英国牛津大学Jamie Hartmann-Boyce团队研究了行为减肥计划的特征与计划结束后体重变化之间的相关性。相关论文发表在2021年8月17日出版的《英国医学杂志》上。
为了确定行为减重方案的特点是否会影响方案结束后体重的变化率，研究组在试验登记处和11个电子数据库等检索截至2019年12月关于超重或肥胖成人行为减肥方案的随机试验，均报告≥12个月的结果，包括方案结束时和方案结束后的结果，对这些随机试验进行系统回顾和荟萃分析。
这些研究由两名独立评审员进行筛选，差异通过讨论解决。检索确定的研究中有5%符合纳入标准。一名评审员提取数据，另一名评审员检查数据。使用Cochrane偏差风险工具（第1版）评估偏差风险。计算体重变化率，并检测体重变化率与预先指定变量之间的相关性。
数据分析包括249项试验（59081例参与者） ，平均随访时间为两年（最长30年）。56%的研究（140项）存在不明确的偏倚风险，21%（52项）偏倚风险低，23%（57项）偏倚风险高。干预组的体重恢复速度快于未干预对照组，但两组之间的差异至少维持了五年。
在项目结束时，每减轻一公斤体重，体重就会以每年0.13-0.19公斤的速度更快反弹。减肥的经济激励与更快地以1-1.5千克/年的速度恢复体重有关。与无膳食替代的计划相比，部分膳食替代的干预措施与更快的体重反弹有关，但在计划期间对体重减轻进行校正后则不相关。在研究之外参加该项目与体重恢复较慢有关。在多变量分析中，相互作用强度逐渐降低的方案也与体重恢复较慢有关，尽管点估计表明这种关联性很小。其他特征不能解释体重恢复的异质性。
研究结果表明，减肥后体重反弹更快与初始体重减轻幅度更大有关，但至少在项目结束后的5年内，初始体重减轻幅度更大仍与体重减轻有关，但之后的数据有限。
附：英文原文
Title: Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis
Author: Jamie Hartmann-Boyce, Annika Theodoulou, Jason L Oke, Ailsa R Butler, Peter Scarborough, Anastasios Bastounis, Anna Dunnigan, Rimu Byadya, F D Richard Hobbs, Falko F Sniehotta, Susan A Jebb, Paul Aveyard
Issue&Volume: 2021/08/17
Abstract:
Objective To determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme.
Design Systematic review and meta-analysis.
Data sources Trial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Randomised trials of behavioural weight loss programmes in adults with overweight or obesity, reporting outcomes at ≥12 months, including at the end of the programme and after the end of the programme.
Review methods Studies were screened by two independent reviewers with discrepancies resolved by discussion. 5% of the studies identified in the searches met the inclusion criteria. One reviewer extracted the data and a second reviewer checked the data. Risk of bias was assessed with Cochrane’s risk of bias tool (version 1). The rate of change in weight was calculated (kg/month; converted to kg/year for interpretability) after the end of the programme in the intervention versus control groups by a mixed model with a random intercept. Associations between the rate of change in weight and prespecified variables were tested.
Results Data were analysed from 249 trials (n=59081) with a mean length of follow-up of two years (longest 30 years). 56% of studies (n=140) had an unclear risk of bias, 21% (n=52) a low risk, and 23% (n=57) a high risk of bias. Regain in weight was faster in the intervention versus the no intervention control groups (0.12-0.32 kg/year) but the difference between groups was maintained for at least five years. Each kilogram of weight lost at the end of the programme was associated with faster regain in weight at a rate of 0.13-0.19 kg/year. Financial incentives for weight loss were associated with faster regain in weight at a rate of 1-1.5 kg/year. Compared with programmes with no meal replacements, interventions involving partial meal replacements were associated with faster regain in weight but not after adjustment for weight loss during the programme. Access to the programme outside of the study was associated with slower regain in weight. Programmes where the intensity of the interaction reduced gradually were also associated with slower regain in weight in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in regain in weight.
Conclusion Faster regain in weight after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with reduced weight for at least five years after the end of the programme, after which data were limited. Continued availability of the programme to participants outside of the study predicted a slower regain in weight, and provision of financial incentives predicted faster regain in weight; no other clear associations were found.
DOI: 10.1136/bmj.n1840
Source: https://www.bmj.com/content/374/bmj.n1840
BMJ-British Medical Journal:《英国医学杂志》，创刊于1840年。隶属于BMJ出版集团，最新IF：93.333
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本期文章：《英国医学杂志》：Online/在线发表
