A two-year randomized trial of obesity treatment in primary care practice.
A two-year randomized trial of obesity treatment in primary care practice.
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DOI：
10.1056/nejmoa1109220
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发表时间：
2011-11-24
期刊：
影响因子：
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通讯作者：
Moore RH
中科院分区：
文献类型：
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作者：
Wadden TA;Volger S;Sarwer DB;Vetter ML;Tsai AG;Berkowitz RI;Kumanyika S;Schmitz KH;Diewald LK;Barg R;Chittams J;Moore RH
呼吁初级保健提供者 (PCP) 为肥胖患者提供行为减肥咨询，但并未就如何提供此类护理提供充分的指导。这项随机试验比较了 2 年期间三种生活方式干预措施的体重减轻情况，所有干预措施均由 PCP 与辅助健康专业人员（生活方式教练）在实践中合作实施。我们将 6 种初级保健实践中的 390 名肥胖成年人随机分配到三种干预类型中的一种：常规护理，包括每季度一次 PCP 就诊，其中包括体重管理教育；简短的生活方式咨询，包括每季度一次的 PCP 就诊以及每月与生活方式教练的简短会议，指导参与者进行行为体重控制；或强化简短的生活方式咨询，提供与先前干预相同的护理，但包括参与者与 PCP 协商后选择的代餐或减肥药物（奥利司他或西布曲明），以潜在地增加体重减轻。在 390 名参与者中，86% 完成了为期 2 年的试验，此时，常规护理、简短生活方式咨询和强化简短生活方式咨询的平均 (±SE) 体重减轻分别为 1.7±0.7、2.9±0.7 和 4.6±0.7 公斤。三组中分别有 21.5%、26.0% 和 34.9% 的参与者初始体重下降至少 5%。在这两项成功指标上，强化生活方式咨询均优于常规护理（分别为 P = 0.003 和 P = 0.02），各组之间没有其他显着差异。即使服用西布曲明的参与者被排除在分析之外，加强生活方式咨询的好处仍然存在。干预组之间严重不良事件的发生率没有显着差异。加强减肥咨询可帮助约三分之一的肥胖患者实现长期、有临床意义的减肥效果。 （由国家心肺血液研究所资助；POWER-UP ClinicalTrials.gov 编号，NCT00826774。）
Calls for primary care providers (PCPs) to offer obese patients behavioral weight-loss counseling have not been accompanied by adequate guidance on how such care could be delivered. This randomized trial compared weight loss during a 2-year period in response to three lifestyle interventions, all delivered by PCPs in collaboration with auxiliary health professionals (lifestyle coaches) in their practices. We randomly assigned 390 obese adults in six primary care practices to one of three types of intervention: usual care, consisting of quarterly PCP visits that included education about weight management; brief lifestyle counseling, consisting of quarterly PCP visits combined with brief monthly sessions with lifestyle coaches who instructed participants about behavioral weight control; or enhanced brief lifestyle counseling, which provided the same care as described for the previous intervention but included meal replacements or weight-loss medication (orlistat or sibutramine), chosen by the participants in consultation with the PCPs, to potentially increase weight loss. Of the 390 participants, 86% completed the 2-year trial, at which time, the mean (±SE) weight loss with usual care, brief lifestyle counseling, and enhanced brief lifestyle counseling was 1.7±0.7, 2.9±0.7, and 4.6±0.7 kg, respectively. Initial weight decreased at least 5% in 21.5%, 26.0%, and 34.9% of the participants in the three groups, respectively. Enhanced lifestyle counseling was superior to usual care on both these measures of success (P = 0.003 and P = 0.02, respectively), with no other significant differences among the groups. The benefits of enhanced lifestyle counseling remained even after participants given sibutramine were excluded from the analyses. There were no significant differences between the intervention groups in the occurrence of serious adverse events. Enhanced weight-loss counseling helps about one third of obese patients achieve long-term, clinically meaningful weight loss. (Funded by the National Heart, Lung, and Blood Institute; POWER-UP ClinicalTrials.gov number, NCT00826774.)