WEIGHTCONNECTION-- WEIGHT LOSS MAINTANANCE USING THE WEB

尽管人们普遍认识到肥胖的发病率和医学后遗症日益增加，但扭转这些趋势的努力收效甚微。虽然参加减肥计划的肥胖者中有75%最初是成功的，但其中90%以上的人在5年内体重会反弹，导致心肺和血管疾病的风险复发甚至加剧。这项建议的重点是预防肥胖个体在成功减肥后体重反弹。减肥维持的最佳预测指标是患者与医生接触的持续时间和强度，而不考虑医生的专业或干预的性质。然而，长期强化干预的高成本限制了对少数患者的最佳管理。这项研究提出的假设是，通过创造性地使用电子通信，可以以一种具有成本效益的方式实现患者与提供者之间的密切互动的一些好处。我们建议开发一个由三部分组成的基于网络的项目（“WeightConnection”），其中包括以下机制：(1)持续的、患者自我监测和关于体重、饮食和运动行为的图形反馈；(2)来自体重咨询师的个人电子咨询建议；(3)在线团体治疗和点对点交流。我们的干预目标是实现强化患者与提供者互动的几个好处，这些好处似乎是成功减肥维持的基础，包括持续的患者动机，减少损耗率和及时的复发管理。拟议方案的每个组成部分都旨在通过提供个人指导、教育机会和心理支持来促进这些目标。我们将首先从MGH体重中心的患者中招募一小群患者志愿者来测试和完善体重连接项目。此后，我们将研究这种干预是否能提高以标准小组为基础的减肥方案的成功率。我们将在30-40例患者中进行一项随机对照研究，比较WeightConnection项目联合标准治疗与单独标准治疗。这项初步研究的结果，包括对体重维持和患者保持的影响，初步亚组分析以及对患者使用和反馈的仔细评估，将用于设计一项更明确的研究，研究电子通信预防复发性体重增加的功效和成本效益。

Despite widespread recognition of the increasing prevalence and medical sequelae of obesity, efforts to reverse these trends have met with limited success. Although 75 percent of obese individuals who enter a weight loss program are initially successful, more than 90 percent of these individuals regain the lost weight within 5 years, leading to renewal or even exacerbation of cardiopulmonary and vascular disease risks. The focus of this proposal is the prevention of weight regain in obese individuals after successful weight loss. The best predictor of weight loss maintenance is the duration and intensity of patient-provider contact, irrespective of practitioner specialty or the nature of the intervention. However, the high costs of intensive interventions over an extended period limit optimal management to a small number of patients. The hypothesis underlying the proposed study is that some of the benefits of intensive patient-provider interaction can be achieved in a cost-efficient manner through creative use of electronic communication. We propose to develop a three-part, web-based program ("WeightConnection") that includes mechanisms for (1) ongoing, patient self-monitoring and graphical feedback about weight, eating and exercise behavior, (2) individual, electronic consultative advice from a weight counselor and (3) on-line group-based therapy and peer-to-peer communication. Our goals for this intervention are to achieve several benefits of intensive patient-provider interaction that appear to underlie successful weight loss maintenance, including sustained patient motivation, diminished attrition rates, and timely relapse management. Each component of the proposed program is designed to promote these goals by providing personal guidance, educational opportunities and psychological support. We will initially test and refine the WeightConnection program with a small group of patient volunteers recruited from MGH Weight Center patients. Thereafter, we will examine whether this intervention improves the success of a standard group-based program in maintaining weight loss. We will conduct a randomized, controlled study in 30-40 patients, comparing the combination of the WeightConnection program and standard therapy vs. standard therapy alone. The results of this pilot study, including effects on weight maintenance and patient retention, preliminary subgroup analysis and careful assessment of patient usage and feedback, will be used to design a more definitive study of the efficacy and cost-effectiveness of electronic communication for prevention of recurrent weight gain.