針對過重或肥胖病人利用社群網站輔助進行減重行為改變介入–隨機對照研究

A Social-networking-site Enhanced Behavioral Intervention for Weight Loss in Overweight or Obese Patients – A Randomized Controlled Trial

黃喬煜(Chiao-Yu Huang)

指導教授 ： 陳端容

國立臺灣大學/公共衛生學院/健康政策與管理研究所/博士(2020年)

https://doi.org/10.6342/NTU202000981

摘要

研究背景
透過行為改變介入的技巧達到飲食及運動型態改變，是臨床門診過重或輕度肥胖病人主要的減重治療手段。現行透過中至高頻率的面對面減重諮商是各類型減重行為改變介入中最有效的方法，但是卻難以持續且中長期成效有限。社群網站是一個具有便捷性、互動性，且可以產生社會支持的網路介入媒介，利用社群網站輔助面對面減重諮商，可為臨床減重行為改變介入開啟新的方向。
研究目的
建構可應用於臨床門診情境，透過社群網站輔助面對面減重諮商的減重行為改變介入模式，並比較其和單純面對面減重諮商，在減重效果、個人行為、心理及生活損害改善程度上的差異，以及不同介入對於體重變化軌跡、心理改善軌跡和生活損害改善軌跡上的影響。
研究方法
收案對象為在台北市的一家醫學中心家庭醫學科門診有減重需求的過重或肥胖成年病人(年齡20歲至64歲)，受試者經電腦輔助塊狀隨機分派至「實驗組(面對面減重諮商加臉書輔助組)」或「對照組(面對面減重諮商組)」接受為期12個月的介入和追蹤，兩組均會接受面對面減重諮商的介入，實驗組的受試者額外會在建構的臉書社團中與其他受試者及介入者互動，並由臉書回報飲食運動紀錄和減重過程所遭遇的問題，再獲得醫師針對紀錄和問題提供的個人化回饋。受試者會在介入後1個月、2個月、3個月、6個月及1年接受追蹤量測減重指標、行為、心理及生活損害等指標，部分受試者在介入及追蹤完成後接受面對面訪談。統計分析會利用成對樣本T檢定、卡方檢定及共變異數分析進行組內及組間差異檢定，也會利用時間分析與多層次成長曲線模型進行重複量測指標的軌跡分析。本研究通過台灣大學醫學院附設醫院倫理委員會審核。
研究結果
自2017年8月至2020年2月，共有72位受試者經隨機分派至實驗組(共37人) 和對照組(共35人)，受試者(42位男性及30位女性)平均年齡(標準差)是35.7(9.9)歲，受試者的平均身體質量指數(標準差)是34.5(5.6) kg/m2，共有54位(75%)受試者完成12個月的介入和追蹤。兩組在介入後1年平均體重均顯著減少(平均減重：實驗組4.5公斤; 對照組3.9公斤)，但在組間直接比較上，在介入後6個月及12個月體重、體脂率、行為、心理及生活損害改善程度兩組並沒有顯著差異。多層次成長曲線模型顯示累積減重量與時間軌跡呈現上凸型二次拋物線，單位時間內的減重量會隨時間而減少，在介入7個月後到達頂點，進而出現復胖情形。在減重軌跡上，在控制性別、年齡及初始體重後，實驗組的受試者，有較高的減重速度(每個月較對照組可多減少0.23公斤)，但未達顯著(P值=0.087)；心理改善軌跡上，相較對照組受試者，實驗組的受試者情緒症狀隨時間改善的速率顯著較快(P值=0.011)，同時所有受試者情緒症狀的變化和情緒性飲食的變化成顯著正相關(P值<0.001)。特別對於實驗組的受試者，個人化訊息回饋參與度較高的減重者，減重速度顯著較高(P值=0.043)；而臉書牆互動程度對減重速度則無顯著調整。質性訪談顯示，實驗組的臉書介入有機會增強減重的行為改變介入的專業性及結構化的模式，並提供部分資訊性和陪伴性的社會支持。
結論
透過臉書輔助面對面減重諮商進行減重行為改變介入除可有效減重外，比起目前常規僅提供的面對面減重諮商，可加速情緒症狀的改善，臉書介入中具結構化及專業性的的個人化訊息回饋，則是成功減重的核心要素，臉書輔助面對面減重諮商可成為臨床門診過重或肥胖病人減重行為改變介入的有效模式。

