精神科日間病患體重控制專案

The Weight Control Program in a Day Care Psychiatric Ward

體重過重與肥胖在精神病患有相當高的盛行率，統計本院日間留院病患身體質量指數（BMI{^A17F^}24kg/m2以上者佔64%，而達肥胖標準者（BMI^27kg/m2）佔58%。分析造成肥胖之原因包括：運動量不足（缺乏動機、空間設備限制）、飲食行為不夠健康，飲食熱量偏高、營養知識不足，以及單位護理人員及家屬缺乏體重控制的認知與技巧。為協助病患控制體重，故成立體重控制專案小組，經過護理人員體重控制共識會議取得配合之共識後，以立意取樣招募BMIg24kg/m2的病患共23位，採單組前後測設計，體重控制之介入期為2008年8月15曰至2008年12月25曰共18週，措施為每週1次，每次60分鐘的團體營養衛教與諮詢，以及每週5次，每次卯分鐘的團體運動與低熱量午餐，並配合獎勵制度、團體經驗分享等激勵病患持續參與的動機，鼓勵家屬參與並協助。結果後測體重平均減輕1.1公斤（t=4.138，p<0.001），體重下降1.46%，BMI平均降低0.5kg/m2（t=2.61，p<0.05），體脂肪平均降低1.1%（t=4.17，p<0.001）；飲食行為量表平均得分增加4.7分（t=4.06，p<0.001）、營養知識量表平均得分增加1.62分（t=2.78，p<0.05）。本專案之體重控制設計內容應可作為精神病患體重控制計畫與相關研究之參考。The prevalence of obesity and overweight within psychiatric patients is quite high. There were 64% of patients with body mass index (BMI) ^ 24 kg/m2 and 58% with BMI ^ 27 kg/m2 in our day care psychiatric ward. The reasons for obesity and overweight were less exercise (no motivation and space limited), inaccurate diet behavior, high caloric food intake, inadequate nutritious knowledge, and no cognition and skill of weight control for the nurses and family. In order to help patients to control their weight, a weight control team was formed. After gaming the common view of weight control in nursing conference, 23 patients whose BMI ^ 24 kg/m2 were recruited by purposive sampling. We used the design of pre test and post test in one group. The 18 week weight control intervention was held from 12 August 2008 to 25 December 2008. We conducted and offered the 60 minute nutrition education and counseling once a week, ninety minute exercises group for five times per week and low caloric diet in every lunch. In addition, a reward system, group experience sharing, and encouragement from families were designed to promote patients’ motivation. The post test results show the mean body weight was 1.1 kg (t=4.138, p<0.001) with the reduction rate of 1.46%. BMI dropped 0. 5 kg/m2 (2.61, p<0.05). The mean body fat was reduced by 1.1% (t=4.17, p<0.001). The score of diet behavior and nutrition knowledge increased 4.7 (t=4.06 , p<0.05) and 1.62 (^2.78, p<0.001), respectively. The weight control design of our program can be the reference of other psychiatric wards and research.