Fear of immigration enforcement policies is generalized across counties. Interventions are needed to increase immigrant Hispanics/Latinos' understanding of their rights and eligibility to utilize health services. Policy-level initiatives are also needed (e.g., driver's licenses) to help undocumented persons access and utilize these services.

This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity.Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months postbaseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science).Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate-to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: −0.09, 95% confidence interval [CI]: −0.22, 0.04; N = 19; I 2 = 32%), 12 months (SMD: −0.17, 95% CI: −0.36, 0.02; N = 5; I 2 = 33%), and 24 months (SMD: −0.21, 95% CI: −0.42, 0.00; N = 2; I 2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery. network meta-analysis, obesity, third-wave behavioural therapy, weight loss 1 | BACKGROUND Although behavioural interventions are effective at helping people to lose weight, many people struggle to sustain effective weight management behaviours over extended periods due to a combination of biological, psychological, social, and environmental factors that drive weight gain. 1,2 Standard behavioural programmes can be effective in the short term, but less so in the longer term. 3-6 These usually combine diet and physical activity advice with core behavioural change techniques including goal setting, self-monitoring, problem solving, and planned social support. 7 It has been proposed that third-wave cognitive behaviour therapies (3wCBT), including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based cognitive behavioural ther- Nazrul Islamhttps://orcid.org/0000-0003-3982-4325

Summary There is good evidence that behavioural weight management interventions improve physical health; however, the impact on mental health remains unclear. We evaluated the impact of behavioural weight management interventions on mental health‐related outcomes in adults with overweight or obesity at intervention‐end and 12 months from baseline. Eligible studies were randomized controlled trials (RCTs) or cluster RCTs of adult behavioural weight loss interventions reporting affect, anxiety, binge eating, body image, depression, emotional eating, quality of life, self‐esteem and stress. We searched seven databases from inception to 7 May 2019 and included 43 articles reporting 42 RCTs. Eighteen studies were deemed to be at high risk of bias. We conducted random‐effects meta‐analyses, stratified analyses and meta‐regression using Stata. Interventions generated greater improvements than comparators for depression, mental health‐related quality of life and self‐efficacy at intervention‐end and 12 months from baseline. There was no difference between groups for anxiety, overall quality of life, self‐esteem or stress at intervention‐end. There was insufficient evidence to assess the impact on anxiety, binge eating, body image, emotional eating, affect, life satisfaction, self‐esteem or stress at intervention‐end and/or 12 months from baseline. Although evidence suggests that interventions benefit some aspects of mental health, high‐quality, transparently reported RCTs measuring a range of mental health outcomes over longer durations are required to strengthen the evidence base.

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