Planned care for obesity and cardiovascular risk reduction using a stepped-down approach: A randomized-controlled trial

PREVENTIVE MEDICINE

卷:114

Article

Liu, Jie¹  Godino, Job G.^2,3  Norman, Gregory J.^2,3  Hill, Linda^1,2  Calfas, Karen²  Sallis, James F.²  Arredondo, Elva⁴  Rock, Cheryl L.²  Criqui, Michael²  Zhu, Shu-Hong²  Griffiths, Kenneth²  Covin, Jennifer²  Dillon, Lindsay³  Patrick, Kevin^2,3 

[1] Univ Calif San Diego, Sch Med, La Jolla, CA 92093 USA

[2] Univ Calif San Diego, Dept Family Med & Publ Hlth, La Jolla, CA 92093 USA

[3] Univ Calif San Diego, Ctr Wireless & Populat Hlth Syst, 9500 Gilman Dr,Dept 0811, La Jolla, CA 92093 USA

[4] San Diego State Univ, Grad Sch Publ Hlth, San Diego, CA 92182 USA

关键词: Obesity;    Randomized controlled trial;    Weight loss;    Cardiovascular disease risk factors;   

DOI  :  10.1016/j.ypmed.2018.07.015

来源: Elsevier

【 摘 要 】

Primary care-based approaches to address concurrent obesity and cardiovascular disease risk factors (CVDRFs) that begin with a high intensity intervention that is subsequently decreased (i.e., stepped-down) if weight loss is achieved have not been rigorously examined. Our study is a 20-month, single-blind randomized controlled trial at five primary care clinics in San Diego, CA, in 2013, where 262 obese adults (aged 25-70 years; 32.1% male; 59.2% white) with at least one CVDRF were enrolled into planned care for obesity and risk reduction (PCORR) using a stepped-down approach or enhanced usual care (EUC). All patients received physician recommendations for weight loss and CVDRFs. EUC patients (n = 132) received an individual session with a health educator every 4 months. PCORR patients (n = 130) received individual and group sessions (in-person, mail, telephone, and email) in three steps, characterized by less contact if success was achieved. At 20 months, 40.7%, 23.8%, and 15.4% of PCORR patients were in steps 1, 2, and 3, respectively (25.2% were lost to follow-up). PCORR resulted in a between-group difference in reduction in body weight of 6.1% [95% Cl, 5.3 to 6.9] compared to EUC 2.8% [95% CI, 2.0 to 3.6] p = 0.007, with a greater reduction in BMI (35.2 [95% CI, 34.4 to 35.9] to 33.7 [95% CI, 32.9 to 34.5] kg/m(2)) than EUC (36.0 [95% CI, 35.3 to 36.8] to 35.1 [95% CI, 34.3 to 35.9] kg/m(2)), as indicated by a significant treatment by time interaction (p = 0.009). PCORR resulted in greater weight loss over 20 months than EUC. Trial Registration: ClinicalTrials.gov, NCT01134029

【 授权许可】

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