Weight loss maintenance in primary care

描述（由申请人提供）：肥胖症的流行率不断上升，对国家的健康造成越来越严重的影响。实现和保持医学上显著的体重减轻对于那些超重个体来说是特别重要的，这些超重个体具有或处于发展与肥胖相关的许多医学病症之一的最大风险。本提案旨在评估初级保健实践中维持减肥的三种治疗方法，这些患者常规接受治疗。一种治疗包括传统的生活方式改变计划（基于LEARN手册）。第二个包括学习计划加上使用代餐（MR），以促进减肥的维持。第三个由LEARN+MR和降低能量密度饮食计划（雷德）组成。这三种治疗将使用两种不同的模式来提供计划，一种是基于小组的（外部专家领导传统的体重控制计划），另一种是基于实践的（医生和基于实践的护理经理合作向个体患者提供计划）。参与者将包括312名超重和肥胖的初级保健患者。所有参与者最初将在相同的1200 - 1500千卡/天饮食（包括两个MR和一顿健康晚餐）下减肥，之后将引入三种维持干预措施之一。该研究的第二个目的是调查负责差异体重维持结果的机制。最后一个目的是检查几个个体差异的措施，作为潜在的主持人的研究结果，无论是单独或与治疗条件相结合。这项研究很重要，因为它可以确定更好的方法来促进在初级保健环境中看到的超重患者的饮食和体重的长期改善。参与者将在一年内接受治疗，并在治疗结束后一年和两年进行随访评估。将根据体重和组成、饮食的营养组成、饮食控制的测量、暴饮暴食和生活质量、身体活动、患者和医生满意度评级、成本效益和若干医学风险因素（血压、脂质、空腹血糖和HbAlc）的变化来评估结果。

DESCRIPTION (provided by applicant): The rising prevalence of obesity is taking an increasingly severe toll on the nation's health. Achieving and maintaining a medically significant weight loss is of particular importance for those overweight individuals who have, or who are at greatest risk for developing, one of the many medical conditions associated with obesity. The present proposal is aimed at evaluating three treatments for weight loss maintenance in primary care practices where such patients are routinely treated. One treatment consists of a conventional lifestyle change program (based on the LEARN manual). The second consists of the LEARN program plus the use of meal replacements (MRs) to facilitate weight loss maintenance. The third consists of LEARN+MR and a Reduced Energy Density Eating program (REDE). The three treatments will be administered using two different modes of delivering the programs, one group-based (where an outside expert leads a traditional weight control program) and the other practice-based (where physicians and a practice-based care manager collaborate to deliver the program to individual patients). Participants will consist of 312 overweight and obese primary care patients. All participants will initially lose weight on identical 1,200-1,500 kcal/day diets (consisting of two MRs and a healthy dinner), after which one of the three maintenance interventions will be introduced. A second aim of the study is to investigate the mechanisms responsible for differential weight maintenance outcomes. A final aim is to examine several individual difference measures as potential moderators of study outcomes, both alone and in combination with treatment condition. This study is important because it may identify better ways of promoting long-term improvements in diet and body weight in overweight patients seen in primary care settings. Participants will receive treatment during a one-year period and follow-up assessments will be conducted one and two years after treatment ends. Outcome will be assessed in terms of changes in body weight and composition, nutritional composition of the diet, measures of eating control, overeating, and quality of life, physical activity, patient and physician satisfaction ratings, cost-effectiveness, and several medical risk factors (blood pressure, lipids, fasting glucose, and HbAlc).