英国拉夫堡大学Claire D Madigan团队研究了初级保健中成人体重管理干预的有效性。这一研究成果发表在2022年5月30日出版的《英国医学杂志》上。

为了评估初级保健中肥胖成年人行为体重管理干预的有效性，研究组在Cochrane中央对照试验注册中心、Medline、PubMed和PsychINFO中提取2018年1月1日至2021年8月19日系统评估的试验，筛选出体重指数≥25的成年人在初级保健中进行行为体重管理干预、且在≥12个月进行随访的随机对照试验，并进行系统评价和荟萃分析。

由两位评审员独立确定合格研究，提取数据，并使用Cochrane偏倚风险工具评估偏倚风险。采用随机效应模型进行荟萃分析，并计算体重（kg）和腰围（cm）的汇总平均差。主要观察指标是从基线检查到12个月的体重变化。次要结局是体重从基线到≥24个月的变化。在12个月时评估腰围的变化。

结果共包括34项试验，其中14项是先前回顾的附加试验。随访12个月时，体重变化的主要结局包括27项试验（8000例），干预组比对照组平均多减重2.3千克，差异显著。在≥24个月（13项试验，5011例）时，干预组比对照组平均多减重1.8千克，差异亦显著。12月时，干预组的腰围比对照组平均少2.5cm。

研究结果表明，初级保健中针对肥胖成年人的行为体重管理干预措施对减肥有效，可向公众推广。

附：英文原文

Title: Effectiveness of weight management interventions for adults delivered in primary care: systematic review and meta-analysis of randomised controlled trials

Author: Claire D Madigan, Henrietta E Graham, Elizabeth Sturgiss, Victoria E Kettle, Kajal Gokal, Greg Biddle, Gemma M J Taylor, Amanda J Daley

Issue&Volume: 2022/05/30

Abstract:

Objective To examine the effectiveness of behavioural weight management interventions for adults with obesity delivered in primary care.

Design Systematic review and meta-analysis of randomised controlled trials.

Eligibility criteria for selection of studies Randomised controlled trials of behavioural weight management interventions for adults with a body mass index ≥25 delivered in primary care compared with no treatment, attention control, or minimal intervention and weight change at ≥12 months follow-up.

Data sources Trials from a previous systematic review were extracted and the search completed using the Cochrane Central Register of Controlled Trials, Medline, PubMed, and PsychINFO from 1 January 2018 to 19 August 2021.

Data extraction and synthesis Two reviewers independently identified eligible studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tool. Meta-analyses were conducted with random effects models, and a pooled mean difference for both weight (kg) and waist circumference (cm) were calculated.

Main outcome measures Primary outcome was weight change from baseline to 12 months. Secondary outcome was weight change from baseline to ≥24 months. Change in waist circumference was assessed at 12 months.

Results 34 trials were included: 14 were additional, from a previous review. 27 trials (n=8000) were included in the primary outcome of weight change at 12 month follow-up. The mean difference between the intervention and comparator groups at 12 months was 2.3 kg (95% confidence interval 3.0 to 1.6 kg, I2=88%, P<0.001), favouring the intervention group. At ≥24 months (13 trials, n=5011) the mean difference in weight change was 1.8 kg (2.8 to 0.8 kg, I2=88%, P<0.001) favouring the intervention. The mean difference in waist circumference (18 trials, n=5288) was 2.5 cm (3.2 to 1.8 cm, I2=69%, P<0.001) in favour of the intervention at 12 months.

Conclusions Behavioural weight management interventions for adults with obesity delivered in primary care are effective for weight loss and could be offered to members of the public.

DOI: 10.1136/bmj-2021-069719

Source: https://www.bmj.com/content/377/bmj-2021-069719