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The effect of weight loss interventions in truck drivers: Systematic review.
Pritchard, EK, Kim, HC, Nguyen, N, van Vreden, C, Xia, T, Iles, R
PloS one. 2022;(2):e0262893
Abstract
INTRODUCTION Truck driving is the most common vocation among males internationally with a high proportion overweight/obese due to a combination of work and lifestyle factors leading to health complications. With limited studies in this area, this systematic review aimed to identify and describe interventions addressing weight reduction in truck drivers. METHODS Five electronic databases were searched, January 2000 to June 2020 (CINAHL, Cochrane Library, Embase, Ovid MEDLINE, Scopus). Inclusion criteria: experimental primary studies, long-distance (≥500 kms) truck drivers, peer reviewed publications in English. Weight loss interventions included physical activity, diet, behavioral therapy, or health promotion/education programs. Exclusions: non-interventional studies, medications or surgical interventions. Two independent researchers completed screening, risk of bias (RoB) and data extraction with discrepancies managed by a third. Study descriptors, intervention details and outcomes were extracted. RESULTS Seven studies (two RCTs, five non-RCTs,) from three countries were included. Six provided either counselling/coaching or motivational interviewing in combination with other components e.g. written resources, online training, provision of exercise equipment. Four studies demonstrated significant effects with a combined approach, however, three had small sample sizes (<29). The effect sizes for 5/7 studies were medium to large size (5/7 studies), indicating likely clinical significance. RoB assessment revealed some concerns (RCTs), and for non-RCTs; one moderate, two serious and two with critical concerns. Based on the small number of RCTs and the biases they contain, the overall level of evidence in this topic is weak. CONCLUSION Interventions that include a combination of coaching and other resources may provide successful weight reduction for truck drivers and holds clinical significance in guiding the development of future interventions in this industry. However, additional trials across varied contexts with larger sample populations are needed.
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Association between characteristics of behavioural weight loss programmes and weight change after programme end: systematic review and meta-analysis.
Hartmann-Boyce, J, Theodoulou, A, Oke, JL, Butler, AR, Scarborough, P, Bastounis, A, Dunnigan, A, Byadya, R, Hobbs, FDR, Sniehotta, FF, et al
BMJ (Clinical research ed.). 2021;:n1840
Abstract
OBJECTIVE To determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme. DESIGN Systematic review and meta-analysis. DATA SOURCES Trial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Randomised trials of behavioural weight loss programmes in adults with overweight or obesity, reporting outcomes at ≥12 months, including at the end of the programme and after the end of the programme. REVIEW METHODS Studies were screened by two independent reviewers with discrepancies resolved by discussion. 5% of the studies identified in the searches met the inclusion criteria. One reviewer extracted the data and a second reviewer checked the data. Risk of bias was assessed with Cochrane's risk of bias tool (version 1). The rate of change in weight was calculated (kg/month; converted to kg/year for interpretability) after the end of the programme in the intervention versus control groups by a mixed model with a random intercept. Associations between the rate of change in weight and prespecified variables were tested. RESULTS Data were analysed from 249 trials (n=59 081) with a mean length of follow-up of two years (longest 30 years). 56% of studies (n=140) had an unclear risk of bias, 21% (n=52) a low risk, and 23% (n=57) a high risk of bias. Regain in weight was faster in the intervention versus the no intervention control groups (0.12-0.32 kg/year) but the difference between groups was maintained for at least five years. Each kilogram of weight lost at the end of the programme was associated with faster regain in weight at a rate of 0.13-0.19 kg/year. Financial incentives for weight loss were associated with faster regain in weight at a rate of 1-1.5 kg/year. Compared with programmes with no meal replacements, interventions involving partial meal replacements were associated with faster regain in weight but not after adjustment for weight loss during the programme. Access to the programme outside of the study was associated with slower regain in weight. Programmes where the intensity of the interaction reduced gradually were also associated with slower regain in weight in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in regain in weight. CONCLUSION Faster regain in weight after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with reduced weight for at least five years after the end of the programme, after which data were limited. Continued availability of the programme to participants outside of the study predicted a slower regain in weight, and provision of financial incentives predicted faster regain in weight; no other clear associations were found. STUDY REGISTRATION PROSPERO CRD42018105744.
