The Effect of a Stepped-Care Approach to Long-Term Weight Loss

阶梯式护理方法对长期减肥的效果

• 批准号: 7680030
• 负责人: John M Jakicic
• 金额: $ 71.74万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7680030
• 关键词: Accounting; Address; Adult; Behavior; Behavior Therapy; Behavioral; Body Weight decreased; Body fat; Body mass index; Cardiovascular Diseases; Caring; Chronic Care; Chronic Disease; Classification; Cost Analysis; Databases; Diabetes Mellitus; Disease; Documentation; Electronics; Energy Intake; Epidemic; Facilities and Administrative Costs; Frequencies; Goals; Health Care Costs; Health Personnel; Healthcare; Hypertension; Individual; Intervention; Length; Link; Maintenance; Malignant Neoplasms; Managed Care; Measures; Methods; Modeling; Motivation; Musculoskeletal; Obesity; Outcome; Overweight; Participant; Patients; Physical activity; Prevalence; Process Measure; Randomized; Relative (related person); Reporting; Research; Research Personnel; Schedule; Self Efficacy; Smoking; Staging; Structure; Substance abuse problem; Time; United States; Weight; Weight maintenance regimen; base; behavior change; chronic care model; clinically relevant; cost; cost effectiveness; depression; disorder later incidence prevention; effective intervention; expectation; health care service organization; improved; innovation; obesity treatment; programs; psychosocial; response; secondary outcome; social cognitive theory; success; theories; weight loss intervention

DESCRIPTION (provided by applicant): The primary aim of this study will be to examine whether a chronic-care obesity intervention delivered in a "stepped-care" manner, results in improved weight loss compared to a standard behavioral weight loss intervention (SBWP group). It is hypothesized that there will be a significant increase in weight loss following an 18-month intervention in Stepped-Care versus SBWP. Secondary outcomes include body fat distribution, process measures of energy intake and physical activity, and behavioral/psychosocial measures that may be influence by the proposed interventions. In additional, a cost analysis will be performed to evaluate these interventions. The prevalence of overweight and obesity have been increasing over the past few decades, and it is now estimated that in excess of 65 percent of adults have a BMI >30 kg/m2. It has been suggested that a chronic care intervention in which there is continued contact between the interventionist and the weight loss participate be implemented to improve long-term weight loss outcomes. In addition, it has been suggested that a model to consider for modifying health-related behaviors is a "stepped-care" intervention, which increases the intensity and frequency of contact between the participant and the interventionist. However, the stepped-care approach has not been systematically and extensively applied to behavioral weight control interventions. This study will randomly assign 356 participants to either 1) standard behavioral weight loss program, 2) stepped-care weight loss program. The length of the intervention will be 18 months with assessments occurring at 0, 3, 6, 9,12,15, and 18 months. The stepped-care intervention will be evaluated based on the ability of the participant to achieve a predetermined weight loss goal at each assessment period. If the goal is achieved, the participant will continue with that intervention step for an additional 3 months. If the weight loss goal is not achieved, the participant is progressed to the next step which increases the intensity and frequency of the contact between the interventionist and participant. If successful, a stepped-care intervention model may have application in various health-care settings and may be appealing to health-care providers and managed care organizations by providing a criterion-based intervention to improve long-term weight loss.

描述（由申请人提供）：本研究的主要目的是检验以“阶梯式护理”方式提供的慢性肥胖干预措施与标准行为减肥干预措施（SBWP 组）相比是否能改善体重减轻。据推测，与 SBWP 相比，经过 18 个月的 Stepped-Care 干预后，体重减轻会显着增加。次要结果包括身体脂肪分布、能量摄入和体力活动的过程测量以及可能受拟议干预措施影响的行为/心理社会测量。此外，还将进行成本分析来评估这些干预措施。过去几十年来，超重和肥胖的患病率一直在增加，目前估计超过 65% 的成年人的 BMI >30 kg/m2。有人建议实施长期护理干预，其中干预者和减肥参与者之间保持持续接触，以改善长期减肥结果。此外，有人建议考虑改变健康相关行为的模型是“阶梯护理”干预，它增加参与者和干预者之间接触的强度和频率。然而，阶梯式护理方法尚未系统、广泛地应用于行为体重控制干预措施。本研究将随机分配 356 名参与者参加 1) 标准行为减肥计划，2) 阶梯护理减肥计划。干预时间为 18 个月，评估在第 0、3、6、9、12、15 和 18 个月进行。将根据参与者在每个评估期实现预定减肥目标的能力来评估阶梯式护理干预措施。如果目标实现，参与者将继续该干预步骤 3 个月。如果减肥目标没有实现，参与者将进入下一步，增加干预者和参与者之间接触的强度和频率。如果成功，阶梯式护理干预模式可能会应用于各种医疗保健环境，并且可能会通过提供基于标准的干预措施来改善长期减肥，从而吸引医疗保健提供者和管理式医疗组织。