成人の体重減少に対する段階的な介護介入アプローチの効果:ランダム化臨床試験
John M Jakicic1, Deborah F Tate, Wei Lang
1Department of Health and Physical Activity, Physical Activity and Weight Management Research Center, University of Pittsburgh, Pittsburgh, PA 15261, USA. jjakicic@pitt.edu
JAMA
|June 28, 2012
まとめ
標準的な行動減量介入 (SBWI) は,段階的なケア (STEP) よりも18ヶ月でより大きな減量をもたらしました. しかし,STEPアプローチはより費用対効果が高く,臨床的に有意義な結果を提供し,実施コストを削減しました.
科学分野:
- 肥満に関する研究.
- 行動医学は,行動医学である.
- 公共衛生の介入 公共衛生の介入
背景:
- 肥満の流行を理由に,効果的で資源効率的な減量治療は極めて重要です.
- 段階的な治療アプローチは,マイルストーンの完了に基づいてカスタマイズ可能な介入を提供し,従来の方法と比較して潜在的に有効性を向上させ,コストを削減します.
研究 の 目的:
- 段階的なケアによる減量介入 (STEP) と,標準的な行動による減量介入 (SBWI) の効果を比較して,より大きな減量を達成する.
- 両方の介入アプローチの費用対効果を評価する.
主な方法:
- 363人の過体重および肥満の成人 (BMI 25-40,年齢 18-55) を含むランダム化臨床試験 (ステップアップ研究) が,米国の2つの大学で実施されました.
- 参加者は18ヶ月の介入期間中にSBWI (n=165) またはSTEP (n=198) にランダムに割り当てられました.
- 両グループは低カロリーダイエット,運動量増加,グループカウンセリングを受けた.STEPグループの介入は,体重減少の進展に基づいて3ヶ月ごとに適応可能であった.
主要な成果:
- 18ヶ月間,SBWIとSTEPの両グループは,著しい体重減少を達成しました (P < .001).
- SBWIは,STEP (-6.9%) に比べて,より大きな平均体重減少 (-8.1%) をもたらしたが,この違いは統計的に有意ではなかった (P = .09).
- STEP介入は,SBWI (P < .001) の1357ドルと比較して,参加者あたりの費用が785ドルで,費用対効果が著しく高かった. 両方の介入は,心臓血管の健康とフィットネスの比較可能な改善をもたらしました.
結論:
- 標準的な行動減量介入 (SBWI) は,過体重および肥満の成人において,ステップケア (STEP) アプローチと比較して,平均減量量が18カ月以上増加したことを示した.
- 体重減少が少ないにもかかわらず,STEP介入は臨床的に有意義な体重減少をもたらし,SBWIよりも実質的に費用対効果が高くなりました.
- 研究結果は,段階的なケアモデルが,体重管理の実行可能で資源効率的な戦略であり,効果と経済的考慮のバランスをとることができることを示唆しています.
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