Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review.
Behavioral treatment of obesity in patients encountered in primary care settings: a systematic review.
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DOI：
10.1001/jama.2014.14173
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发表时间：
2014-11-05
影响因子：
120.7
通讯作者：
Tsai, Adam G.
中科院分区：
文献类型：
--
作者：
Wadden, Thomas A.;Butryn, Meghan L.;Hong, Patricia S.;Tsai, Adam G.
2011年，医疗保险和医疗补助服务中心（CMS）批准了针对初级保健机构肥胖受益人的强化行为减肥咨询（即，在6个月内进行大约14分钟，10-15分钟的面对面会议），由医生和其他CMS定义的初级保健从业者（pcp）提供。对从初级保健招募的超重/肥胖患者进行行为咨询的系统回顾，这些患者由单独工作的pcp或与训练有素的干预师（如医疗助理、注册营养师）或独立工作的训练有素的干预师提供。我们检索了PubMed、CINAHL和EMBASE的随机对照试验（1980年1月- 2014年6月），这些试验招募了来自初级保健的超重/肥胖患者；提供≥3个月的行为咨询（即饮食、运动和行为治疗），随机化后随访≥6个月；纳入≥15名受试者/治疗组，客观测量体重；并进行了比较，意向治疗分析，1年的损失率<30%，更长时间的损失率<40%。对3304篇摘要的回顾得出12项试验（总共3893名受试者）符合纳入/排除标准和预先指定的质量评级。没有研究发现pcp按照CMS指南提供咨询（6个月14次）。干预组6个月平均体重变化（相对于基线）范围为- 0.3至- 6.6 kg，对照组相应值为+0.9至- 2.0 kg。随着随访时间的延长（12-24个月），两组患者的体重减轻程度普遍下降。同时规定减少能量摄入（例如，≥500千卡/天的赤字）和增加身体活动（例如，≥150分钟/周的步行）的干预措施，与传统行为疗法相比，通常比没有这三个特定成分的干预措施产生更大的体重减轻。在之前的试验中，由训练有素的干预人员亲自或通过电话提供更多的治疗疗程，与更大的平均体重减轻和减少基线体重≥5%的可能性相关。强化行为咨询可以诱导临床有意义的减肥，但关于pcp提供这种护理的研究很少。目前的研究结果表明，在治疗初级保健中遇到的超重/肥胖患者时，可以考虑一系列训练有素的干预学家，他们可以亲自或通过电话提供咨询。
In 2011, the Centers for Medicare and Medicaid Services (CMS) approved intensive behavioral weight loss counseling (i.e., approximately 14, 10–15 minute, face-to-face sessions in 6 months) for obese beneficiaries in primary care settings, when delivered by physicians and other CMS-defined primary care practitioners (PCPs). To conduct a systematic review of behavioral counseling for overweight/obese patients recruited from primary care, as delivered by PCPs working alone or with trained interventionists (e.g., medical assistants, registered dietitians), or by trained interventionists working independently. We searched PubMed, CINAHL, and EMBASE for randomized controlled trials (January 1980–June 2014) which: recruited overweight/obese patients from primary care; provided behavioral counseling (i.e., diet, exercise, and behavior therapy) for ≥3 months, with ≥6 months post-randomization follow-up; included ≥15 participants/treatment group and objectively measured weights; and had a comparator, an intention-to-treat analysis, and attrition <30% at 1 year or <40% at longer follow-up. Review of 3,304 abstracts yielded 12 trials (with 3,893 total participants) that met inclusion/exclusion criteria and pre-specified quality ratings. No studies were found in which PCPs delivered counseling following CMS guidelines (14 sessions in 6 months). Mean 6-month weight changes (relative to baseline) in the intervention group ranged from −0.3 to −6.6 kg, with corresponding values of +0.9 to −2.0 kg in control group. Weight loss in both groups generally declined with longer follow-up (12–24 months). Interventions that prescribed both reduced energy intake (e.g., ≥500 kcal/day deficit) and increased physical activity (e.g., ≥150 minutes/week of walking), with traditional behavior therapy, generally produced larger weight loss than interventions without all three specific components. In the former trials, more treatment sessions, delivered in person or by phone by trained interventionists, were associated with greater mean weight loss and likelihood of losing ≥5% of baseline weight. Intensive behavioral counseling can induce clinically meaningful weight loss, but there is little research on PCPs providing such care. The present findings suggest that a range of trained interventionists, who deliver counseling in person or by telephone, could be considered in treating overweight/obesity in patients encountered in primary care.
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影响因子：
158.5
作者：
Knowler, WC;Barrett-Connor, E;Nathan, DM
通讯作者：
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Christian, James G.;Bessesen, Daniel H.;Bock, Beth C.
通讯作者：
Bock, Beth C.
影响因子：
5.1
作者：
Harvey-Berino, Jean;West, Delia;Skelly, Joan
通讯作者：
Skelly, Joan