關鍵字

肥胖 ； 減重 ； 行為改變介入 ； 透過網路進行介入 ； 社群網站 ； 個人化回饋 ； 社會支持 ； 心理健康

並列摘要

Background
Lifestyle modification by behavior change intervention is the mainstream treatment for most overweight or obesity patients. Moderate-to-high frequency onsite face-to-face consultation is the most effective for weight loss among different kinds of delivery methods, but it is difficult to disseminate. Nowadays, the application of social networking site by internet in delivering behavior change intervention for weight loss shows tremendous potential and has become a growing field of practice and scholarship.
Aim
The aim of the present study is to (1) develop and assess the efficacy of a hybrid of face-to-face consultation and Facebook-based behavior change intervention for weight loss in primary care setting. It also aims to (2) explore the trajectories of weight change and psychosocial impacts throughout the different courses of intervention.
Methods
In this randomised controlled trial, we enrolled overweight or obese patients (aged 20-64 years) from a medical center in Taipei, Taiwan. Participants were randomly assigned (1:1) to receive a 12-month intervention and follow-up of either “Facebook enhanced group - a hybrid of face-to-face consultation and Facebook-based behavior change intervention,” or “Control group - face-to-face consultation only group”. Weight, body fat percentage, and questionanaire-surveyed behavior and psychosocial impact were objectively measured after interventions. Samples of participants also received qualitative interviews after the 12-month intervention. The differences intra- and between groups were evaluated using student pair-t test, chi-square test and Analysis of Covariance. The trajectories of weight change and psychosocial impacts were evaluated using Hierarchical Growth Curve Models.
Results
Between August 2017 and Feburary 2020, 72 individuals (42 males and 30 females) were randomly assigned to the Facebook-enhanced group (n=37) or Control group (n=35). Participants' mean (SD) age was 35.7 (9.9) years. Mean (SD) body-mass index at baseline was 34.5 (5.6) kg/m 2. A total of 54 (75%) participants completed the 12 month-intervention and all assessments. The mean weight of both groups significantly decreased at 12 months. Weight, body fat percentage, behavior and socio-psychological impacts were not different between two groups at 6 and 12 months. The Growth Curve Model showed the total amount of weight loss (y) as a concave-down quadratic function of time after intervention(x). The speed of weight loss, adjusted for sex, age and initial weight was higher for participants in the Facebook-enhanced group than those in the control group without statistical significance (0.23 kg higher per month, P=0.087). For psychosocial impact, the improvement of psychological symptoms was significantly faster for participants in the Facebook-enhanced group than those in the control group after adjustments (P=0.011). For participants in the Facebook-enhanced group, the speed of weight loss significantly increased with higher engagement of personalized feedback by Facebook messenger after adjustments. The qualitative interviews showed the use of a structured model of Facebook-based behavior intervention can promote the professionalism and provide social support during behavior change intervention for weight loss.
Conclusions
A social-networking-site enhanced behavior change intervention not only can produce significant weight loss, it can also speed up the improvement of psychological symptoms during weight loss. The personalized feedback both in Facebook and in face-to-face consultation is the core element in such program. A hybrid of face-to-face consultation and Facebook-based intervention may be an effective behavioral treatment for overweight or obese patients in primary care setting.

並列關鍵字

Obesity ； Weight loss ； Behavior change intervention ； Web-based intervention ； Social networking site ； Personalized feedback ； Social support ； Mental health

參考文獻

Alvarez-Jimenez, M., Bendall, S., Lederman, R., Wadley, G., Chinnery, G., Vargas, S., . . . Gleeson, J. J. S. r. (2013). On the HORYZON: moderated online social therapy for long-term recovery in first episode psychosis. 143(1), 143-149.

An, R., Ji, M., & Zhang, S. (2017). Effectiveness of social media-based interventions on weight-related behaviors and body weight status: review and meta-analysis. American journal of health behavior, 41(6), 670-682.

Anglé, S., Engblom, J., Eriksson, T., Kautiainen, S., Saha, M.-T., Lindfors, P., . . . Rimpelä, A. (2009). Three factor eating questionnaire-R18 as a measure of cognitive restraint, uncontrolled eating and emotional eating in a sample of young Finnish females. International Journal of Behavioral Nutrition and Physical Activity, 6(1), 41.

Appel, L. J., Clark, J. M., Yeh, H.-C., Wang, N.-Y., Coughlin, J. W., Daumit, G., . . . Geller, S. (2011). Comparative effectiveness of weight-loss interventions in clinical practice. New England Journal of Medicine, 365(21), 1959-1968.

Arem, H., & Irwin, M. (2011). A review of web‐based weight loss interventions in adults. Obesity reviews, 12(5), e236-e243.