減重個案長期體重控制之相關因素分析

Factors Associated with Long-term Weight Control in Weight Reduction Subjects

肥胖的治療應以維持長期體重控制，減少相關健康風險為目的，短期治療的成效究竟能維持多久，是我們關切的重點，因此本研究目的為探討長期體重控制成功的相關因素，從減重個案的性別、年齡、睡眠時數、是否吃早餐、每週運動時間、減重前身高、體重、身體質量指數、減重期望率找出可預測的因子。研究對象為南部某醫學中心減重門診612位追蹤一年以上的個案，經由飲食及運動衛教介入之後觀察其體重控制情形，於第三個月時有298人（48.7%）中途退出，其餘314人（51.3%）持續減重，分析兩組的差異發現女性中輟率略多於男性（51.1% vs. 42.5%），但未達到顯著統計差異。以逐步迴歸分析法探討各因素對中輟的影響程度，經調整性別、年齡、睡眠時數、是否吃早餐、每週運動時間、減重期望率及減重前體重、BMI、減重年數等因素，結果顯示BMI <30 kg/m2（勝算比2.09）及每週運動時間小於150分鐘（勝算比1.67）中輟率較高。於減重屆滿一年時評估所有個案體重控制狀況，長期體重控制成功定義為減輕原始體重10%，且持續至少一年以上，依定義區分為長期體重控制成功組與不成功組，成功組有52人（8.5%）、不成功組560人（91.5%），成功維持減輕的體重可能受到減重個案性別、年齡、睡眠時數、是否吃早餐、每週運動時間、減重期望率及減重前體重的影響，以逐步迴歸分析法探討各因素對長期體重控制的影響，經調整各因素之後發現，年齡30歲以下（勝算比是3.83），每週運動時間≧150分鐘（勝算比是4.56），皆有利於長期體重控制成功，其餘因素則無顯著相關。

Many overweight and obese individuals are able to lose significant amounts of weight, but the majority regain the weight over a period of time. There is also a significant patient dropout rate in weight control programs, thus not only resulting in wasted medical resources, but also increasing the frustration between the therapist and the patient. This study was aimed at determining the critical factors that lead to differences in long-term weight maintenance. According to The National Weight Control Registry, we defined long-term weight maintenance as the loss of at least 10% of the initial body weight and maintenance of the loss for at least one year. In this study, we enrolled 612 individuals who had a BMI≧25kg/m2. Each participant was screened with a medical history and physical examination, and administered a questionnaire pertaining to sleep habits, weight loss expectations, dietary habits, whether or not they ate breakfast, and the weekly exercise time. The participants underwent weight reduction by changing their lifestyle, including controlling their diet and encouraging exercise. By the third month of treatment, 298 (48.7%) participants had dropped out. We analyzed the difference between the continuous treatment and attrition groups. Females had a greater tendency to drop from the program than males (51.1% vs. 42.5%), and those with a BMI＜30kg/m2 (OR=2.09) and a weekly exercise time＜150 minutes (OR=1.67) had higher dropout rates. At the end of treatment, only 52 (8.5%) participants maintained weight loss successfully. We analyzed the difference between the successful long-term weight maintenance and the non-successful groups using logistic regression, which showed that an age below 30 years (OR=3.83) and a weekly exercise time ＞ 150 min (OR=4.56) were related to successful long-term weight maintenance.