Department of Medicine, New York University Grossman School of Medicine, New York, New York
Department of Population Health, New York University Grossman School of Medicine, New York, New York.
Ann Fam Med. 2024 Sep-Oct;22(5):392-399. doi: 10.1370/afm.3150.
We undertook a trial to test the efficacy of a technology-assisted health coaching intervention for weight management, called Goals for Eating and Moving (GEM), within primary care.
This cluster-randomized controlled trial enrolled 19 primary care teams with 63 clinicians; 9 teams were randomized to GEM and 10 to enhanced usual care (EUC). The GEM intervention included 1 in-person and up to 12 telephone-delivered coaching sessions. Coaches supported goal setting and engagement with weight management programs, facilitated by a software tool. Patients in the EUC arm received educational handouts. We enrolled patients who spoke English or Spanish, were aged 18 to 69 years, and either were overweight (body mass index 25-29 kg/m) with a weight-related comorbidity or had obesity (body mass index ≥30 kg/m). The primary outcome (weight change at 12 months) and exploratory outcomes (eg, program attendance, diet, physical activity) were analyzed according to intention to treat.
We enrolled 489 patients (220 in the GEM arm, 269 in the EUC arm). Their mean (SD) age was 49.8 (12.1) years; 44% were male, 41% Hispanic, and 44% non-Hispanic Black. At 12 months, the mean adjusted weight change (standard error) was -1.4 (0.8) kg in the GEM arm vs -0.8 (1.6) kg in the EUC arm, a nonsignificant difference ( = .48). There were no statistically significant differences in secondary outcomes. Exploratory analyses showed that the GEM arm had a greater change than the EUC arm in mean number of weekly minutes of moderate to vigorous physical activity other than walking, a finding that may warrant further exploration.
The GEM intervention did not achieve clinically important weight loss in primary care. Although this was a negative study possibly affected by health system resource limitations and disruptions, its findings can guide the development of similar interventions. Future studies could explore the efficacy of higher-intensity interventions and interventions that include medication and bariatric surgery options, in addition to lifestyle modification.
我们开展了一项试验，旨在测试一种名为“饮食和运动目标（GEM）”的技术辅助健康辅导干预措施在基层医疗中的减肥效果。
这项整群随机对照试验纳入了 19 个基层医疗团队的 63 名临床医生；其中 9 个团队被随机分配到 GEM 组，10 个团队被分配到强化常规护理（EUC）组。GEM 干预包括 1 次面对面和最多 12 次电话提供的辅导课程。教练通过软件工具支持目标设定和参与体重管理计划。EUC 组的患者接受教育手册。我们招募了讲英语或西班牙语、年龄在 18 至 69 岁之间、超重（体重指数 25-29kg/m²）并伴有与体重相关的合并症或肥胖（体重指数≥30kg/m²）的患者。主要结局（12 个月时的体重变化）和探索性结局（如参与项目、饮食、身体活动）按意向治疗进行分析。
我们共纳入了 489 名患者（GEM 组 220 名，EUC 组 269 名）。他们的平均（SD）年龄为 49.8（12.1）岁；44%为男性，41%为西班牙裔，44%为非西班牙裔黑人。12 个月时，GEM 组的平均调整体重变化（标准误差）为-1.4（0.8）kg，EUC 组为-0.8（1.6）kg，差异无统计学意义（=0.48）。次要结局无统计学差异。探索性分析显示，GEM 组在除散步以外的每周中等至剧烈体力活动的分钟数方面的变化大于 EUC 组，这一发现可能需要进一步探索。
GEM 干预措施在基层医疗中未能实现临床上重要的减肥效果。尽管这是一项可能受到卫生系统资源限制和中断影响的阴性研究，但它的发现可以为类似干预措施的发展提供指导。未来的研究可以探索更高强度的干预措施和包括药物和减肥手术选择的干预措施的疗效，除了生活方式的改变。
