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

Claire D Madigan; Henrietta E Graham; Elizabeth Sturgiss; Victoria E Kettle; Kajal Gokal; Greg Biddle; Gemma M J Taylor; Amanda J Daley

doi:10.1136/bmj-2021-069719

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

Claire D Madigan, Henrietta E Graham, Elizabeth Sturgiss, Victoria E Kettle, Kajal Gokal, Greg Biddle, Gemma M J Taylor, Amanda J Daley

Research output: Contribution to journal › Article › peer-review

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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, I2=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, I2=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, I2=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.

Original language	English
Article number	069719
Journal	BMJ (Clinical research ed.)
Volume	377
DOIs	https://doi.org/10.1136/bmj-2021-069719
Publication status	Published - 30 May 2022

Bibliographical note

AJD is supported by a National Institute for Health and Care Research (NIHR) research professorship award. This research was supported by the NIHR Leicester Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. ES’s salary is supported by an investigator grant (National Health and Medical Research Council, Australia). GT is supported by a Cancer Research UK fellowship. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication.

Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.

ASJC Scopus subject areas

General Medicine

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

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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, I2=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, I2=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, I2=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.",

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note = "AJD is supported by a National Institute for Health and Care Research (NIHR) research professorship award. This research was supported by the NIHR Leicester Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. ES{\textquoteright}s salary is supported by an investigator grant (National Health and Medical Research Council, Australia). GT is supported by a Cancer Research UK fellowship. The funders had no role in considering the study design or in the collection, analysis, interpretation of data, writing of the report, or decision to submit the article for publication. Publisher Copyright: {\textcopyright} Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. No commercial re-use. See rights and permissions. Published by BMJ.",

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AU - Madigan, Claire D

AU - Graham, Henrietta E

AU - Sturgiss, Elizabeth

AU - Kettle, Victoria E

AU - Gokal, Kajal

AU - Biddle, Greg

AU - Taylor, Gemma M J

AU - Daley, Amanda J

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N2 - 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, I2=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, I2=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, I2=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.

AB - 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, I2=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, I2=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, I2=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.

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

Abstract

Bibliographical note

ASJC Scopus subject areas

UN SDGs

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