The Role of Choice in Weight Loss Strategies: A Systematic Review and Meta-Analysis

Abstract

Effective strategies to achieve weight loss and long-term weight loss maintenance have proved to be elusive. This systematic review and meta-analysis aims to explore whether the choice of weight loss strategy is associated with greater weight loss. An electronic search was conducted using the MEDLINE (Medical Literature Analysis and Retrieval System Online, or MEDLARS Online), EMBASE (Excerpta Medica database), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO (Database of Abstracts of Literature in the Field of Psychology, produced by the American Psychological Association and distributed on the association’s APA PsycNET) databases for clinical trials and randomized controlled trials, investigating the role of choice in weight loss strategies. A total of nine studies were identified as meeting the pre-specified criteria. All of the studies included a ‘Choice’ or preference arm and a ‘No Choice’ arm or group who did not receive their preference as a control. A total of 1804 subjects were enrolled in these studies, with weight loss observed in both experimental and control groups of all studies, irrespective of dietary intervention, study duration, or follow-up length. Twelve interventions in nine trials were used for the meta-analysis, with results indicating a greater weight loss in the control groups, 1.09 ± 0.28 (overall mean difference in weight loss between groups ± standard error; p = 0). There was no significant effect of duration or attrition. In this meta-analysis, the choice of weight loss strategy did not confer a weight loss benefit.

A phenotypic approach to obesity treatment

“…In fact, three studies demonstrated a statistically significant increase in mean weight loss in participants in the no‐choice groups. Of note, attrition rates were similar in choice and no‐choice groups in the studies, indicating no particular advantage in offering a choice to weight‐loss participants regarding adherence and retention 80 …”

Factors associated with choice of behavioural weight loss program by adults with obesity

“…18,19 4.4 | Evidence on the effect of being assigned to the preferred treatment on weight loss outcomes Weight loss studies that incorporate participants' preference to test the effect of preference on weight loss outcomes do not provide strong evidence that receiving a preferred treatment leads to or is associated with better outcomes compared with receiving a randomly assigned treatment or the non-preferred treatment. [20][21][22][23][24][25] For example, Renjilian et al 21 randomly assigned adult participants with obesity to the weight loss treatments for which they expressed preference within a 2  2 factorial design (individual/group treatment  preferred/non-preferred).…”

Ten things to know about ten cardiovascular disease risk factors – 2022

“… [13] Dietary patterns most associated with reduced CVD risk are those that: [ 6 , 7 , 8 , 9 , 10 ] • Prioritize: Vegetables, fruits, legumes, nuts, whole grains, seeds, and fish Foods rich in monounsaturated and polyunsaturated fatty acids such as fish, nuts, and non-tropical vegetable oils Soluble fiber •Limit: Saturated fat, such as tropical oils, as well as ultra-processed meats preserved by smoking, curing, or salting or addition of chemical preservatives, such as bacon, salami, sausages, hot dogs, or processed deli or luncheon meats, which in addition to containing saturated fats, may also have increased sodium, nitrate, and other components which might account for an increase CVD risk compared to unprocessed red meat [14] Excessive sodium Cholesterol, especially in patients at high risk for CVD with known increases in cholesterol blood levels with increased cholesterol intake Ultra-processed carbohydrates Sugar-sweetened beverages Alcoholic beverages [ 15 , 16 ] Trans fats

Figure 1 Adoption of healthful nutrition is a shared decision process between clinician and patient, with priorities based upon evidence-based dietary patterns, nutrition goals, cultural applicability, cost, and availability. While potentially counterintuive, patient preference is not consistently associated with improved health outcomes when implemeting medical nutrition therapy [17] , [18] , [19] . Healthful food choices made after medical nutrition therapy may differ from “preferred” food choices made before medical nutrition therapy.

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“… Adoption of healthful nutrition is a shared decision process between clinician and patient, with priorities based upon evidence-based dietary patterns, nutrition goals, cultural applicability, cost, and availability. While potentially counterintuive, patient preference is not consistently associated with improved health outcomes when implemeting medical nutrition therapy [17] , [18] , [19] . Healthful food choices made after medical nutrition therapy may differ from “preferred” food choices made before medical nutrition therapy.…”