Effectiveness of weight management interventions for adults delivered in primary care: systematic review and meta-analysis of randomised controlled trials

Abstract

Objective To examine the effectiveness of behavioural weight management interventions for adults with obesity delivered in primary care. Design Systematic review and meta-analysis of randomised controlled trials. Eligibility criteria for selection of studies Randomised controlled trials of behavioural weight management interventions for adults with a body mass index ≥25 delivered in primary care compared with no treatment, attention control, or minimal intervention and weight change at ≥12 months follow-up. Data sources Trials from a previous systematic review were extracted and the search completed using the Cochrane Central Register of Controlled Trials, Medline, PubMed, and PsychINFO from 1 January 2018 to 19 August 2021. Data extraction and synthesis Two reviewers independently identified eligible studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tool. Meta-analyses were conducted with random effects models, and a pooled mean difference for both weight (kg) and waist circumference (cm) were calculated. Main outcome measures Primary outcome was weight change from baseline to 12 months. Secondary outcome was weight change from baseline to ≥24 months. Change in waist circumference was assessed at 12 months. Results 34 trials were included: 14 were additional, from a previous review. 27 trials (n=8000) were included in the primary outcome of weight change at 12 month follow-up. The mean difference between the intervention and comparator groups at 12 months was −2.3 kg (95% confidence interval −3.0 to −1.6 kg, I 2 =88%, P<0.001), favouring the intervention group. At ≥24 months (13 trials, n=5011) the mean difference in weight change was −1.8 kg (−2.8 to −0.8 kg, I 2 =88%, P<0.001) favouring the intervention. The mean difference in waist circumference (18 trials, n=5288) was −2.5 cm (−3.2 to −1.8 cm, I 2 =69%, P<0.001) in favour of the intervention at 12 months. Conclusions Behavioural weight management interventions for adults with obesity delivered in primary care are effective for weight loss and could be offered to members of the public. Systematic review registration PROSPERO CRD42021275529.

A closer look at weight loss interventions in primary care: A systematic review and meta-analysis

“…An important strength, however, was that this analysis was not limited to trials examining behavior modification for weight loss nor did it include auxiliary personnel providing care. (42) It was intended to review the full breadth of what has been (hence could be) done in routine medical practice using conventional workflow and established scope of training for primary care providers.…”

Preventing chronic disease in overweight and obese patients with low health literacy using eHealth and teamwork in primary healthcare (HeLP-GP): a cluster randomised controlled trial

“…6 A recent systematic review and meta-analysis supports weight loss programmes delivered by primary care practitioners as they provide effective weight loss and reduction in waist circumference. 7 Multicomponent intensive behavioural interventions (delivered by various clinicians and provided through group, individual, technology or printbased methods) have been recommended for patients with a BMI of 30 or higher. 8 Health coaching provided by a trained professional has become a popular tool to address weight through behaviour change strategies 9 and high-intensity behavioural counselling (12 or more sessions per year delivered in person, by phone or electronically) is accepted to produce clinically meaningful weight loss.…”

“…Behavioural interventions in primary care have been demonstrated to achieve a 5%–7% improvement in weight, blood pressure (BP) or lipids for patients, potentially preventing or delaying the onset of type 2 diabetes and cardiovascular disease 6. A recent systematic review and meta-analysis supports weight loss programmes delivered by primary care practitioners as they provide effective weight loss and reduction in waist circumference 7. Multicomponent intensive behavioural interventions (delivered by various clinicians and provided through group, individual, technology or print-based methods) have been recommended for patients with a BMI of 30 or higher 8.…”

Intervallfasten ohne Zusatznutzen

“…Geringe Evidenz für Ernährungsberatungen: Bei Sichtung der Literatur ist bedauerlicherweise insgesamt festzustellen, dass keine robuste Evidenz für eine starke und anhaltende Wirksamkeit von Ernährungsberatungen auf die mittelfristige Gewichtsreduktion besteht 2 3 . 2–3 Jahre nach einer Ernährungsberatung besteht im Mittel kein Unterschied zum Ausgangsgewicht mehr („Jojo-Effekt“).…”