臺灣博碩士論文加值系統

由於青少年肥胖率逐年升高，本研究目的在應用跨理論模式發展體重控制課程，來探討此方案對大學生體重控制之成效。本研究採類實驗設計，於北部某大學招募56位BMI超過23.1kg/m2的學生為研究對象，實驗組36人、比較組20人。實驗組接受十二週體重管理計畫包含個人目標設定、心理支持、六個半小時飲食與運動衛教、每週飲食日誌討論及每週兩小時有氧運動，比較組提供衛教手冊。課程前後均進行體重、體脂肪、皮下脂肪厚度、腰臀比、血壓、柔軟度、肌肉耐力、心肺適能測量，血液分析則包含總膽固醇、三酸甘油酯、高密度脂蛋白膽固醇、低高密度脂蛋白膽固醇與空腹血糖，並利用問卷收集飲食攝取量、身體活動量、體重控制改變階段、改變過程、決策權衡、自我效能、社會支持資料。資料收集點包括前測、介入措施後立即測量及計畫結束後三個月測量。以SPSS（12.0）套裝軟體進行統計分析。
本研究結果為：體重過重大學生實施體重控制介入措施後立即性效果，首先在體位方面，對體重過重的大學生進行十二週體重管理計畫介入措施後，體重顯著下降 (F=24.17, p=.001)、BMI顯著下降 (F=5.88, p=.01)、體脂肪顯著下降 (F=13.31, p=.001)、腰臀比顯著下降 (F=10.25, p=.001)，但在皮下脂肪厚度沒有顯著效果(F=1.30, p>.05)。其次在體適能方面，經介入措施後實驗組柔軟度增加 (F=3.17, p=.05)、肌肉耐力增加 (F=8.33, p=.001)，但在心肺耐力增加上沒有顯著效果 (F=2.19, p>.05)。再者血液生化資料方面，總膽固醇顯著下降 (F=7.62, p=.01)，而在飯前血糖、HDL、LDL、TG、血壓沒有顯著差異。最後在量表部分，體重控制改變階段往行動期及持續期增加 (χ2=27.72, p=.000)、改變過程顯著上升 (F=4.56, p=.01)、自我效能顯著上升 (F=9.22, p=.000)、社會支持顯著上升 (F=3.75, p=.05)，而在知覺障礙與知覺利益方面沒有顯著差異。實施體重控制介入措施後，對體重過重大學生短期性效果方面，實驗組接受體重控制介入措施後，確實能降低體重、BMI、體脂肪、腰臀比、增加柔軟度，且效果持續達三個月之久。
因此本研究結果呈現應用跨理論來執行體重管理計畫，可使體重過重學生體重、體脂肪、腰臀比下降並增加柔軟度，期望未來可做為臨床上體重控制參考。

Due to increased incidents of teenage obesity every year, the purpose of this study is to develop a set of transtheoretical model weight loss program in order to probe into the effectiveness of the program in controlling college students’ weight. This research has adopted the quasi-experiment design, using 56 students from a university in northern Taiwan as study subjects, whose BMI exceed 23.1kg/m2. The experimental group comprises of 36 students and the control group 20 students. First, the experimental group underwent a 12-week weight management program, which covered: target setting, psychological support, 6.5 hours of diet and exercise related health education, weekly diet forum, and 2 hours of aerobics per week. The control group on the other hand was only given a health education handbook. The weight, body fat, subcutaneous fat thickness, waist-hip ratio, blood pressure, flexibility, muscular endurance, and cardiopulmonary fitness of the study subjects were measured. Blood analysis was also conducted to find out the total cholesterol, triglyceride, high density lipoprotein (HDL), and low density lipoprotein (LDL). The questionnaire survey was distributed to collect information on dietary intake, physical activity, stages of weight control change, change processes, decision-making, self-efficiency, and social support. The data was collected during the pre-test, immediately after intervention, and 3 months after the end of the program. SPSS (12.0) software was used in the statistical analysis.

