Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial.
Screening and brief intervention for obesity in primary care: a parallel, two-arm, randomised trial.
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DOI：
10.1016/s0140-6736(16)31893-1
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发表时间：
2016-11-19
期刊：
影响因子：
168.9
通讯作者：
Jebb, Susan A.
中科院分区：
文献类型：
--
作者：
Aveyard, Paul;Lewis, Amanda;Tearne, Sarah;Hood, Kathryn;Christian-Brown, Anna;Adab, Peymane;Begh, Rachna;Jolly, Kate;Daley, Amanda;Farley, Amanda;Lycett, Deborah;Nickless, Alecia;Yu, Ly-Mee;Retat, Lise;Webber, Laura;Pimpin, Laura;Jebb, Susan A.
肥胖是导致非传染性疾病的常见原因。指南建议医生进行筛查并提供简短建议，通过转介到行为减肥计划来激励减肥。然而，医生很少进行干预，也没有进行过相关试验。我们进行了这项试验，以确定医生的简短干预是否可接受，是否能有效减轻肥胖症患者的体重。
在这项平行、双臂、随机试验中，英国 137 名初级保健医生对就诊患者进行了肥胖筛查。年龄在 18 岁以上、体重指数至少为 30 kg/m2（亚裔至少为 25 kg/m2）、体脂百分比升高的患者均可参加。咨询结束后，医生将参与者（1:1）随机分配到两种为期 30 秒的干预措施中的一种。随机分配是通过事先准备好的随机分配卡进行的，卡上标有代表分配的代码，随机分配卡放在不透明的密封信封中，在分配治疗时交给医生打开。在积极干预中，医生会将患者转介到体重管理小组（每周一次，每次1小时，共12次），如果转介被接受，医生会确保患者预约并提供随访。在对照干预中，医生会告知患者，减轻体重将有利于他们的健康。主要研究结果是意向治疗人群在 12 个月时的体重变化，该结果在治疗分配盲法下进行评估。我们还询问了患者因其他原因就诊时讨论体重问题的感受。鉴于干预措施的性质，我们预计不会出现通常意义上的不良事件，因此未对安全性结果进行评估。该试验已在 ISRCTN 注册中心注册，注册号为 ISRCTN26563137。
在 2013 年 6 月 4 日至 2014 年 12 月 23 日期间，我们筛选了 8403 名患者，其中 2728 人（32%）为肥胖患者。在这些肥胖患者中，2256 人（83%）同意参与，1882 人符合条件，入选并纳入意向治疗分析，其中支持组 940 人，建议组 942 人。722人（77%）被分配到支持干预组，其中379人（40%）同意参加体重管理组，而82人（9%）被分配到建议干预组。在整个研究人群中，支持干预组 12 个月的平均体重变化为 2-43 公斤，建议干预组为 1-04 公斤，调整后的差异为 1-43 公斤（95% CI 0-89-1-97）。患者对全科医生简短干预的反应在适当性（调整后的几率比0-89，95% CI 0-75-1-07，P=0-21）或有用性（1-05，0-89-1-26，P=0-54）方面在研究组之间没有显著差异；总体而言，有4名（<1%）患者认为他们的干预不适当且没有帮助，有1530名（81%）患者认为干预适当且有帮助。
以行为为导向、非常简短、由医生提供的机会性干预是患者可以接受的，也是降低人口平均体重的有效方法。
英国国家预防研究计划。
Obesity is a common cause of non-communicable disease. Guidelines recommend that physicians screen and offer brief advice to motivate weight loss through referral to behavioural weight loss programmes. However, physicians rarely intervene and no trials have been done on the subject. We did this trial to establish whether physician brief intervention is acceptable and effective for reducing bodyweight in patients with obesity. In this parallel, two-arm, randomised trial, patients who consulted 137 primary care physicians in England were screened for obesity. Individuals could be enrolled if they were aged at least 18 years, had a body-mass index of at least 30 kg/m2 (or at least 25 kg/m2 if of Asian ethnicity), and had a raised body fat percentage. At the end of the consultation, the physician randomly assigned participants (1:1) to one of two 30 s interventions. Randomisation was done via preprepared randomisation cards labelled with a code representing the allocation, which were placed in opaque sealed envelopes and given to physicians to open at the time of treatment assignment. In the active intervention, the physician offered referral to a weight management group (12 sessions of 1 h each, once per week) and, if the referral was accepted, the physician ensured the patient made an appointment and offered follow-up. In the control intervention, the physician advised the patient that their health would benefit from weight loss. The primary outcome was weight change at 12 months in the intention-to-treat population, which was assessed blinded to treatment allocation. We also assessed asked patients' about their feelings on discussing their weight when they have visited their general practitioner for other reasons. Given the nature of the intervention, we did not anticipate any adverse events in the usual sense, so safety outcomes were not assessed. This trial is registered with the ISRCTN Registry, number ISRCTN26563137. Between June 4, 2013, and Dec 23, 2014, we screened 8403 patients, of whom 2728 (32%) were obese. Of these obese patients, 2256 (83%) agreed to participate and 1882 were eligible, enrolled, and included in the intention-to-treat analysis, with 940 individuals in the support group and 942 individuals in the advice group. 722 (77%) individuals assigned to the support intervention agreed to attend the weight management group and 379 (40%) of these individuals attended, compared with 82 (9%) participants who were allocated the advice intervention. In the entire study population, mean weight change at 12 months was 2·43 kg with the support intervention and 1·04 kg with the advice intervention, giving an adjusted difference of 1·43 kg (95% CI 0·89–1·97). The reactions of the patients to the general practitioners' brief interventions did not differ significantly between the study groups in terms of appropriateness (adjusted odds ratio 0·89, 95% CI 0·75–1·07, p=0·21) or helpfulness (1·05, 0·89–1·26, p=0·54); overall, four (<1%) patients thought their intervention was inappropriate and unhelpful and 1530 (81%) patients thought it was appropriate and helpful. A behaviourally-informed, very brief, physician-delivered opportunistic intervention is acceptable to patients and an effective way to reduce population mean weight. The UK National Prevention Research Initiative.