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

描述（由申请人提供）：本研究的主要目的是研究与标准行为减肥干预（SBWP组）相比，以“分步治疗”方式提供的慢性肥胖治疗干预是否能改善体重减轻。据推测，与SBWP相比，在阶梯护理干预18个月后，体重减轻将显著增加。次要结果包括体脂分布、能量摄入和身体活动的过程测量，以及可能受到拟议干预措施影响的行为/社会心理测量。此外，还将进行成本分析以评估这些干预措施。在过去的几十年里，超重和肥胖的患病率一直在上升，据估计，现在超过65%的成年人的体重指数为30公斤/平方米。有研究建议，在长期护理干预中，干预者和减肥参与者之间要有持续的接触，以改善长期的减肥结果。此外，有研究表明，一种可以考虑改变健康相关行为的模式是“阶梯式护理”干预，该干预增加了参与者与干预者之间的接触强度和频率。然而，分步治疗方法尚未被系统和广泛地应用于行为体重控制干预。这项研究将随机分配356名参与者参加1)标准行为减肥计划，2)循序渐进减肥计划。干预时间为18个月，评估时间分别为0、3、6、9、12、15和18个月。阶梯式护理干预将根据参与者在每个评估期达到预定减肥目标的能力进行评估。如果目标达到，参与者将继续进行额外3个月的干预步骤。如果减肥目标没有实现，参与者将进入下一步，这将增加干预者和参与者之间接触的强度和频率。如果取得成功，阶梯式护理干预模式可应用于各种卫生保健环境，并可通过提供基于标准的干预措施来改善长期减肥，从而吸引卫生保健提供者和管理式卫生保健组织。

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.