Multidimensional Cognitive Behavioral Therapy for Obesity Applied by Psychologists Using a Digital Platform: Open-Label Randomized Controlled Trial
Multidimensional Cognitive Behavioral Therapy for Obesity Applied by Psychologists Using a Digital Platform: Open-Label Randomized Controlled Trial
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DOI：
10.2196/14817
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发表时间：
2020-04-30
影响因子：
5
通讯作者：
Choi, Hyung Jin
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文献类型：
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作者：
Kim, Meelim;Kim, Youngin;Choi, Hyung Jin
背景：由于肥胖是一个主要的健康问题，开发有效的、广泛适用的体重管理计划是医疗保健的首要任务。目的：本研究开发并调查了一种基于认知行为治疗(CBT)模块的新的、全面的、多因素的、日常的、强化的心理学家指导计划。该计划通过数字医疗移动服务Noom Coach和InBody提供。方法：这是一项开放标签、主动比较、随机对照的试验。将体重指数>24 kg/m(2)且除肥胖外无其他临床问题的70名女性受试者随机分为实验组和对照组。实验(即数字CBT)组(n=45)接受治疗师干预，使用数字健康护理服务，提供每日反馈和任务，持续8周。对照组(n=25)也使用数字化医疗服务，但在没有治疗师干预的情况下进行自我护理。这项研究的主要结果在基线、8周和24周被客观测量，包括体重(Kg)和其他身体成分。结果：8周时数字CBT组的平均体重下降显著高于对照组(-3.1%，SD 4.5，vs-0.7%，SD 3.4，P=0.04)。此外，数字CBT组的受试者在8周时达到常规体重减轻5%的比例显著高于对照组(32%[12/38]比4%[1/21]，P=0.02)，但在24周时不是这样。8周时数字CBT组的平均脂肪质量下降也显著大于对照组(-6.3%，SD 8.8，vs-0.8%，SD 8.1，P=0.02)。8周时数字CBT组的平均瘦素和胰岛素抵抗显著低于对照组(-15.8%，SD 29.9，vs 7.2%，SD 35.9，P=0.01；-7.1%，SD 35.1，vs 14.4%，SD 41.2，P=0.04)。8周时，用问卷(即荷兰饮食行为问卷)测量的情绪性饮食行为(即平均分)与对照组相比有显著改善(-2.8%，SD 34.4，vs21.6%，SD 56.9，P=0.048)。干预期数字CBT组的平均零食卡路里摄入量显著低于对照组(135.9千卡，SD86.4，VS 208.2千卡，SD 166.3，P=0.02)。最后，基线抑郁、焦虑和自尊水平显著预测长期临床结果(24周)，而基线动机显著预测短期(8周)和长期临床结果。结论：这些发现证实了基于技术的干预应该是多维度的，并且在人类的反馈和支持下最有效。这项研究在成功开发和验证基于数字技术而不是独立的基于技术的干预的多学科团队的新CBT方法的效果方面具有创新性。
Background: Developing effective, widely useful, weight management programs is a priority in health care because obesity is a major health problem.Objective: This study developed and investigated a new, comprehensive, multifactorial, daily, intensive, psychologist coaching program based on cognitive behavioral therapy (CBT) modules. The program was delivered via the digital health care mobile services Noom Coach and InBody.Methods: This was an open-label, active-comparator, randomized controlled trial. A total of 70 female participants with BMI scores above 24 kg/m(2) and no clinical problems besides obesity were randomized into experimental and control groups. The experimental (ie, digital CBT) group (n=45) was connected with a therapist intervention using a digital health care service that provided daily feedback and assignments for 8 weeks. The control group (n=25) also used the digital health care service, but practiced self-care without therapist intervention. The main outcomes of this study were measured objectively at baseline, 8 weeks, and 24 weeks and included weight (kg) as well as other body compositions. Differences between groups were evaluated using independent t tests and a per-protocol framework.Results: Mean weight loss at 8 weeks in the digital CBT group was significantly higher than in the control group (-3.1%, SD 4.5, vs -0.7%, SD 3.4, P=.04). Additionally, the proportion of subjects who attained conventional 5% weight loss from baseline in the digital CBT group was significantly higher than in the control group at 8 weeks (32% [12/38] vs 4% [1/21], P=.02) but not at 24 weeks. Mean fat mass reduction in the digital CBT group at 8 weeks was also significantly greater than in the control group (-6.3%, SD 8.8, vs -0.8%, SD 8.1, P=.02). Mean leptin and insulin resistance in the digital CBT group at 8 weeks was significantly reduced compared to the control group (-15.8%, SD 29.9, vs 7.2%, SD 35.9, P=.01; and -7.1%, SD 35.1, vs 14.4%, SD 41.2, P=.04). Emotional eating behavior (ie, mean score) measured by questionnaire (ie, the Dutch Eating Behavior Questionnaire) at 8 weeks was significantly improved compared to the control group (-2.8%, SD 34.4, vs 21.6%, SD 56.9, P=.048). Mean snack calorie intake in the digital CBT group during the intervention period was significantly lower than in the control group (135.9 kcal, SD 86.4, vs 208.2 kcal, SD 166.3, P=.02). Lastly, baseline depression, anxiety, and self-esteem levels significantly predicted long-term clinical outcomes (24 weeks), while baseline motivation significantly predicted both short-term (8 weeks) and long-term clinical outcomes.Conclusions: These findings confirm that technology-based interventions should be multidimensional and are most effective with human feedback and support. This study is innovative in successfully developing and verifying the effects of a new CBT approach with a multidisciplinary team based on digital technologies rather than standalone technology-based interventions.