Nutritional intervention strategies for the management of overweight and obesity in primary health care: A systematic review with meta‐analysis

Abstract

Summary A systematic review with meta‐analysis (MA) was conducted to synthesize the effectiveness of nutrition intervention strategies for managing overweight and obesity in the adult population attending primary health care. Relevant articles were searched in the PubMed, Embase, Web of Science, Cochrane and LILACS databases from inception to January 2020. Seventy studies were identified: 45 randomized controlled trials (RCTs) and 25 uncontrolled before‐after studies (UBAs). The MA of nutritional intervention revealed a reduced average estimate of the effect on weight in RCTs (weighted mean differences [WMD] = −1.80 kg, 95% confidence interval [CI], −2.40 to −1.19), BMI (WMD = −0.80 kg/m2, 95% CI, −1.11 to −0.49), and WC (WMD = −2.28 cm, 95% CI, −3.06 to −1.49); and for UBAs showed reductions in weight (WMD = −4.17 kg; 95% CI, −5.18 to −1.70), BMI (WMD = −1.26 kg/m2; 95% CI, −1.81 to −0.72) and (WMD = −2.90 cm; 95%CI, −4.21 to −1.59). There was no association between treatment effect and follow‐up for both designs. Nutritional interventions alone yielded a higher but nonsignificant average reduction on weight when compared with combined components intervention. Interventions delivered through individual or group sessions showed a similar positive effect on weight decrease. The dietary prescription approach yielded a greater effect on weight loss than did the behavioural approaches but only in UBA studies.

Long-Term Efficacy and Safety of Anti-Obesity Treatment: Where Do We Stand?

“…The fundamental approach for weight reduction is to induce a negative energy balance by increasing physical activities and starting a calorie restriction diet [7]. Guidelines on obesity control define clinically significant weight loss as at least a 5% reduction in weight from the baseline level and associated with improvements in cardio-metabolic risk factors [8].…”

“…Guidelines on obesity control define clinically significant weight loss as at least a 5% reduction in weight from the baseline level and associated with improvements in cardio-metabolic risk factors [8]. However, as the rate of long-term adherence to lifestyle This article is part of the Topical Collection on Metabolism modifications is low, most patients with obesity lose only modest weight with non-pharmacological interventions alone [7]. Even if they achieve significant weight reduction, approximately one-third, more than half, and almost the total population with obesity return to their original weight within a year, 2 years, and 5 years, respectively [9].…”

“…Energy intake in the form of food is highly controlled by the central and peripheral hormonal signaling, with different mechanisms targeting various factors in diverse pathways [10]. Numerous medications for obesity treatment have been developed mainly by exploiting the following mechanisms: (1) reducing appetite and thereby energy intake, (2) promoting energy expenditure, and (3) lowering calorie absorption [7][8][9]. Some drugs in the development stage were expected to be effective in the treatment of obesity in vivo and theoretically, but they were abandoned due to minimal weight loss effect in additional animal studies and early clinical trials [11].…”

Efecto de la dieta cetogénica baja en calorías sobre la composición corporal en adultos con sobrepeso y obesidad: revisión sistemática y metaanálisis

“…En cuanto a la pérdida de peso corporal, los resultados de este metaanálisis indican que la dieta cetogénica promueve una mayor pérdida de peso que la dieta hipocalórica, lo que coincide con metaanálisis previos elaborados con modelos frecuentistas y bayesianos; sin embargo, a pesar de que los resultados de este y anteriores metaanálisis están orientados en la misma dirección, se observan discrepancias entre los valores agregados de cada metaanálisis, lo cual se puede atribuir a las diferencias en los criterios de selección e intervenciones entre los estudios primarios de cada uno de estos. Un ejemplo de esto es el uso de cointervenciones para los cambios de estilos de vida, pacientes con diabetes, períodos de seguimiento, distribución de sexo, gradientes de edad, definición de dieta cetogénica e intervención de control (1,2,11,(31)(32)(33)(34)(35) . Por lo tanto, futuros experimentos y metaanálisis deberán tender hacia el establecimiento de criterios de selección amplios y definidos que permitan realizar análisis por subgrupos, como un grupo de diabéticos, obesos y con actividad física.…”

Developing our understanding of nutrition in depression

“…social deprivation, relationship breakdown, traumatic life events), nutritional change, while challenging, is achievable (e.g. in obesity: Canuto et al, 2021;Habib-Mourad et al, 2020;Lopes et al, 2021). However, two issues remain in giving population level findings clinical bearing.…”