Thomas M, Guyon Lebouffi Y
Ann Med Interne (Paris). 1984;135(3):199-204.
One hundred and thirty-eight out of 250 obese patients admitted to hospitals between 1972 and 1976 for dietetic treatment comprising 1,000 calories and 100 g carbohydrates were recontacted with a minimum follow-up of 5 years. Seventy-five patients refused to answer the questionnaire or attend an outpatient appointment. Four patients were later excluded from the study. Finally, fifty-nine patients were reassessed. The percentage of good results at 5 years (defined as greater than or equal to 5 p. 100 loss of initial body weight) was 45.5 p. 100 of those reassessed, a minimum of 20 p. 100 of the total number recontacted. The course of obesity was not linear. During the follow-up period there were 45.5 p. 100 of secondary failures (regain of initial body weight after having lost at least 5 p. 100), but also 17 p. 100 of secondary successes. The prognosis was not related to the age of onset of obesity, its duration, sex, occupation, alleged trigger factors, apparent motivation, duration of hospital admission, or treatment before or after hospitalisation. The prognosis was better in patients under 30 or over 50 years of age at the time of treatment (P less than 0.01) and when the body weight had not varied +/- 5 kg in the years preceding treatment (P less than 0.01). The following factors may also play a favourable role (but not statistically significant): the degree of obesity (better results in major obesity greater than or equal to 50 p. 100 overweight), a positive family history, the detection of a physical factor (glucose intolerance) during investigation, and the repetition of medical check-ups after initial counselling.
1972年至1976年间,250名因饮食治疗(每日1000卡路里、100克碳水化合物)而入院的肥胖患者中,138人被再次联系,随访期至少为5年。75名患者拒绝回答问卷或参加门诊预约。4名患者后来被排除在研究之外。最终,59名患者接受了重新评估。5年时取得良好效果(定义为初始体重减轻大于或等于5%)的患者占重新评估患者的45.5%,占再次联系的总人数的至少20%。肥胖的发展过程并非呈线性。在随访期间,有45.5%的患者出现继发性失败(在体重至少减轻5%后又恢复到初始体重),但也有17%的患者继发性成功。预后与肥胖发病年龄、病程、性别、职业、所谓的触发因素、明显的动机、住院时间或住院前后的治疗无关。治疗时年龄在30岁以下或50岁以上的患者预后较好(P<0.01),且治疗前数年体重未在±5千克范围内波动的患者预后较好(P<0.01)。以下因素可能也起到有利作用(但无统计学意义):肥胖程度(超重50%及以上的重度肥胖患者效果较好)、阳性家族史、检查期间发现身体因素(葡萄糖不耐受)以及初次咨询后重复进行体检。