Overweight or obese women who were assigned to a structured weight-loss program with free prepared meals lost a significantly greater amount of weight at 2 years than did those who received usual care.

In addition, a greater proportion of women enrolled in the program maintained a 5% weight loss at 2 years than did those who received usual care.

“For clinical practitioners, the evidence suggests that the structured program as applied in this study provides another route for their overweight or obese patients to achieve and maintain weight loss through behavioral changes for at least a 2-year period,” researchers led by Cheryl L. Rock, Ph.D., of the University of California, San Diego School of Medicine, wrote in a study published online Oct. 9 in JAMA.

For the study, 442 overweight or obese women at one of four study sites were randomly assigned to one of three groups: an in-person center-based intervention group, a telephone-based intervention group, or a usual care group.

Women in the intervention groups received free one-on-one weight-loss counseling for 2 years, and were educated on recommendations for a nutritionally sound, reduced-calorie diet with 20-30% of calories from fat, and 30 minutes of physical exercise at least 5 days per week (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1503]). They also received free access to prepackaged prepared foods from Jenny Craig Inc. to help them achieve their nutritional goals.

“Over time, participants were transitioned to a meal plan based mainly not on food provided from the commercial program, although participants could choose to include one prepackaged meal per day during weight-loss maintenance,” Dr. Rock and her associates noted.

Women assigned to the usual care group received a 1-hour consultation with a dietetics professional at baseline and at 6 months. During these sessions, they received publicly available materials on dietary and physical activity recommendations to achieve and maintain weight loss, as well as sample meal plans and advice on reading food labels and estimating serving sizes. Women in this group were followed up monthly via e-mail or telephone contact.

All study participants received U.S.$25 for each completed clinic visit, but no payment was provided for participating in the intervention or counseling sessions.

The mean age of study participants was 44 years, and 73% were non-Hispanic white. At 2 years, 407 participants remained in the trial, for a retention rate of 92%. The mean weight loss was 7.4 kg in the center-based group, 6.2 kg in the telephone-based group, and 2.0 kg in the usual care group. In addition, 62% in the center-based group and 56% in the telephone-based group had maintained a weight loss of at least 5% by the end of the study period, compared with just 29% in the usual care group.

A reduction in C-reactive protein levels and improvement in leptin levels were greater in both intervention groups compared with the usual care group, but there were no significant intervention effects on other measures, including cardiopulmonary fitness, cholesterol levels, physical or mental quality of life, or depression.

Dr. Rock and her associates acknowledged certain limitations of the study, including the fact that the prepackaged foods were provided free of charge. If women in the intervention groups were paying out-of-pocket, participant food costs would have averaged U.S.$85 per week for a total of U.S.$4,080 for the year, they wrote. “For the second year of the program, when participants transitioned to their own foods, food costs would have averaged $45 per week for a total of $2,160 for the year.”

They also noted that weight-loss program counselors were unblinded, “which may have influenced their behavior and effectiveness, although they were instructed to provide the program and services as designed to be delivered to paying customers.”

In an accompanying editorial, Rena R. Wing, Ph.D.,wrote, “The findings of this trial raise the possibility that if structured commercial weight-loss programs could be provided free-of-charge to participants, both retention and average weight-loss outcomes might be far better than when participants must pay for these programs. Currently, insurance companies will cover the cost of bariatric surgery for obesity (estimated at $19,000-$29,000 per patient from insurance data), but they do not cover the cost of commercial weight-loss programs (such as that evaluated in this study, with estimated costs of approximately $1,600 for 12 weeks of the program and for food).”

Dr. Wing, director of the Weight Control and Diabetes Research Center at Miriam Hospital, Providence, Rhode Island, continued: “Providing commercial weight-loss programs free-of-charge to participants might be a worthwhile health care investment. Future studies should directly compare the outcomes achieved in a variety of different commercial weight-loss programs and examine whether providing these programs free-of-charge to participants would be a cost-effective approach” (JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1529).

She disclosed that preparation of the editorial was supported by a grant from the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

The study was supported by Jenny Craig Inc., which had a minimal role in the design of the study. Dr. Rock disclosed that she served on the advisory board of Jenny Craig from 2003 to 2004. None of her coauthors reported having any relevant financial conflicts.

Copyright (c) 2010 Elsevier Global Medical News. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

在2年内均采用结构化减重方案的超重或肥胖女性所取得的减肥效果明显优于接受常规护理的同伴，且在第2年时，她们中得以将体重降低程度维持在5%的受试者比例也显著高于常规护理组。

 

受试者平均年龄为44岁，73%为非西班牙裔白人。本研究依照干预方式的不同将442例超重或肥胖女性随机分配接受以下3种干预方式：患者本人至医学中心亲身接受减肥指导，依靠电话接受指导以及常规护理。干预组女性在2年内接受一对一式的减肥咨询，其间研究者通过宣教向其推荐了一种营养丰富且可减少20%~30%脂肪能量摄入的饮食，以及每周至少5天、每次30 min的体育锻炼(JAMA 2010 Oct. 9 [Epub doi:10.1001/jama.2010.1503])。受试者免费获得包装好的成品食物以帮助她们达成营养目标。随时间推移，受试者逐渐开始向自制食品过渡，但在维持体重期间仍被允许每日食用1餐成品食物。接受常规护理的女性在基线和第6个月时对专职营养师进行咨询。在此期间，受试者需要利用可公开获得的食材准备饮食，按照推荐要求进行体育锻炼，参照配餐范例计划饮食方案，并依照营养师的指导辨别食品标签并估计食物分量。研究者每月通过电子邮件或电话联系对该组受试者进行随访。每次就诊结束后，所有受试者均可以获得25美元补贴，但参与干预计划本身及进行咨询不会获得额外补贴。

 

2年后有407例受试者仍在继续参与试验，保留率达92%。现场参与组、电话指导组和常规护理组受试者体重平均降低7.4、6.2和2.0 kg，此外，在研究结束时在这3组中体重减轻程度得以维持在5%的人数比例分别为62%、56%和29%。与常规护理组相比，两个干预组的受试者C-反应蛋白水平降低，瘦素水平增高的程度更为明显，但其他指标方面并无显著差异(包括心肺功能、胆固醇水平、身体或精神生活质量或抑郁状况)。

 

结果表明，受试者保留率和人均减重成果均显著优于付费模式。不过本研究也存在局限性，譬如研究为受试者提供免费成品食物，参与该计划的咨询师并未遵循盲法要求。

 

本研究为肥胖患者通过改变行为模式减肥或维持体重提供了另一条途径。在商业化减重方案中推行免费模式可能是一项非常值得的公共卫生投资，但免费模式是否具备成本效益优势还有待进一步研究确认。

 

本研究由Jenny Craig公司赞助。

 

爱思唯尔 版权所有