Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients A Randomized Trial
Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients A Randomized Trial
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DOI：
10.7326/0003-4819-150-4-200902170-00006
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发表时间：
2009-02-17
影响因子：
39.2
通讯作者：
Dvorak, Roman V.
中科院分区：
文献类型：
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作者：
Digenio, Andres G.;Mancuso, James P.;Dvorak, Roman V.
背景：医生经常开减肥药物，但提供很少的生活方式咨询，尽管结合这两种干预措施有额外的好处。目的：比较接受西布曲明治疗的肥胖患者实施生活方式改变方案的5种方法。设计：随机，6个月，开放标签研究。通过使用计算机生成的随机排列块的时间表，参与者被分配到干预组。块长度为5。设置：12个独立的研究诊所，具有开展肥胖试验的经验。患者：肥胖（体重指数>= 30 < 40 kg/m）患者376例(2)。干预方式：高频面对面生活方式改变咨询（HF-F2F） （n = 74）、低频面对面咨询（LF-F2F） （n = 76）、高频电话咨询（HFTEL） （n = 76）、高频电子邮件咨询（HF-EMAIL） （n = 74）或不联系营养师（自助[SELF]） （n = 76）。所有参与者均服用西布曲明，10 mg/d；生活方式手册；以及进入一个减肥网站。测量：6个月时体重变化百分比是主要观察指标。次要终点包括腰围的变化；血脂、血糖和胰岛素水平；血压;体重相关症状;6个月时的生活质量。结果：6个月时，相对于基线，HF-F2F组和HF-TEL组的平均体重减轻相似（8.9% [95% CI， 8.0%至9.8%]和7.7% [CI， 6.8%至8.7%]），显著高于其他组（LF-F2F, 6.4% [CI， 5.4%至7.3%];HF-EMAIL, 5.9% [CI， 5.0%至6.8%]；SELF, 5.2% [CI， 4.3%至6.1%]）。所有组在腰围、高密度脂蛋白胆固醇和甘油三酯水平、生活质量和体重相关症状方面均有显著改善。各组间无严重不良事件发生，轻微事件发生率无差异。限制：大多数参与者是女性，流失率为30%。结论：与营养学家的高频电话联系与HF-F2F联系类似，可支持试图减肥的肥胖患者改变生活方式。这些发现可能会被医疗服务提供者和卫生系统用来促进患者健康生活方式的改变。
Background: Physicians frequently prescribe medications for weight loss but offer minimal lifestyle counseling despite the additional benefits of combining both interventions.Objective: To compare 5 methods of delivering a lifestyle modification program to obese patients receiving sibutramine.Design: Randomized, 6-month, open-label study. Participants were assigned to intervention groups by using a computer-generated schedule of randomly permuted blocks. Block length was 5.Setting: 12 independent research clinics with experience running obesity trials.Patients: 376 patients with obesity ( body mass index >= 30 and < 40 kg/m(2)).Intervention: High-frequency face-to-face lifestyle modification counseling (HF-F2F) (n = 74), low-frequency face-to-face counseling (LF-F2F) ( n = 76), high-frequency telephone counseling (HFTEL) ( n = 76), high-frequency e-mail counseling (HF-EMAIL) ( n = 74), or no dietitian contact (self-help [ SELF]) ( n = 76). All participants received sibutramine, 10 mg/d; a lifestyle manual; and access to a weight-loss Web site.Measurements: Percentage change in body weight at 6 months was the primary outcome. Secondary end points included changes in waist circumference; lipid, glucose, and insulin levels; blood pressure; weight-related symptoms; and quality of life at 6 months. Results: At 6 months, the mean weight loss, relative to baseline, in the HF-F2F and HF-TEL groups was similar (8.9% [95% CI, 8.0% to 9.8%] and 7.7% [ CI, 6.8% to 8.7%]) and significantly greater than that in the other groups (LF-F2F, 6.4% [ CI, 5.4% to 7.3%]; HF-EMAIL, 5.9% [ CI, 5.0% to 6.8%]; and SELF, 5.2% [ CI, 4.3% to 6.1%]). All groups showed significant improvements in waist circumference, high-density lipoprotein cholesterol and triglyceride levels, and measures of quality of life and weight-related symptoms. There were no serious adverse events and no differences in minor events among groups.Limitation: Most participants were women, and the attrition rate was 30%.Conclusion: High-frequency telephone contact with a dietitian was similar to HF-F2F contact for supporting lifestyle modification in obese patients trying to lose weight. The findings might be used by providers and health systems to promote healthy lifestyle changes for their patients.