Page 62 - 2022-22-中国全科医学

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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- Ⅱ were 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.
【Key words】 Overweight；Obesity；Daily weighing；Online interaction；Cognitive intervention；Self monitoring；
Railway employee；Beijing

肥胖是威胁人类健康的十大疾病之一 ［1］ 。《中国居 的影响尚存争议 ［8-9］ 。医疗卫生与信息化的深度融合发展，
民营养与慢性病状况报告（2020 年）》显示，中国超过 使互联网技术越来越多地被应用于超重 / 肥胖人群的减
半数成年居民存在超重 / 肥胖问题，超重 / 肥胖可明显 重干预中。与既往研究更多地探讨基于网络的饮食、运
增加高血压、冠心病、脑卒中和血脂异常等慢性病的发 动等生活方式干预对受试者减重效果的影响不同 ［10-11］ ，
病率和死亡率 ［2］ 。《“健康中国 2030”规划纲要》提出， 本研究基于在线互动模式，通过鼓励受试者进行为期 3
要加强对职业群体的科学指导，促进妇女、老年人和职 个月的每日自我称重，实现体质量监测与干预的常态化，
业群体积极参与全民健身 ［3］ 。近年来，随着我国高速铁 并借由评估干预前后北京铁路局超重 / 肥胖女职工在体
路事业快速发展，铁路女职工劳动强度大、饮食和作息 成分、血脂指标及健康促进生活方式等方面的变化情况，
不规律、长期缺乏锻炼等问题日益凸显，加之新型冠状 评价基于在线互动的每日称重干预对减轻受试者体质
病毒肺炎疫情常态化防控背景下，铁路女职工工作压力 量、改善其生活方式的效果，旨在为今后“铁路职工健
明显增大，导致其易出现代谢紊乱，并易发生肥胖及其 康行动计划”的开展提供有效的干预手段。
相关疾病，从而给铁路运输工作带来一定的安全隐患 ［1］ 。 1 对象与方法
铁路女职工已成为肥胖的高风险人群，其健康状况亟待 1.1 研究对象 本研究为小样本的探索性、前瞻性随机
关注。大量证据表明，行为干预会使超重 / 肥胖的成年 对照研究。于 2019-06-01 至 2019-09-01，采用招募志
人体质量明显下降，包括饮食干预 ［4］ 、运动干预 ［5］ 和 愿者的方式，选取北京铁路局超重 / 肥胖女职工 72 例为
认知层面的干预（如刺激控制、目标设定 ［6］ ）。每日自 研究对象，采集其年龄、身高、体质量、受教育程度、
我称重是基于认知干预的自我监控策略，其已得到自我 个人月收入及婚姻状况等方面的资料。采用随机数字表
调节理论的支持。该理论认为，当通过自我监控和评估 法1 ∶ 1 将其分为试验组（36 例）和对照组（36 例）。
发现目前行为未达到目标时，个体能够更好地自我调节， 纳入标准：（1）18~45 岁女性；（2）体质指数（BMI）
2
2
从而做出积极的改变 ［7］ 。目前，每日自我称重对改善超 ≥ 24.0 kg/m 且 <32.5 kg/m ；（3）无精神运动障碍；（4）
重 / 肥胖人群体质量的效果，以及对健康促进生活方式 平素无规律测量体质量的习惯；（5）知情同意，愿意