eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia.
School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia.
Int J Obes (Lond). 2023 Jun;47(6):487-495. doi: 10.1038/s41366-023-01285-6. Epub 2023 Mar 3.
There is growing evidence that internet-delivered cognitive behavioural therapy (iCBT) can improve functioning and reduce psychological distress in people with chronic health conditions. Obesity frequently co-occurs with chronic health conditions, yet its impact on response to psychological interventions in this population is not known. The current study examined associations between BMI and clinical outcomes (depression, anxiety, disability, and satisfaction with life) following a transdiagnostic iCBT program targeting adjustment to chronic illness.
Participants from a large randomised controlled trial, who provided information on height and weight, were included (N = 234; mean age= 48.32, SD = 13.80; mean BMI = 30.43, SD = 8.30, range 16.18-67.52; 86.8% female). The influence of baseline BMI range on treatment outcomes at post-treatment and 3-month follow-up was examined using generalized estimating equations. We also examined changes in BMI and in participants' perceived impact of weight on their health.
Improvement in all outcomes occurred across BMI ranges; additionally, persons with obesity or overweight generally experienced greater symptom reductions than those within a healthy weight range. A greater proportion of participants with obesity achieved clinically significant change on key outcomes (e.g., depression: 32% [95% CI: 25%, 39%]) than participants with a healthy weight (21% [95% CI: 15%, 26%]) or overweight (24% [95% CI: 18%, 29%], p = 0.016). There were no significant changes in BMI from pre-treatment to 3-month follow-up, however there were significant reductions on the self-rated impact of weight on health.
Persons with chronic health conditions and with obesity or overweight benefit at least as much as those with a healthy BMI from iCBT programs targeting psychological adjustment to chronic illness, even without changes in BMI. iCBT programs may be an important component in the self-management of this population, and may address barriers implicated in health behaviour change.
越来越多的证据表明，互联网提供的认知行为疗法（iCBT）可以改善慢性疾病患者的功能并减轻心理困扰。肥胖症常与慢性健康状况同时发生，但尚不清楚其对该人群对心理干预的反应的影响。本研究检查了针对慢性疾病适应的跨诊断 iCBT 计划后，BMI 与临床结局（抑郁，焦虑，残疾和生活满意度）之间的关联。
参加大型随机对照试验并提供身高和体重信息的参与者被纳入（N=234；平均年龄=48.32，SD=13.80；平均 BMI=30.43，SD=8.30，范围 16.18-67.52；86.8％为女性）。使用广义估计方程检查基线 BMI 范围对治疗结束时和 3 个月随访时治疗结果的影响。我们还检查了 BMI 的变化以及参与者对体重对其健康的感知影响。
所有结果均在 BMI 范围内有所改善；此外，肥胖或超重的人通常比健康体重范围内的人经历更大的症状减轻。在关键结局（例如，抑郁：32％[95％CI：25％，39％]）上，肥胖患者中达到临床显著变化的比例高于健康体重（21％[95％CI：15％，26％]）或超重（24％[95％CI：18％，29％]，p=0.016）的参与者。从治疗前到 3 个月随访时，BMI 没有明显变化，但是体重对健康的自我评估影响有显著降低。
患有慢性健康疾病且肥胖或超重的人至少与 BMI 健康的人一样受益于针对慢性疾病心理调整的 iCBT 计划，即使 BMI 没有变化。iCBT 计划可能是该人群自我管理的重要组成部分，并且可能解决与健康行为改变有关的障碍。
