Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice

被引：554

作者：

Appel, Lawrence J. ^{[1
,2
,6
]}

Clark, Jeanne M. ^{[1
,2
,6
]}

Yeh, Hsin-Chieh ^{[1
,2
,6
]}

Wang, Nae-Yuh ^{[1
,2
,7
]}

Coughlin, Janelle W. ^{[4
]}

Daumit, Gail ^{[1
,2
]}

Miller, Edgar R., III ^{[1
,2
]}

Dalcin, Arlene ^{[2
]}

Jerome, Gerald J. ^{[2
,9
]}

Geller, Steven ^{[10
]}

Noronha, Gary ^{[2
,8
]}

Pozefsky, Thomas ^{[2
,3
,11
]}

Charleston, Jeanne ^{[6
]}

Reynolds, Jeffrey B. ^{[2
]}

Durkin, Nowella ^{[2
]}

Rubin, Richard R. ^{[5
]}

Louis, Thomas A. ^{[7
]}

Brancati, Frederick L. ^{[1
,2
,6
]}

机构：

[1] Johns Hopkins Univ, Welch Ctr Prevent Epidemiol & Clin Res, Baltimore, MD 21218 USA

[2] Johns Hopkins Univ, Sch Med, Div Gen Internal Med, Baltimore, MD USA

[3] Johns Hopkins Univ, Sch Med, Div Endocrinol, Baltimore, MD USA

[4] Johns Hopkins Univ, Sch Med, Dept Psychiat & Behav Sci, Baltimore, MD 21205 USA

[5] Johns Hopkins Univ, Sch Med, Dept Pediat, Baltimore, MD 21205 USA

[6] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD USA

[7] Johns Hopkins Bloomberg Sch Publ Hlth, Dept Biostat, Baltimore, MD USA

[8] Johns Hopkins Community Phys, Baltimore, MD USA

[9] Towson Univ, Dept Kinesiol, Towson, MD USA

[10] Centennial Med Grp, Elkridge, MD USA

[11] Pk Med Associates, Lutherville Timonium, MD USA

来源：

NEW ENGLAND JOURNAL OF MEDICINE | 2011年 / 365卷 / 21期

关键词：

LIFE-STYLE MODIFICATION; BLOOD-PRESSURE; PRIMARY-CARE; RANDOMIZED-TRIAL; OBESITY; REDUCTION; OVERWEIGHT; PROGRAM;

D O I：

10.1056/NEJMoa1108660

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND Obesity and its cardiovascular complications are extremely common medical problems, but evidence on how to accomplish weight loss in clinical practice is sparse. METHODS We conducted a randomized, controlled trial to examine the effects of two behavioral weight-loss interventions in 415 obese patients with at least one cardiovascular risk factor. Participants were recruited from six primary care practices; 63.6% were women, 41.0% were black, and the mean age was 54.0 years. One intervention provided patients with weight-loss support remotely - through the telephone, a study-specific Web site, and e-mail. The other intervention provided in-person support during group and individual sessions, along with the three remote means of support. There was also a control group in which weight loss was self-directed. Outcomes were compared between each intervention group and the control group and between the two intervention groups. For both interventions, primary care providers reinforced participation at routinely scheduled visits. The trial duration was 24 months. RESULTS At baseline, the mean body-mass index (the weight in kilograms divided by the square of the height in meters) for all participants was 36.6, and the mean weight was 103.8 kg. At 24 months, the mean change in weight from baseline was -0.8 kg in the control group, -4.6 kg in the group receiving remote support only (P<0.001 for the comparison with the control group), and -5.1 kg in the group receiving in-person support (P<0.001 for the comparison with the control group). The percentage of participants who lost 5% or more of their initial weight was 18.8% in the control group, 38.2% in the group receiving remote support only, and 41.4% in the group receiving in-person support. The change in weight from baseline did not differ significantly between the two intervention groups. CONCLUSIONS In two behavioral interventions, one delivered with in-person support and the other delivered remotely, without face-to-face contact between participants and weight-loss coaches, obese patients achieved and sustained clinically significant weight loss over a period of 24 months. (Funded by the National Heart, Lung, and Blood Institute and others; ClinicalTrials.gov number, NCT00783315.)

引用

页码：1959 / 1968

页数：10

共 27 条

[1]

[Anonymous], 2003, HLTH AFF MILLWOOD S

[2]

[Anonymous], HLTH PROMOT PRACT

[3]

Appel LJ, 2003, JAMA-J AM MED ASSOC, V289, P2083, DOI 10.1001/jama.289.16.2083

[4] Weight control in the physician's office [J].

Ashley, JM ;

St Jeor, ST ;

Schrage, JP ;

Perumean-Chaney, SE ;

Gilbertson, MC ;

McCall, NL ;

Bovee, V .

ARCHIVES OF INTERNAL MEDICINE, 2001, 161 (13) :1599-1604

[5] Screening for obesity in adults: Recommendations and rationale [J].

Berg, AO ;

Allan, JD ;

Frame, P ;

Homer, CJ ;

Johnson, MS ;

Klein, JD ;

Lieu, TA ;

Mulrow, CD ;

Orleans, CT ;

Peipert, JF ;

Pender, NJ ;

Siu, AL ;

Teutsch, SM ;

Westhoff, C ;

Woolf, SH .

ANNALS OF INTERNAL MEDICINE, 2003, 139 (11) :930-932

[6] Design considerations and rationale of a multi-center trial to sustain weight loss: the weight loss maintenance trial [J].

Brantley, Phillip ;

Appel, Lawrence ;

Hollis, Lack ;

Stevens, Victor ;

Ard, Jamy ;

Champagne, Catherine ;

Elmer, Patricia ;

Harsha, David ;

Myers, Valerie ;

Proschan, Michael ;

William, Vollmer ;

Svetkey, Laura .

CLINICAL TRIALS, 2008, 5 (05) :546-556

[7] Comparison of Methods for Delivering a Lifestyle Modification Program for Obese Patients A Randomized Trial [J].

Digenio, Andres G. ;

Mancuso, James P. ;

Gerber, Robert A. ;

Dvorak, Roman V. .

ANNALS OF INTERNAL MEDICINE, 2009, 150 (04) :255-U54

[8]

DPP Res Grp, 2002, DIABETES CARE, V25, P2165

[9] Effects of comprehensive lifestyle modification on diet, weight, physical fitness, and blood pressure control: 18-Month results of a randomized trial [J].

Elmer, PJ ;

Obarzanek, E ;

Vollmer, WM ;

Simons-Morton, D ;

Stevens, VJ ;

Young, DR ;

Lin, PH ;

Champagne, C ;

Harsha, DW ;

Svetkey, LP ;

Ard, J ;

Brantley, PJ ;

Proschan, MA ;

Erlinger, TP ;

Appel, LJ .

ANNALS OF INTERNAL MEDICINE, 2006, 144 (07) :485-495

[10] Kansas primary care weighs in: A pilot randomized trial of a chronic care model program for obesity in 3 rural Kansas primary care practices [J].

Ely, Andrea C. ;

Banitt, Angela ;

Befort, Christie ;

Hou, Qing ;

Rhode, Paula C. ;

Grund, Chrysanne ;

Greiner, Allen ;

Jeffries, Shawn ;

Ellerbeck, Edward .

JOURNAL OF RURAL HEALTH, 2008, 24 (02) :125-132

← 1 2 3 →