Comparative effectiveness of weight-loss interventions in clinical practice.
Comparative effectiveness of weight-loss interventions in clinical practice.
复制标题
DOI：
10.1056/nejmoa1108660
复制
发表时间：
2011-11-24
期刊：
影响因子：
--
通讯作者：
Brancati FL
中科院分区：
文献类型：
--
作者：
Appel LJ;Clark JM;Yeh HC;Wang NY;Coughlin JW;Daumit G;Miller ER 3rd;Dalcin A;Jerome GJ;Geller S;Noronha G;Pozefsky T;Charleston J;Reynolds JB;Durkin N;Rubin RR;Louis TA;Brancati FL
肥胖及其心血管并发症是非常常见的医学问题，但在临床实践中如何实现减肥的证据很少。我们进行了一项随机对照试验，在415名至少有一个心血管危险因素的肥胖患者中检查两种行为减肥干预措施的效果。参与者从六个初级保健实践招募; 63.6%是女性，41.0%是黑人，平均年龄为54.0岁。一项干预措施通过电话、特定研究网站和电子邮件为患者提供远程减肥支持。另一种干预措施是在小组和个人会议期间提供面对面的支持，沿着提供三种远程支持手段。还有一个对照组，其中减肥是自我指导的。结果进行了比较，每个干预组和对照组之间，两个干预组之间。对于这两种干预措施，初级保健提供者加强参与定期安排的访问。试验持续时间为24个月。基线时，所有参与者的平均体重指数（体重（千克）除以身高（米）的平方）为36.6，平均体重为103.8千克。24个月时，对照组体重较基线的平均变化为-0.8 kg，仅接受远程支持的组为-4.6 kg（与对照组相比P<0.001），接受现场支持的组为-5.1 kg（与对照组相比P<0.001）。对照组中体重下降5%或以上的参与者比例为18.8%，仅接受远程支持的参与者比例为38.2%，接受面对面支持的参与者比例为41.4%。两个干预组之间体重较基线的变化无显著差异。在两种行为干预中，一种是面对面的支持，另一种是远程提供的，参与者和减肥教练之间没有面对面的接触，肥胖患者在24个月的时间内实现并持续了临床显著的体重减轻。（由国家心肺血液研究所和其他机构资助; ClinicalTrials.gov编号，NCT 00783315。
Obesity and its cardiovascular complications are extremely common medical problems, but evidence on how to accomplish weight loss in clinical practice is sparse. We conducted a randomized, controlled trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients with at least one cardiovascular risk factor. Participants were recruited from six primary care practices; 63.6% were women, 41.0% were black, and the mean age was 54.0 years. One intervention provided patients with weight-loss support remotely — through the telephone, a study-specific Web site, and e-mail. The other intervention provided in-person support during group and individual sessions, along with the three remote means of support. There was also a control group in which weight loss was self-directed. Outcomes were compared between each intervention group and the control group and between the two intervention groups. For both interventions, primary care providers reinforced participation at routinely scheduled visits. The trial duration was 24 months. At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) for all participants was 36.6, and the mean weight was 103.8 kg. At 24 months, the mean change in weight from baseline was −0.8 kg in the control group, −4.6 kg in the group receiving remote support only (P<0.001 for the comparison with the control group), and −5.1 kg in the group receiving in-person support (P<0.001 for the comparison with the control group). The percentage of participants who lost 5% or more of their initial weight was 18.8% in the control group, 38.2% in the group receiving remote support only, and 41.4% in the group receiving in-person support. The change in weight from baseline did not differ significantly between the two intervention groups. In two behavioral interventions, one delivered with in-person support and the other delivered remotely, without face-to-face contact between participants and weight-loss coaches, obese patients achieved and sustained clinically significant weight loss over a period of 24 months. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT00783315.)