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Group versus one-to-one multi-component lifestyle interventions for weight management: a systematic review and meta-analysis of randomised controlled trials.
Abbott, S, Smith, E, Tighe, B, Lycett, D
Journal of human nutrition and dietetics : the official journal of the British Dietetic Association. 2021;(3):485-493
Abstract
BACKGROUND Multi-component lifestyle interventions that incorporate diet, physical activity and behaviour change are effective for weight management. However, it is not clear whether delivery in a group or one-to-one format influences weight loss efficacy. The present study aimed to systematically review the evidence of the effectiveness of group compared to one-to-one multi-component lifestyle interventions for weight management. METHODS MEDLINE, EMBASE, CINAHL, CENTRAL and ISRCTN databases were searched from inception up to February 2020 for randomised controlled trials comparing group versus one-to-one multi-component lifestyle interventions for weight loss in adults with a body mass index ≥ 25 kg m-2 . The primary outcome was weight loss (kg) at 12 months and the secondary outcome was attainment of ≥5% weight loss at 12 months. Risk of bias was assessed using the Cochrane Risk of Bias Tool. Meta-analysis used random effects and estimated risk ratios and continuous inverse variance methods. Heterogeneity was investigated using I2 statistics and sensitivity analyses. RESULTS Seven randomised controlled trials with 2576 participants were included. Group interventions were favoured over one-to-one interventions for weight loss at 12 months (-1.9 kg, 95% confidence interval = -1.3 to -2.6; I2 = 99%). Participants of group interventions were more likely to attain ≥5% weight loss at 12 months relative to one-to-one interventions (relative risk = 1.58, 95% confidence interval = 1.25-2.00; I2 = 60%). CONCLUSIONS Group multi-component lifestyle interventions are superior for weight loss compared to one-to-one interventions with respect to adult weight management. Further research is required to determine whether specific components of group interventions can explain the superiority of weight loss outcomes in group interventions.
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Effects of Lifestyle Modification Interventions to Prevent and Manage Child and Adolescent Obesity: A Systematic Review and Meta-Analysis.
Salam, RA, Padhani, ZA, Das, JK, Shaikh, AY, Hoodbhoy, Z, Jeelani, SM, Lassi, ZS, Bhutta, ZA
Nutrients. 2020;(8)
Abstract
The objective of this review was to assess the impact of lifestyle interventions (including dietary interventions, physical activity, behavioral therapy, or any combination of these interventions) to prevent and manage childhood and adolescent obesity. We conducted a comprehensive literature search across various databases and grey literature without any restrictions on publication, language, or publication status until February 2020. We included randomized controlled trials and quasi-experimental studies from both high income countries (HIC) and low-middle-income countries (LMICs). Participants were children and adolescents from 0 to 19 years of age. Studies conducted among hospitalized children and children with any pre-existing health conditions were excluded from this review. A total of 654 studies (1160 papers) that met the inclusion criteria were included in this review. A total of 359 studies targeted obesity prevention, 280 studies targeted obesity management, while 15 studies targeted both prevention and management. The majority of the studies (81%) were conducted in HICs, 10% of studies were conducted in upper middle income countries, while only 2% of the studies were conducted in LMICs. The most common setting for these interventions were communities and school settings. Evidence for the prevention of obesity among children and adolescents suggests that a combination of diet and exercise might reduce the BMI z-score (MD: -0.12; 95% CI: -0.18 to -0.06; 32 studies; 33,039 participants; I2 93%; low quality evidence), body mass index (BMI) by 0.41 kg/m2 (MD: -0.41 kg/m2; 95% CI: -0.60 to -0.21; 35 studies; 47,499 participants; I2 98%; low quality evidence), and body weight (MD: -1.59; 95% CI: -2.95 to -0.23; 17 studies; 35,023 participants; I2 100%; low quality evidence). Behavioral therapy alone (MD: -0.07; 95% CI: -0.14 to -0.00; 19 studies; 8569 participants; I2 76%; low quality evidence) and a combination of exercise and behavioral therapy (MD: -0.08; 95% CI: -0.16 to -0.00; 9 studies; 7334 participants; I2 74%; low quality evidence) and diet in combination with exercise and behavioral therapy (MD: -0.13; 95% CI: -0.25 to -0.01; 5 studies; 1806 participants; I2 62%; low quality evidence) might reduce BMI z-score when compared to the control group. Evidence for obesity management suggests that exercise only interventions probably reduce BMI z-score (MD: -0.13; 95% CI: -0.20 to -0.06; 12 studies; 1084 participants; I2 0%; moderate quality evidence), and might reduce BMI (MD: -0.88; 95% CI: -1.265 to -0.50; 34 studies; 3846 participants; I2 72%) and body weight (MD: -3.01; 95% CI: -5.56 to -0.47; 16 studies; 1701 participants; I2 78%; low quality evidence) when compared to the control group. and the exercise along with behavioral therapy interventions (MD: -0.08; 95% CI: -0.16 to -0.00; 8 studies; 466 participants; I2 49%; moderate quality evidence), diet along with behavioral therapy interventions (MD: -0.16; 95% CI: -0.26 to -0.07; 4 studies; 329 participants; I2 0%; moderate quality evidence), and combination of diet, exercise and behavioral therapy (MD: -0.09; 95% CI: -0.14 to -0.05; 13 studies; 2995 participants; I2 12%; moderate quality evidence) also probably decreases BMI z-score when compared to the control group. The existing evidence is most favorable for a combination of interventions, such as diet along with exercise and exercise along with behavioral therapy for obesity prevention and exercise alone, diet along with exercise, diet along with behavioral therapy, and a combination of diet, exercise, and behavioral therapy for obesity management. Despite the growing obesity epidemic in LMICs, there is a significant dearth of obesity prevention and management studies from these regions.
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Change in obesity-related metabolic abnormalities associated with body mass index improvement through life-style intervention: A meta-regression.
Matson, RI, Perry, R, Hunt, LP, Chong, AH, Beynon, R, Hamilton-Shield, J, Birch, L
Pediatric diabetes. 2020;(2):173-193
Abstract
The reduction in body mass index standard deviation score (BMI-SDS) associated with improvement in biomarkers relating to metabolic health in obese children is unknown. We aimed to establish the change in BMI-SDS associated with improved inflammation, liver function, and insulin resistance to inform clinical guidelines for pediatric weight management interventions and to assess the efficacy of future trials. A large-scale systematic review was conducted to identify relevant studies. Studies of children with a diagnosis of obesity according to defined BMI thresholds, participating in lifestyle interventions to reduce obesity, were included. Studies must have reported baseline (pre-) and postintervention (or change of) BMI-SDS and either fasting glucose, homeostatic model of insulin resistance (HOMA-IR), alanine aminotransferase (ALT), C-reactive protein (CRP), or interleukin-6 (IL-6). A series of meta-regressions were conducted to establish links between BMI-SDS change scores and change in metabolic markers of health. Sixty-eight articles were identified. From the meta-regression analyses, across all study subsets, greater mean falls in all four parameters, (HOMA-IR, Glucose, ALT, and CRP) were observed with greater mean loss of BMI-SDS, but the trends were only statistically significant for HOMA-IR and CRP (P = .003; P = .021). However, we could not find minimum changes in BMI-SDS that would ensure a fall in these outcomes. At this time, we are unable to recommend a definitive value of BMI-SDS reduction needed to improve the markers of metabolic health. Future trials should aim to report additional indices of derived BMI values, which may better reflect changes in actual adiposity.
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The Effects of Physical Activity and Diet Interventions on Body Mass Index in Latin American Children and Adolescents: A Systematic Review and Meta-Analysis.
