Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities A Randomized Clinical Trial
Effect of Telehealth Extended Care for Maintenance of Weight Loss in Rural US Communities A Randomized Clinical Trial
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DOI：
10.1001/jamanetworkopen.2020.6764
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发表时间：
2020-06-15
影响因子：
13.8
通讯作者：
Befort, Christie A.
中科院分区：
文献类型：
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作者：
Perri, Michael G.;Shankar, Meena N.;Befort, Christie A.
问题 与预防体重增加的教育计划相比，在农村社区通过个人或团体电话咨询远程提供的肥胖管理扩展护理是否可以改善体重减轻的维持？结果 在这项对 445 名完成生活方式减肥干预的参与者进行的随机临床试验中，与单独的教育相比，通过个人电话咨询远程提供的延伸护理减少了体重反弹，并增加了实现有临床意义的体重减轻的参与者比例。意义 这些研究结果表明，通过个人电话咨询远程提供的长期护理可能会减少体重反弹，并增加实现长期体重减轻至少 10% 的参与者比例。这项随机临床试验检查了美国农村社区个人或团体电话咨询与教育控制对维持体重减轻的效果。重要性 针对肥胖的生活方式干预可减轻体重，从而降低患糖尿病的风险 和心血管疾病，但受到减肥维持效果不佳和资源匮乏社区传播不足的限制。目的 评估通过美国合作推广系统在农村社区远程提供的肥胖管理延伸护理计划的有效性。设计、设置和参与者 这项随机临床试验于 2013 年 10 月 21 日至 2018 年 12 月 21 日在佛罗里达州 14 个县的合作推广服务办公室进行。共有 851 人接受了参与筛选； 220 人不符合资格标准，103 人拒绝参加。在开始为期 4 个月的生活方式干预的 528 人中，有 445 人符合随机分组条件。数据分析时间为 2019 年 8 月 22 日至 10 月 21 日。 干预措施 参与者被随机分配接受通过个人或团体电话咨询或通过电子邮件提供的教育控制计划提供的延伸护理。所有参与者都接受了 18 个模块，其中包含维持减重的治疗后建议。在基于电话的干预中，健康教练为参与者提供了 18 场个人或小组课程，重点是解决维持减肥的障碍问题。主要结果和措施 主要结果是从初始干预结束（第 4 个月）到最终随访（第 22 个月）期间的体重变化。另一个结果是随访时体重减轻至少 10% 的参与者比例。结果 在 445 名参与者（平均 [SD] 年龄，55.4 [10.2] 岁；368 [82.7%] 女性；329 [73.9%] 白人）中，149 名参与者 (33.5%) 被随机分配到个人电话咨询，143 名参与者 (32.1%) 被随机分配到团体电话咨询，153 名参与者 (34.4%) 被随机分配到电子邮件教育对照。平均 (SD) 基线体重为 99.9 (14.6) 公斤，初始干预后平均 (SD) 体重减轻为 8.3 (4.9) 公斤。随访时个体电话咨询组的平均体重反弹为 2.3（95% 可信区间 [CrI]，1.2-3.4）kg，团体电话咨询组为 2.8（95% CrI，1.4-4.2）kg，教育对照组为 4.1（95% CrI，3.1-5.0）kg，与对照组相比，个体电话咨询组的体重反弹明显较小组（后验概率 >.99)。与对照组 (19.1% [95% CrI, 14.1%-24.9%]) 相比，个体电话咨询组中体重减轻至少 10% 的参与者 (31.5% [95% CrI, 24.1%-40.0%]) 的比例更大 (后验概率 >.99)。结论和相关性 这项随机临床试验发现，通过个人电话咨询为农村社区的肥胖管理提供长期护理可减少体重反弹，并增加持续有临床意义的体重减轻的参与者比例。
Question Does extended care for obesity management delivered remotely via individual or group telephone counseling in rural communities improve the maintenance of weight loss compared with an education program about weight gain prevention? Findings In this randomized clinical trial of 445 participants who completed a lifestyle weight-loss intervention, extended care delivered remotely via individual telephone counseling decreased weight regain and increased the proportion of participants who achieved clinically meaningful weight losses compared with education alone. Meaning These findings suggest that extended care delivered remotely via individual telephone counseling may reduce weight regain and increase the proportion of participants who achieve long-term weight reductions of at least 10%.This randomized clinical trial examines the efficacy of individual or group telephone counseling vs an educational control for weight loss maintenance among individuals in rural communities in the US.Importance Lifestyle interventions for obesity produce reductions in body weight that can decrease risk for diabetes and cardiovascular disease but are limited by suboptimal maintenance of lost weight and inadequate dissemination in low-resource communities. Objective To evaluate the effectiveness of extended care programs for obesity management delivered remotely in rural communities through the US Cooperative Extension System. Design, Setting, and Participants This randomized clinical trial was conducted from October 21, 2013, to December 21, 2018, in Cooperative Extension Service offices of 14 counties in Florida. A total of 851 individuals were screened for participation; 220 individuals did not meet eligibility criteria, and 103 individuals declined to participate. Of 528 individuals who initiated a 4-month lifestyle intervention, 445 qualified for randomization. Data were analyzed from August 22 to October 21, 2019. Interventions Participants were randomly assigned to extended care delivered via individual or group telephone counseling or an education control program delivered via email. All participants received 18 modules with posttreatment recommendations for maintaining lost weight. In the telephone-based interventions, health coaches provided participants with 18 individual or group sessions focused on problem solving for obstacles to the maintenance of weight loss. Main Outcomes and Measures The primary outcome was change in body weight from the conclusion of initial intervention (month 4) to final follow-up (month 22). An additional outcome was the proportion of participants achieving at least 10% body weight reduction at follow-up. Results Among 445 participants (mean [SD] age, 55.4 [10.2] years; 368 [82.7%] women; 329 [73.9%] white), 149 participants (33.5%) were randomized to individual telephone counseling, 143 participants (32.1%) were randomized to group telephone counseling, and 153 participants (34.4%) were randomized to the email education control. Mean (SD) baseline weight was 99.9 (14.6) kg, and mean (SD) weight loss after the initial intervention was 8.3 (4.9) kg. Mean weight regains at follow-up were 2.3 (95% credible interval [CrI], 1.2-3.4) kg in the individual telephone counseling group, 2.8 (95% CrI, 1.4-4.2) kg for the group telephone counseling group, and 4.1 (95% CrI, 3.1-5.0) kg for the education control group, with a significantly smaller weight regain observed in the individual telephone counseling group vs control group (posterior probability >.99). A larger proportion of participants in the individual telephone counseling group achieved at least 10% weight reductions (31.5% [95% CrI, 24.1%-40.0%]) than in the control group (19.1% [95% CrI, 14.1%-24.9%]) (posterior probability >.99). Conclusions and Relevance This randomized clinical trial found that providing extended care for obesity management in rural communities via individual telephone counseling decreased weight regain and increased the proportion of participants who sustained clinically meaningful weight losses.