The study results show that the college students who are overweight showed immediate results after the weight control intervention. First, in terms of body mass, the overweight students significantly reduced weight (F=24.17, p=.001), body fat (F=13.31, p=.001), BMI (F=5.88, p=.01), and waist-hip ratio (F=10.25, p=.001) after the 12-week weight management program intervention. However, there was no significant difference in subcutaneous fat thickness (F=1.30, p>.05). In terms of physical fitness, the experimental group showed increased flexibility (F=3.17, p=.05), increased muscular endurance (F=8.33, p=.001), but showed no significant difference in cardiopulmonary fitness (F=2.19, p>.05). Moreover, in terms of blood analysis, the total cholesterol reduced significantly (F=7.62, p=.01), but showed no significant difference in blood sugar level, HDL, LDL, TG, and blood pressure before meals. Finally, in terms of scaling, the weight control change stages showed increases in the action period and continuation stage (χ2=27.72, p=.000). Change process (F=4.56, p=.01), self-efficiency (F=9.22, p=.000), and social support (F=3.75, p=.05) significantly increased. However, there was no significant difference in cognitive barriers and cognitive benefit. After the weight control intervention, the experimental group that underwent weight control intervention indeed lost weight, had reduced BMI, body fat, waist-hip ratio, flexibility in a short time and the results lasted for 3 months.

Therefore, the research results show that the transtheoretical model weight management program indeed helps overweight students reduce weight, body fat, waist-hip ratio, and flexibility. Hopefully, such results shall serve as reference for clinical weight control in the future.

目錄
指導教授推薦書………………………………………………………
口試委員會審定書……………………………………………………
博碩士論文著作授權書 III
致謝 IV
中文摘要 V
英文摘要 VII
目錄 IX
第一章 緒論 1
第一節 研究背景 1
第二節 研究動機 4
第三節 研究目的 7
第四節 研究問題 8
第五節 名詞界定 9
第二章 文獻探討 11
第一節 體重過重 11
第二節 影響體重過重之原因及相關因素 18
第三節 體重控制策略應用 22
第四節 跨理論模式 35
第三章 研究方法 40
第一節 研究設計 40
第二節 研究架構 43
第三節 研究場所、對象 46
第四節 研究對象人權保護 48
第五節 資料收集過程 49
第六節 研究介入 53
第七節 研究工具及信效度 57
第八節 資料分析 63
第四章 研究結果 64
第一節 體重管理前測資料分析 65
第二節 衛教介入措施之成效 85
第三節 體重控制介入措施三個月後復胖率 128
第五章 研究討論 129
第六章 結論與建議 136
第一節 研究結論 136
第二節 研究建議 138
第三節 研究限制 143
參考資料 144
附錄一 問卷調查表 161
附錄二 體重改變過程 162
附錄三 體重決策權衡 164
附錄四 社會支持量表 165
附錄五 健康行為自我效能量表 166
附錄六 飲食運動日誌 168
附錄七 人體試驗倫理委員會同意臨床試驗證明書 170
附錄八 研究工具使用同意書 171

圖目錄
圖3-1 概念架構 43
圖3-2 理論架構 44
圖3-3 「生活型態調整、健康諮詢和社會支持措施對大學生體重控制之成效：應用跨理論模式」之研究架構 45
圖3-4 資料收集過程 52

表目錄
表2-1 實驗性研究 28
表3-1 非平均控制組前測後測設計 42
表4-1-1 研究對象之社會人口學特性 69
表4-1-2 兩組研究對象前測臨床結果之比較 77
表4-1-3 兩組研究對象體重控制改變階段前測分析之比較 78
表4-1-4 兩組研究對象體重控制改變過程、決策權衡量表前測資料之比較 81
表4-1-5 兩組研究對象健康行為自我效能量表前測資料之比較 83
表4-1-6 兩組研究對象社會支持量表前測資料之比較 84
表4-2-1 兩組研究對象第一、二次後測體位之比較 90
表4-2-2 兩組研究對象第一、二次後測測體適能之比較 93
表4-2-3 兩組研究對象第一、二次後測血液生化資料之比較 97
表4-2-4 兩組研究對象體重控制改變階段第一、二次後測分析之比較 103
表4-2-5 兩組研究對象體重控制改變過程量表第一次後測資料之比較 104
表4-2-6 兩組研究對象體重控制決策權衡量表第一、二次後測資料之比較 105
表4-2-7 兩組研究對象體重控制行為自我效能量表第一、二次後測資料之比較 106
表4-2-8 兩組研究對象社會支持量表第一、二次後測資料之比較 108
表4-2-9 兩組研究對象第一、二次後測資料ANCOVA之比較 122
表4-3-1 三個月後復胖率 128

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