Godoy-Cumillaf, A, Fuentes-Merino, P, Díaz-González, A, Jiménez-Díaz, J, Martínez-Vizcaíno, V, Álvarez-Bueno, C, Cavero-Redondo, I
Nutrients. 2020;(5)
Abstract
The objective of this systematic review and meta-analysis is to compare the effect of physical activity only with that of physical activity plus diet interventions on body mass index (BMI) in Latin American children and adolescents. We searched the Medline, Embase, Scopus, Web of Science, and Scielo databases from their inception until March 2020, including studies examining the effect of physical activity or physical activity plus diet interventions on BMI in children and adolescents and based on data from intervention studies. The DerSimonian and Laird method was used to compute a pooled standardized mean difference for BMI in terms of effect size (ES) and respective 95% confidence intervals (CIs). Eighteen studies were included. Analyses were performed based on intervention (four studies were included for physical activity only and four studies were included for physical activity plus diet). In the analysis of physical activity only versus control, there was no effect on BMI (ES = 0.00; 95% CI -0.17-0.17, I2 = 0.0%; p = 0.443). In the analysis of physical activity plus diet versus control, there was a decrease in BMI in favour of the intervention group (ES = -0.28; 95% CI -0.42--0.14, I2 = 74.5%; p = 0.001). When ES was estimated considering only the effect in intervention groups, there was no evidence of a decrease in BMI (ES = -0.17; 95% CI -0.44-0.11, I2 = 84.5%; p < 0.001) for physical activity only (eight studies). However, there was a statistically significant decrease in BMI (ES = -0.30; 95% CI -0.50-0.11, I2 = 95.8%; p < 0.001) for physical activity plus diet (ten studies). Some limitations of this review could compromise our results, but the main limitation that should be stated is the quality of the studies (mainly medium/moderate), especially as physical activity and diet interventions cannot be blinded, compromising the quality of these studies. In summary, this meta-analysis offers evidence that physical activity plus diet interventions produced a reduction in BMI in Latin American children and adolescents, but physical activity only interventions did not.
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Which behaviour change techniques within interventions to prevent weight gain and/or initiate weight loss improve adiposity outcomes in young adults? A systematic review and meta-analysis of randomized controlled trials.
Ashton, LM, Sharkey, T, Whatnall, MC, Haslam, RL, Bezzina, A, Aguiar, EJ, Collins, CE, Hutchesson, MJ
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2020;(6):e13009
Abstract
Young adulthood is associated with the highest rate of weight gain compared with any other adult age group. This review evaluates the effectiveness of interventions with adiposity outcomes among young adults and identifies which behaviour change techniques (BCTs) are most effective. BCT utilization was assessed using Michie's 93-item BCT Taxonomy v1. Six electronic databases were searched for randomized controlled trials assessing change in adiposity in young adults (17-35 years) until December 2019; identifying 21,582 articles. Fifty-one studies were included. Meta-analyses for weight (n=19 studies), body mass index (BMI) (n=20 studies), and waist circumference (n=10 studies) demonstrated no significant between-group differences at ≤3 or >3 months. There were no differences between interventions focusing on weight loss or weight-gain prevention. Narrative synthesis showed significant between-group differences in weight change, favouring the intervention in 14/43 (33%) studies. In studies assessing BMI and waist circumference, this was 31% (11/36) and 25% (4/16). Two BCTs had a percentage effectiveness ratio >50% in weight loss interventions; social support (unspecified) and self-monitoring behaviour, and one in weight-gain prevention interventions; and goal-setting (outcome). Findings demonstrate initial potential for these types of BCTs and can help build cumulative evidence towards delivering effective, cost-efficient, and replicable interventions.
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Educational weight loss interventions in obese and overweight adults with type 2 diabetes: a systematic review and meta-analysis of randomized controlled trials.
Maula, A, Kai, J, Woolley, AK, Weng, S, Dhalwani, N, Griffiths, FE, Khunti, K, Kendrick, D
Diabetic medicine : a journal of the British Diabetic Association. 2020;(4):623-635
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Abstract
AIM: The worldwide prevalence of type 2 diabetes mellitus is increasing, with most individuals with the disease being overweight or obese. Weight loss can reduce disease-related morbidity and mortality and weight losses of 10-15 kg have been shown to reverse type 2 diabetes. This review aimed to determine the effectiveness of community-based educational interventions for weight loss in type 2 diabetes. METHODS This is a systematic review and meta-analysis of randomized controlled trials (RCT) in obese or overweight adults, aged 18-75 years, with a diagnosis of type 2 diabetes. Primary outcomes were weight and/or BMI. CINAHL, MEDLINE, Embase, Scopus and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to June 2019. Trials were classified into specified a priori comparisons according to intervention type. A pooled standardized mean difference (SMD) (from baseline to follow-up) and 95% confidence intervals (95% CI) between trial groups (difference-in-difference) were estimated through random-effects meta-analyses using the inverse variance method. Heterogeneity was quantified using I2 and publication bias was explored visually using funnel plots. RESULTS Some 7383 records were screened; 228 full-text articles were assessed and 49 RCTs (n = 12 461 participants) were included in this review, with 44 being suitable for inclusion into the meta-analysis. Pooled estimates of education combined with low-calorie, low-carbohydrate meal replacements (SMD = -2.48, 95% CI -3.59, -1.49, I2 = 98%) or diets (SMD = -1.25, 95% CI -2.11, -0.39, I2 = 95%) or low-fat meal replacements (SMD = -1.15, 95%CI -2.05, -1.09, I2 = 85%) appeared most effective. CONCLUSION Low-calorie, low-carbohydrate meal replacements or diets combined with education appear the most promising interventions to achieve the largest weight and BMI reductions in people with type 2 diabetes.
