Weight loss maintenance in primary care

描述（由申请人提供）：肥胖率的上升对国民健康造成了越来越严重的影响。对于那些患有或极有可能患上与肥胖相关的多种疾病之一的超重者来说，实现并保持医学上显著的体重减轻尤为重要。目前的建议是旨在评估三种治疗减肥维持在初级保健实践中，这类患者的常规治疗。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LEARN计划加上使用代餐（MRs）来促进减肥的维持。第三个包括LEARN+MR和降低能量密度饮食计划（REDE）。这三种治疗方法将采用两种不同的模式来实施，一种是基于群体的（由外部专家领导传统的体重控制项目），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项目）。参与者将包括312名超重和肥胖的初级保健患者。最初，所有参与者都将以相同的1200 - 1500千卡/天的饮食（包括两次MRs和一顿健康晚餐）减肥，之后将引入三种维持干预措施中的一种。该研究的第二个目的是调查造成不同体重维持结果的机制。最后的目的是检查几个个体差异测量作为研究结果的潜在调节因素，无论是单独的还是与治疗条件结合的。这项研究很重要，因为它可能为初级保健机构中超重患者的饮食和体重的长期改善找到更好的方法。参与者将接受为期一年的治疗，并在治疗结束后1年和2年进行随访评估。结果将根据体重和组成的变化、饮食的营养组成、饮食控制措施、暴饮暴食和生活质量、身体活动、患者和医生满意度评分、成本效益和几个医疗风险因素（血压、血脂、空腹血糖和HbAlc）来评估。

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).