Home vs Center-Based Weight Loss & Exercise in Menopause

描述（由申请人提供）：多方面的肥胖治疗显示了最佳的减肥（WL）效果，但最有效的治疗地点和方法以及随访仍未确定。更复杂的是，女性的衰老与越来越久坐的生活方式有关，这种生活方式减少了每天的总能量消耗，容易导致肥胖。此外，有助于体重和体脂分布遗传力的候选基因也可能影响对WL处理的反应。在一个肥胖持续流行的国家，对治疗的需求远远超过了卫生保健系统为个人提供护理的能力。本研究的目的是：1)评估以家庭为基础和以中心为基础的多层面WL项目对WL、心血管疾病危险因素和心理社会因素的影响；2)确定以HOME或center为基础的多方面方法是否更有效地导致持续的治疗入组；3)回顾性地确定在选定的肥胖-能量消耗或胰岛素敏感性候选基因中有一个或多个变异的女性在治疗后和/或随访时是否与没有遗传易感性的女性有不同的结果。绝经后至少一年但年龄小于65岁的超重或肥胖（BMI 25-40 kg/m2）妇女（n=100）将随机接受中心或基于家庭的WL干预，包括低强度运动（步行）。所有女性将接受为期2周的中心或家庭项目现场培训，并在6个月的中心或家庭项目开始前收集基线数据。评估将在干预后保持稳定的饮食和运动状态，并在中心或家庭维持6个月后再次评估。将使用多变量分析来减少多次比较的误差膨胀，或者在不可能进行多变量分析时使用Bonferonni修正。以促进健康为重点，护理是开展和转化以研究为基础的生活方式改变的WL干预措施的理想学科。绝经后妇女将接受和维持的WL干预措施对于在她们生命中最脆弱的时期促进健康和预防疾病至关重要。

DESCRIPTION (provided by applicant): Multi-faceted obesity treatment demonstrates the best weight loss (WL) outcomes, yet the most effective site and methods for treatment delivery and follow-up remain elusive. Compounding the persistent treatment enigmas, aging in women is associated with an increasingly sedentary lifestyle that reduces total daily energy expenditure, predisposing to obesity. Moreover, candidate genes that contribute to the heritability of body weight and body fat distribution also may influence the response to WL treatment. In a nation with an unrelenting epidemic of obesity, the need for treatment far exceeds the capacity of the health care system to provide care on an individual basis. The purpose of this study is to: 1) assess the effects of a multi-faceted HOME-versus CENTER-based WL program on WL, CVD risk factors, and psychosocial factors; 2) determine whether a multi-faceted HOME- or CENTER-based approach more effectively leads to sustained treatment enrollment; and 3) retrospectively determine whether women with one or more variants in selected obesity-energy expenditure or insulin-sensitivity candidate genes have different outcomes post-treatment and/or at follow-up than women without a genetic predisposition. Overweight or obese (BMI 25-40 kg/m2) women (n=100) at least one year postmenopausal but < 65 years of age will be randomized to receive CENTER- or HOME-based interventions for WL that include low intensity exercise (walking). All women will receive 2 weeks of orientation to CENTER or HOME programs onsite and have baseline data collected before 6-month CENTER or HOME-based programs begin. Evaluation will be in a stable diet and exercise status post intervention, and again after 6 months maintenance at CENTER or HOME. Multivariate analyses will be used to reduce error inflation from multiple comparisons, or Bonferonni corrections will be used when multivariate analyses are not possible. With its health promotion emphasis, nursing is an ideal discipline to conduct and translate research-based, lifestyle-modification WL interventions into practice. WL interventions that postmenopausal women will accept and sustain are essential for promoting health and prevention disease during the period of major vulnerability in their lives.