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Effect of Behavioral Weight Management Interventions Using Lifestyle mHealth Self-Monitoring on Weight Loss: A Systematic Review and Meta-Analysis.
Cavero-Redondo, I, Martinez-Vizcaino, V, Fernandez-Rodriguez, R, Saz-Lara, A, Pascual-Morena, C, Álvarez-Bueno, C
Nutrients. 2020;(7)
Abstract
Alongside an increase in obesity, society is experiencing the development of substantial technological advances. Interventions that are easily scalable, such as lifestyle (including diet and physical activity) mobile health (mHealth) self-monitoring, may be highly valuable in the prevention and treatment of excess weight. Thus, the aims of this systematic review and meta-analysis were to estimate the following: (i) the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss and (ii) the adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring. MEDLINE via PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and the Web of Science databases were systematically searched. The DerSimonian and Laird method was used to estimate the effect of and adherence to behavioral weight management interventions using lifestyle mHealth self-monitoring on weight loss. Twenty studies were included in the systematic review and meta-analysis, yielding a moderate decrease in weight and higher adherence to intervention of behavioral weight management interventions using lifestyle mHealth self-monitoring, which was greater than other interventions. Subgroup analyses showed that smartphones were the most effective mHealth approach to achieve weight management and the effect of behavioral weight management interventions using lifestyle mHealth self-monitoring was more pronounced when compared to usual care and in the short-term (less than six months). Furthermore, behavioral weight management interventions using lifestyle mHealth self-monitoring showed a higher adherence than: (i) recording on paper at any time and (ii) any other intervention at six and twelve months.
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A systematic review and meta-analysis of the effectiveness of meal replacements for weight loss.
Astbury, NM, Piernas, C, Hartmann-Boyce, J, Lapworth, S, Aveyard, P, Jebb, SA
Obesity reviews : an official journal of the International Association for the Study of Obesity. 2019;(4):569-587
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Meal replacements (MR) are generally not recommended in clinical guidelines for the management of obesity. The aim of this review is to provide an up-to-date systematic evaluation of the effect of weight loss interventions incorporating MR compared with alternative interventions on weight change at 1 year in adults with overweight or obesity. Six electronic databases were searched from inception to the end of August 2018 for randomized controlled trials comparing the effect of MR with interventions that did not include MR on weight at 1 year. We excluded studies using diets providing <3347 kJ/(800 kcal)/day and those which used total diet replacement (TDR) from this review. Risk of bias was assessed using the Cochrane risk of bias tool. Twenty-three studies with 7884 adult participants were included. Six out of 23 studies were judged at low risk of bias across all domains, and 5/23 studies were judged at high risk of bias in at least one domain. Studies with similar intervention and comparators were grouped into five comparisons for analysis. Mean weight change at 1 year favoured the MR group relative to the control group in each comparison. In those comparisons where we conducted meta-analysis, in people assigned to a diet incorporating MR, mean difference was -1.44 kg (-2.48 to -0.39 kg; I2 = 38%) compared with alternative kinds of diets. In those assigned to a MR diet along with support, mean difference was -2.22 kg (-3.99 to -0.45, I2 = 81%) compared with other diets with support and -3.87 kg (-7.34 to -0.40; I2 = 60%) compared with other kinds of diet without support. In those assigned a MR diet with an enhanced level of support, mean difference was -6.13 kg (-7.35 to -4.91, I2 = 19%) compared with alternative diets and regular support. Programmes incorporating meal replacements led to greater weight loss at 1 year than comparator weight loss programmes and should be considered as a valid option for management of overweight and obesity in community and health care settings.