電話減重法

與營養師電話諮商可能可以有效的減重


作者：Laurie Barclay, MD
出處：WebMD醫學新聞

February 20, 2009 — 根據發表於2月17日內科學誌一篇隨機分派、追蹤6個月的開放標記試驗結果，頻繁地與營養師電話諮商，可能可以改變肥胖病人的生活型態，進而幫助他們減重。

康乃迪克州輝瑞藥廠的Andres G. Digenio 博士與其同事寫到，對減重病患而言，醫師常對減重的病患開立藥物治療，除了藥物之外，合併治療能提供其他好處，但卻鮮少有生活型態的諮商；可能原因在於，生活型態的諮商缺乏行為訓練；無法持續進行；缺乏各專業的人員；沒有適當的設施；頻繁看診造成的花費，這不是醫療機構所能改變的。

這項研究的目標是比較12個獨立醫療診所之肥胖試驗中，使用sibutramine治療之肥胖病患五種履行生活型態改變的方法，由電腦產生的塊狀排列，隨機分派376個肥胖受試者（身體質量指數介於30至40 kg/m2）至介入組。

在試驗期間，所有受試者都使用每天10毫克的sibutramine；一本生活型態手冊；以及登入減重網站。五種介入包括高頻率面對面生活型態改變諮商（74人），低頻率面對面諮商（76人），高頻率電話諮商（76人），高頻率電子郵件諮商（74人），或是沒有營養師接觸（即自主管理，有76人）。

主要試驗終點在看6個月後體重改變的百分比，次要試驗終點是腰圍的改變；脂肪、血糖及胰島素濃度；血壓；肥胖相關症候群；及6個月的生活品質。

高頻率面對面諮商與高頻率電話諮商，在6個月時有相似的減重效果（分別降低8.9%及7.7%，95%信賴區間為8.0-9.8%及6.8-8.7%），明顯高於其他組別（低頻率面對面諮商是6.4%，95%信賴區間為5.4-7.3%；高頻率電子郵件諮商是5.9%，95%信賴區間為5.6-6.8%；無營養師介入是5.2%，95%信賴區間為4.3%至6.1%）。

每組在腰圍、高密度脂蛋白膽固醇及三酸甘油酯濃度以及生活品質和體重相關症候群，皆有明顯改善。此外，並未發生嚴重副作用，在輕微副作用方面各組也沒有明顯差異。

研究作者寫到，高頻率與營養師電話接觸以及面對面接觸，對於肥胖病人生活型態改變後的體重減輕有類似效果。這項發現可以使提供者及健康照護系統應用於促進健康的生活型態改變。

本試驗的限制是大部分受試者是白人女性，使這項發現無法普及化，且退出率高達30%。

研究作者結論表示，生活型態的種類及諮商的頻率對減重是有效果的。受試者以面對面方式與營養師接觸能達最大減重效果，如未與營養師接觸，只能降低一些體重。合併藥物治療及營養師諮商，能在緊急時以電話方式取代面對面諮商。

輝瑞全球研究發展部門支持此項研究，且雇用4位研究作者。

Telephone Counseling With Dietitian May Be Effective for Weight Loss

By Laurie Barclay, MD
Medscape Medical News

February 20, 2009 — High-frequency telephone contact with a dietitian may be an effective method for supporting lifestyle modification in obese patients trying to lose weight, according to the results of a randomized, 6-month, open-label study reported in the February 17 issue of the Annals of Internal Medicine.

"Physicians frequently prescribe medications for weight loss but offer minimal lifestyle counseling despite the additional benefits of combining both interventions," write Andres G. Digenio, MD, PhD, from Pfizer in South Lyme, Connecticut, and colleagues. "Possible reasons for omitting lifestyle counseling may be little or no training in behavioral counseling; inability to dedicate time for ongoing counseling; lack of multidisciplinary staff; inadequate infrastructure; and costs associated with more frequent visits, which are seldom covered by medical insurance."

The goal of this study was to compare 5 methods of delivering a lifestyle modification program to obese patients being treated with sibutramine at 12 independent research clinics with experience running obesity trials. With use of a computer-generated schedule of randomly permuted blocks (block length was 5), 376 obese participants (body mass index ? 30 kg/m2 and < 40 kg/m2) were assigned to intervention groups.

During the study, all participants were treated with sibutramine, 10 mg/day; a lifestyle manual; and access to a weight-loss Web site. The 5 interventions were high-frequency face-to-face lifestyle modification counseling (n = 74), low-frequency face-to-face counseling (n = 76), high-frequency telephone counseling (n = 76), high-frequency email counseling (n = 74), or no dietitian contact (self-help; n = 76).

The main endpoint of the study was percentage change in body weight at 6 months, and secondary outcomes were changes in waist circumference; lipid, glucose, and insulin levels; blood pressure; weight-related symptoms; and quality of life at 6 months.

The high-frequency face-to-face and high-frequency telephone groups had similar mean weight loss from baseline to 6 months (8.9%; 95% confidence interval [CI], 8.0% - 9.8%; and 7.7% [95% CI, 6.8% - 8.7%]), which was significantly greater vs the other groups (low-frequency face-to-face, 6.4% [CI, 5.4% - 7.3%]; high-frequency email, 5.9% [CI, 5.0% - 6.8%]; and no dietitian contact, 5.2% [CI, 4.3% - 6.1%]).

Significant improvements in waist circumference, high-density lipoprotein cholesterol and triglyceride levels, and measures of quality of life and weight-related symptoms occurred in all groups. No serious adverse events were reported, and there were no significant differences in minor adverse events among groups.

"High-frequency telephone contact with a dietitian was similar to HF-F2F [high-frequency face-to-face] contact for supporting lifestyle modification in obese patients trying to lose weight," the study authors write. "The findings might be used by providers and health systems to promote healthy lifestyle changes for their patients."

Limitations of this study were most participants being white women, limiting generalizability of the findings, and a high attrition rate of 30%.

"The type and frequency of lifestyle counseling support have a profound effect on weight loss," the study authors conclude. "Participants lost the greatest amount of weight when exposed to frequent face-to-face contact with a dietitian and lost the least amount of weight when they had no dietitian support. Dietitian counseling over the telephone emerged as an effective alternative to face-to-face counseling in combination with pharmacologic treatment."

Pfizer Global Research and Development supported this study and employs 4 of the study authors.

Ann Intern Med. 2009;150:255-262.