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检查与标准行为减肥干预（SBWP组）相比，以“阶梯式护理”方式提供的慢性肥胖症干预是否能改善体重减轻。据推测，与SBWP相比，阶梯式护理干预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，以评估这些干预措施。在过去的几十年里，超重和肥胖的流行率一直在增加，现在估计超过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持续接触，以改善长期减肥结果。此外，有人建议，考虑修改与健康有关的行为的模式是“阶梯式护理”干预，这增加了参与者和干预者之间接触的强度和频率。然而，分级护理方法尚未系统和广泛地应用于行为体重控制干预。本研究将356名参与者随机分配到1）标准行为减肥计划，2）分步护理减肥计划。干预持续时间为18个月，在0、3、6、9、12、15和18个月时进行评估。将根据受试者在每个评估期实现预定体重减轻目标的能力评价分级护理干预。如果达到目标，受试者将继续该干预步骤额外3个月。如果没有达到减肥目标，则参与者前进到下一步骤，这增加了干预者和参与者之间的接触的强度和频率。如果成功的话，分步护理干预模式可能会在各种医疗保健环境中得到应用，并可能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护理组织。

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.