Randomized Controlled Trials to Treat Obesity in Military Populations: A Systematic Review and Meta-Analysis

Abstract

In recent years, overweight and obesity have reached an alarmingly high incidence and prevalence worldwide; they have also been steadily increasing in military populations. Military personnel, as an occupational group, are often exposed to stressful and harmful environments that represent a risk factor for disordered eating, with major repercussions on both physical and mental health. This study aims to explore the effectiveness of weight loss interventions and assess the significance of current obesity treatments for these populations. Three online databases (PubMed, PsycInfo, and Web of Science) were screened to identify randomized controlled trials (RCTs) aiming to treat obesity in active-duty military personnel and veterans. Random-effects meta-analyses were conducted for body weight (BW) and body mass index (BMI) values, both longitudinally comparing treatment groups from pre-to-post intervention and cross-sectionally comparing the treatment group to controls at the end of the intervention. A total of 21 studies were included: 16 cross-sectional (BW: n = 15; BMI: n = 12) and 16 longitudinal (BW: n = 15; BMI: n = 12) studies were meta-analyzed, and 5 studies were narratively synthesized. A significant small overall BW and BMI reduction from baseline to post-intervention was observed (BW: g = −0.10; p = 0.015; BMI: g = −0.32; p < 0.001), together with a decreased BMI (g = −0.16; p = 0.001) and nominally lower BW (g = −0.08; p = 0.178) in the intervention group compared to controls at the post-intervention time-point. Despite limitations, such as the heterogeneity across the included interventions and the follow-up duration, our findings highlight how current weight loss interventions are effective in terms of BW and BMI reductions in military populations and how a comprehensive approach with multiple therapeutic goals should be taken during the intervention.

Body Image, Nutrition, and Mental Health

“…A systematic review and meta-analysis of randomized controlled trials to treat obesity in military populations was performed by Gravina et al [ 16 ]. They found that the current weight loss interventions are effective in military populations with a high level of evidence for physical activity, dietary and nutritional interventions, cognitive behavioral therapy, and structured outcome monitoring (clinical or self-monitoring).…”

“…The GDF-15 receptor GFRAL, which is known to be involved in appetite regulation, was found to be expressed across various central-nervous as well as peripheral tissues [ 12 ], and visfatin, S100B, and leptin are associated with the development of metabolic syndrome in people with bipolar depression [ 13 ]. Four articles of this Special Issue [ 14 , 15 , 16 , 17 ] summarized already available (e.g., nutritional interventions, psychological and family therapy) [ 14 ] and experimental (smart toy Purrble) [ 15 ] therapies for AN, effective therapies for the treatment of obesity (e.g., physical activity, dietary and nutritional intervention, cognitive behavioral therapy, clinical and self-monitoring) [ 16 ], as well as the preventive and therapeutic options for oral health consequences of EDs [ 17 ]. Witaszek et al’s finding that liraglutide and semaglutide were associated with increased cognitive restraint [ 8 ] is also therapeutically relevant as these GLP-1 receptor agonists are approved for the treatment of obesity.…”