基于在线互动的每日称重干预对铁路超重/肥胖女职工减重效果的随机对照研究

Efficacy of Daily Self-weighing and Online Group-based Cognitive-behavioral Interventions for Weight Loss in Overweight and Obese Female Railway Workers:a Randomized Controlled Trial

背景铁路女职工是肥胖的高风险人群,信息化技术被越来越多地应用于超重/肥胖人群的减重干预中,每日自我称重是基于认知干预的体质量自我监控策略,目前其对改善超重/肥胖人群体质量的效果尚存争议。目的探讨基于在线互动的每日称重干预对北京铁路局超重/肥胖女职工减重及健康生活方式的影响。方法本研究为前瞻性随机对照研究。于2019-06-01至2019-09-01,采用招募志愿者的方式,选取北京铁路局超重/肥胖女职工72例为研究对象,采用随机数字表法1∶1随机分为试验组和对照组各36例,对其进行为期3个月的减重干预。在按个体化饮食、运动建议控制体质量的基础上,试验组采用基于在线互动的每日称重干预,对照组每月测量1次体质量并接受1次随访。观察两组干预前后体成分〔体质量、体质指数(BMI)、体脂率、脂肪含量、腰围、臀围、腰臀比〕和血脂〔总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)〕指标水平、健康促进生活方式量表(HPLP-Ⅱ)总得分及各维度得分的变化情况。采用单因素和多因素Logistic回归探究北京铁路局超重/肥胖女职工体质量较基线减轻≥5%的影响因素。结果共有71例研究对象完成了随访,其中试验组35例,对照组36例。干预前,两组人群体成分和血脂指标水平、HPLP-Ⅱ总得分及各维度得分比较,差异均无统计学意义(P>0.05)。干预后,试验组人群除腰臀比外的其他体成分指标、除HDL-C外的其他血脂指标水平较干预前下降,HPLP-Ⅱ总得分及各维度得分较干预前升高,差异有统计学意义(P<0.05);对照组人群体成分和血脂指标水平、HPLP-Ⅱ总得分及各维度得分与干预前相比,差异均无统计学意义(P>0.05);试验组人群除腰臀比外的其他体成分指标、除HDL-C外的其他血脂指标水平均低于对照组,HPLP-Ⅱ总得分及各维度得分均高于对照组,差异有统计学意义(P<0.05)。22例(31.0%)研究对象体质量较基线降低≥5%,其中16例(72.7%)来自试验组,6例(27.3%)来自对照组。单因素Logistic回归和多因素Logistic回归分析结果均显示,干预组别和基线营养状况是北京铁路局超重/肥胖女职工体质量较基线降低≥5%的影响因素(P<0.05)。结论基于在线互动的每日称重干预有助于减轻北京铁路局超重/肥胖女职工的体质量,促进其健康生活方式的形成,改善其生活质量。

Background Female railway workers are a high-risk group for obesity.Information technology is increasingly used in interventions for weight loss in overweight and obese populations.Daily self-weighing is a cognitive-behavioral strategy for self-monitoring of weight,but its effect on weight loss remains still controversial.Objective To investigate the effect of daily self-weighing plus online group interaction on weight loss and development of healthy lifestyle in overweight and obese female workers in Beijing Railway Bureau.Methods A prospective randomized controlled study was conducted.Participants were 72 overweight or obese female workers of Beijing Railway Bureau voluntarily recruited from June 1 to September1,2019.They were equally randomized into an experimental group and a control group,receiving different weight loss interventions for 3 months(intervention scheme for the experimental group:individualized diet and exercise recommendations,daily self-weighing plus online group-based cognitive-behavioral therapy for weight loss,and that for the control group:individualized diet and exercise recommendations,and self-measurement of body weight with weight management counseling during the telephone or hospital follow-up once a month).Baseline and post-intervention data of both groups were collected,including composition indices(body weight,BMI,body fat percentage,fat content,waist circumference,hip circumference,waist-to-hip ratio),blood lipid indices〔total cholesterol(TC),triacylglyceride(TG),high-density liptein cholesterol(HDL-C),low-density liptein cholesterol(LDL-C)〕and total score and dimension scores of the Health Promoting Lifestyle Profile-Ⅱ(HPLP-Ⅱ).Univariate and multivariate Logistic regression was used to explore factors associated with a 5%or more weight loss from baseline.Results Seventy-one participants(35 cases and 36 controls)who completed the study were finally included for analysis.The each body composition index,each blood lipid index,and total score and dimension scores of the HPLP-Ⅱwere similar in both groups at baseline(P>0.05).After the intervention,the experimental group showed a significant decrease in the body composition indices(except the waist-to-hip ratio),blood lipid indices(except the HDL-C),and a significant increase in the total score and dimension scores of the HPLP-Ⅱ(P<0.05).However,no significant differences were found in each observation index in the control group before and after the intervention(P>0.05).Compared with the control group,the experimental group showed lower post-intervention body composition indices(except the waist-to-hip ratio)and blood lipid indices(except the HDL-C),and higher post-intervention total score and dimension scores of the HPLP-Ⅱ(P<0.05).A total of 22 participants(31.0%)had a weight loss of≥5%from the baseline,including 16 cases(72.7%),and 6 controls(27.3%).Both univariate and multivariate Logistic regression analyses showed that intervention scheme and baseline nutrition status were the influencing factors of a 5%or more weight loss from baseline.Conclusion Daily self-weighing and online group-based cognitive-behavioral interventions contributed to weight loss,formation of a healthy lifestyle,and improvement in quality of life in overweight and obese female workers in Beijing Railway Bureau.