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强化生活方式有助于服务不足人群减重

时间:2020-09-05 13:09来源:葡京捕鱼赌场 作者:葡京娱乐 点击:
本期文章:《新英格兰医学杂志》:Vol.383 No.10 美国彭宁顿生物医学研究中心Peter T. Katzmarzyk团队研究了服务不足地区患者减重的疗效。2020年9月3日,该研究发表在《新英格兰医学杂志

本期文章:《新英格兰医学杂志》:Vol.383 No.10

美国彭宁顿生物医学研究中心Peter T. Katzmarzyk团队研究了服务不足地区患者减重的疗效。2020年9月3日,该研究发表在《新英格兰医学杂志》上。

在服务不足的人群中,初级保健机构治疗肥胖症的效果尚不明确。

研究组进行了一项集群随机试验,以评估初级保健诊所高强度、基于生活方式的肥胖治疗方案的有效性,其中大部分患者来自低收入人群。研究组随机分配了18家诊所,9家诊所为患者提供强化的生活方式干预,以减少热量摄入和增加体育锻炼为重点;9家诊所为患者提供常规护理。

强化生活方式组的患者参与了由诊所内的健康教练实施的高强度计划,前6个月每周一次,后18个月每月一次。常规护理组患者接受初级保健团队提供的标准护理。主要结局是24个月时体重与基线的变化百分比。

每个诊所平均有40.5名患者入组。研究组共招募了803名肥胖成年人,其中强化生活方式组452名,常规护理组351名。67.1%为黑人,65.5%其家庭年收入低于4万美元。83.4%的患者完成了24个月的试验。24个月后,强化生活方式组参与者与基线相比,体重减轻了4.99%,减重幅度显著高于常规护理组(减轻了0.48%)。两组间不良事件发生率没有显著差异。

研究结果表明,在服务不足的初级保健人群中实施针对肥胖症的高强度、基于生活方式的治疗计划,24个月后体重在临床上明显减轻。

附:英文原文

Title: Weight Loss in Underserved Patients — A Cluster-Randomized Trial

Author: Peter T. Katzmarzyk, Ph.D.,, Corby K. Martin, Ph.D.,, Robert L. Newton, Jr., Ph.D.,, John W. Apolzan, Ph.D.,, Connie L. Arnold, Ph.D.,, Terry C. Davis, Ph.D.,, Eboni G. Price-Haywood, M.D.,, Kara D. Denstel, M.P.H.,, Emily F. Mire, M.S.,, Tina K. Thethi, M.D.,, Phillip J. Brantley, Ph.D.,, William D. Johnson, Ph.D.,, Vivian Fonseca, M.D.,, Jonathan Gugel, M.D.,, Kathleen B. Kennedy, Ph.D.,, Carl J. Lavie, M.D.,, Daniel F. Sarpong, Ph.D.,, and Benjamin Springgate, M.D.

Issue&Volume: 2020-09-02

Abstract: Background

Evidence of the effectiveness of treatment for obesity delivered in primary care settings in underserved populations is lacking.

Methods

We conducted a cluster-randomized trial to test the effectiveness of a high-intensity, lifestyle-based program for obesity treatment delivered in primary care clinics in which a high percentage of the patients were from low-income populations. We randomly assigned 18 clinics to provide patients with either an intensive lifestyle intervention, which focused on reduced caloric intake and increased physical activity, or usual care. Patients in the intensive-lifestyle group participated in a high-intensity program delivered by health coaches embedded in the clinics. The program consisted of weekly sessions for the first 6 months, followed by monthly sessions for the remaining 18 months. Patients in the usual-care group received standard care from their primary care team. The primary outcome was the percent change from baseline in body weight at 24 months.

Results

All 18 clinics (9 assigned to the intensive program and 9 assigned to usual care) completed 24 months of participation; a median of 40.5 patients were enrolled at each clinic. A total of 803 adults with obesity were enrolled: 452 were assigned to the intensive-lifestyle group, and 351 were assigned to the usual-care group; 67.2% of the patients were Black, and 65.5% had an annual household income of less than $40,000. Of the enrolled patients, 83.4% completed the 24-month trial. The percent weight loss at 24 months was significantly greater in the intensive-lifestyle group (change in body weight, 4.99%; 95% confidence interval [CI], 6.02 to 3.96) than in the usual-care group (0.48%; 95% CI, 1.57 to 0.61), with a mean between-group difference of 4.51 percentage points (95% CI, 5.93 to 3.10) (P<0.001). There were no significant between-group differences in serious adverse events.

Conclusions

A high-intensity, lifestyle-based treatment program for obesity delivered in an underserved primary care population resulted in clinically significant weight loss at 24 months.

DOI: NJ202009033831008

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2007448

期刊信息

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
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