验则无差异；1 项 RCT 报告了生活质量测量的改善。1 项试验中，干预并未增加抑郁或压力的测量值；1 项试验中，运动咨询组的自我报告跌倒率（37%比 29%；< 0.001）和受伤率（19%比 14%；= 0.03）更高。
试验通常规模较小、异质性较大，且缺乏危害、长期健康结局和特定患者人群的数据。
针对中年女性预防体重增加的咨询干预可能会导致体重变化的适度差异，而不会造成重要危害。需要开展更多研究来确定最佳内容、频率、时长和所需的会话次数，并且应该纳入更多的患者群体。
卫生资源和服务管理局。
