Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials.
Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials.
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DOI：
10.1136/bmj.g2646
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发表时间：
2014-05-14
期刊：
影响因子：
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通讯作者：
Sniehotta FF
中科院分区：
文献类型：
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作者：
Dombrowski SU;Knittle K;Avenell A;Araújo-Soares V;Sniehotta FF
目的 系统回顾并描述目前用于支持肥胖成年人维持体重减轻的现有方法，并评估这些干预措施有效性的证据。
设计 采用荟萃分析的系统综述。
数据来源 Medline、PsycINFO、Embase以及Cochrane对照试验中心登记库。
研究选择 研究检索截至2014年1月。纳入对初始肥胖（年龄≥18岁）且体重减轻≥5%的成年人提供维持体重减轻干预措施的随机试验，且对体重变化进行长期（≥12个月）随访（主要结局）。
研究评估与综合 潜在研究由双人独立筛选；提取研究特征和结果。采用逆方差法和随机效应模型进行荟萃分析以评估干预措施对维持体重减轻的效果。结果以体重变化的平均差值表示，并给出95%置信区间。
结果 共纳入45项试验，涉及7788人。在12个月时，侧重于食物摄入和身体活动的行为干预措施与对照组相比，体重反弹平均差值为 -1.56千克（95%置信区间 -2.27至 -0.86千克；25次比较，2949名参与者）。奥利司他联合行为干预措施在12个月时与安慰剂相比，差值为 -1.80千克（ -2.54至 -1.06；8次比较，1738名参与者）。所有奥利司他研究均报告实验组与安慰剂对照组相比，胃肠道不良事件发生频率更高。发现奥利司他治疗存在剂量 - 反应关系，每日3次120毫克剂量与每日3次60毫克和30毫克剂量相比，能更好地维持体重减轻（ -2.34千克， -3.03至 -1.65），而后者为 -0.70千克，95%置信区间 -1.92至0.52，P = 0.02。
结论 涉及饮食和身体活动的行为干预措施在维持体重减轻方面显示出虽小但显著的益处。
Objective To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions. Design Systematic review with meta-analysis. Data sources Medline, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials. Study selection Studies were identified through to January 2014. Randomised trials of interventions to maintain weight loss provided to initially obese adults (aged ≥18) after weight loss of ≥5% body weight with long term (≥12 months) follow-up of weight change (main outcome) were included. Study appraisal and synthesis Potential studies were screened independently and in duplicate; study characteristics and outcomes were extracted. Meta-analyses were conducted to estimate the effects of interventions on weight loss maintenance with the inverse variance method and a random effects model. Results are presented as mean differences in weight change, with 95% confidence intervals. Results 45 trials involving 7788 individuals were included. Behavioural interventions focusing on both food intake and physical activity resulted in an average difference of −1.56 kg (95% confidence interval −2.27 to −0.86 kg; 25 comparisons, 2949 participants) in weight regain compared with controls at 12 months. Orlistat combined with behavioural interventions resulted in a −1.80 kg (−2.54 to −1.06; eight comparisons, 1738 participants) difference compared with placebo at 12 months. All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups. A dose-response relation for orlistat treatment was found, with 120 mg doses three times a day leading to greater weight loss maintenance (−2.34 kg, −3.03 to −1.65) compared with 60 mg and 30 mg three times a day (−0.70 kg, 95% confidence interval −1.92 to 0.52), P=0.02. Conclusions Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance.