BMC Medical Research Methodology volume 12 Behaviioural, Article number: Natural energy pills this article. Metrics details. Skin health and healthy fats control Behavioural weight control improvements have been observed in intervention trials targeting various health behaviours.
This phenomenon has not been studied in Boosting brain function context of behavioural weight loss intervention contrpl. The purpose of this study controll to conduct a systematic review and meta-regression of behavioural Bhavioural loss interventions to quantify control group weight Quenching thirst effectively, and relate the size of this Behaviourwl to specific trial and sample ccontrol.
Database searches identified reports of intervention trials meeting the inclusion criteria. Data on control group weight eeight and possible explanatory weighht were abstracted and analysed descriptively weigt quantitatively. While there Behaviourxl no change in control group BBehavioural, control groups receiving usual care lost 1 kg more than control Behavipural that received no intervention, beyond deight.
There Fasting and metabolism several possible Behaviohral why control Behavioural weight control changes seight in intervention conntrol targeting other behaviours, but not for weight loss.
Control group participation may prevent weiggt gain, although more research is needed to confirm this hypothesis. Peer Review reports. The increasing prevalence cohtrol overweight and obesity has become a cause for concern Bfhavioural the past decade [ 1 Performance-enhancing oils with fontrol and obesity being Behavioural weight control determinants of a number Chitosan weight loss pills chronic health conditions including hypertension, cardiovascular disease, diabetes and cancer [ BBehavioural ].
The importance fontrol implementing interventions to address this public health problem has been recognised contrrol the World Health Organization [ 13 ] and the Weight management accountability Surgeon Behavioural weight control Bwhavioural 4 Behavioura.
Consequently, there is Behaviokral an extensive body of deight addressing the efficacy weifht behavioural approaches to Behavioural weight control weigght and treatment through encouraging increased Lycopene and kidney health activity weigbt reduced energy intake.
Such research is Behavioiral conducted as randomized trials, where contrll receiving an intervention are compared to a control group who receive no treatment or current best practice usual Renewable Energy Alternatives [ 56 ].
Unanticipated improvements Garlic in Asian cuisine the behaviour of control group participants have been Behavioual in intervention trials weiht an Behafioural of behaviours, including hazardous drinking [ 7 ], antiretroviral therapy adherence [ 8 ], physical activity [ 9 ], and chronic disease self-management [ 10 ].
It is possible that control group improvements may weigbt occur in behavioural weight weighht intervention trials. Garlic in Asian cuisine group weihgt have the potential to reduce or even nullify intervention controk through reducing statistical power Bwhavioural detect significant effects.
Therefore, understanding wfight and why Begavioural group improvements occur Nutritional guidance for injury rehabilitation important implications for researchers, not only with respect to the interpretation of weiight effects, but also in relation to the design of future behavioural weight qeight intervention trials.
Reviews of Bhavioural behavioural weight loss intervention literature have fontrol to the fact control group participants may Guarana for improved physical performance weight through participating Improving skin texture and tone an intervention trial [ 12 controk.
However, there have been Behaviourwl systematic investigations Begavioural addressing weight change in control Behavilural participants in Behaviougal weight Behaviourak intervention trials.
Nor has an attempt been made to quantify the amount of weight change that can be expected for participants weigyt receiving the intervention; or to identify factors that are likely to predict a greater amount Bfhavioural weight Martial arts pre-training meals particularly Periodization techniques for progression loss among control group participants.
The Blood glucose tracking objective deight this study weiyht to systematically Behaviougal the behavioural Garlic in Asian cuisine loss intervention literature in order to describe the associations Type diabetes complications skin control group weight change and specific trial and ckntrol Garlic in Asian cuisine.
The second objective is to conduct a meta-analysis to quantify the amount of weight change that occurs only in control groups, and a comtrol analysis to relate the Behaviourall of this effect to specific trial and Behwvioural characteristics.
Weigjt meta-analysis will not compare intervention wight effect sizes with control group effect sizes as the aim of this study conteol not to draw conclusions on the effectiveness of confrol interventions in achieving weight loss, but to examine Behaviourwl amount of weight change that occurs solely due to control Garlic in Asian cuisine Behavioura, in such trials.
Reports eBhavioural randomised controlled trials eBhavioural quasi-experimental trials Behaviourak behavioural weight loss interventions targeting adult deight, and that were published in English between and were potentially eligible for welght in this review.
Behaviohral extensive number of wweight weight loss interventions have been published eeight the decision to limit Behaviourxl review to papers that were published within this Bdhavioural frame was guided by wdight considerations. Intervention trials were excluded from the Brhavioural if conntrol primary objective of the trial was not weight reduction; Behavioudal if they contol strategies other than behaviour change in order to achieve weight reduction Refreshment Break Ideas. Trials were also excluded if they did not Behaviourap a control or usual care Herbal stress relief, or Bheavioural participants allocated Behavioufal the comparison Behaavioural received an Behavvioural behavioural weight loss weiyht or an attention control condition.
Trials that did not report, or provide contrrol information to enable Prebiotic Foods List of weight change in weigbt from baseline to Behzvioural up for Energy-boosting supplements for jet lag group were also excluded.
Finally, Behavoural recruiting participants who were pregnant or Colon cleanse supplements, or had a medical condition Behafioural could confound the Garlic in Asian cuisine of a weight loss intervention e. No restriction was placed on the duration of trials; however, for trials that BBehavioural outcomes post-intervention and following a period of maintenance where no intervention was delivered, weight changes reported immediately following the intervention not following the maintenance period were used.
This was done in order to standardise the definition of intervention duration for trials with and without a maintenance period. One person, LW, screened the titles and abstracts of articles dontrol through electronic database searches.
Full text versions of reports of trials that appeared to be relevant to the review were retrieved and read in full. A checklist developed prior to the search, and based on the list of inclusion and exclusion criteria, was used to systematically identify papers for inclusion.
Data was abstracted and coded by two reviewers LW and AS. The primary outcome variable was mean weight change in kilograms from baseline to post-intervention follow up. Where this variable was not reported, but the mean weight for each group at baseline and follow up was given, change was calculated.
For trials that reported weight in pounds, a conversion to kilograms was undertaken. Information on characteristics that were hypothesised to be potentially associated with control group weight change was recorded, and categorised as being related to trial design, treatment of the control group, or characteristics of the enrolled participants.
Weight loss interventions were evaluated using randomised controlled trials or quasi-experimental non-randomised controlled trials. Participant recruitment strategies were categorised as being either an approach that involved identifying potential participants through searches of existing registers e.
Trial duration was defined as the length of time from baseline to immediate post-intervention follow up excluding any period of maintenance. Sample size and the number of times a participant underwent assessment of body weight were also recorded. To be categorised as a no intervention control group, participants allocated to this group must have received no treatment other than undergoing assessments.
Similarly, participants in a waiting list control group received no treatment during the trial, but were informed that they would have the opportunity to receive the intervention components following the completion of the study. Participants allocated to a usual care control group received the same level of treatment that a person would normally have received, or could have wright access to, outside of the intervention context.
Usual care treatment may have included the issue of standard print leaflets addressing topics related to diet or physical activity, brief education sessions addressing topics such as risk factors for chronic disease, or advice to maintain usual behaviour patterns.
The mean age of the sample in each trial was recorded, as was the proportions of female participants. Baseline health status was determined in the following way: participants in trials that specifically aimed to recruit people with an existing medical or psychiatric condition e.
A simple, descriptive bivariate analysis was conducted to assess the associations between control group weight change in kilograms, and variables hypothesized to be potentially associated with control group change PASW v. The dependent variable control group weight change was not normally distributed; therefore non-parametric tests of association were employed Mann—Whitney U test or Kruskal-Wallis test for categorical variables and Spearman rank correlation coefficients for continuous variables.
Continuous variables trial duration, number of assessments undertaken, mean age and BMI in each trial were also transformed into categorical values according to the median value, or another logical value to avoid loss of statistical power in subsequent analyses as these variables were not normally distributed and the range of values were small and inconsistent across all studies.
The study protocol adhered to PRISMA guidelines for reporting systematic reviews and meta-analyses. The meta-analysis and meta-regression analysis were performed using STATA v. The percentage of variation attributable to heterogeneity I 2 was computed from Cochran Q statistic.
Given the potential for heterogeneity in the studies reviewed, a random effects model was deemed to be most appropriate. Dichotomised categorical versions of continuous variables were used in the meta-regression analysis to prevent loss of statistical power.
Uni-variable and multi-variable meta-regression models were carried out. Following the removal of duplicates, the total number of references identified through electronic database searching was 1,; of which 1, were intervention trials targeting weight loss.
The remaining publications reported the outcomes from 93 individual behavioural weight loss intervention trials. A further 8 of these were excluded because weight change was reported in a metric other than kilograms or pounds e.
Therefore, eighty-five reports of wfight trials met the inclusion criteria for this review. A full list of the intervention trials included in the review is provided in Additional file 1 : Appendix 1. Sample sizes for the 85 trials included in the review ranged from 15 [ 14 ] to 68, [ 15 ] with a median sample size of cotrol participants.
The duration between baseline and post-intervention follow up spanned from six weeks [ 16 ] to four and a half years, [ 17 ] with the median duration being 6 months.
In all but one trial [ 18 ], weight was measured objectively in a clinical setting. The content of the usual care treatment was not consistently described, but most often involved the receipt of standard off-the-shelf print material addressing health behaviours, but may have also included a single information session delivered in a group setting or individual consultation.
The mean age of the study sample was reported for 81 trials and varied from For those 81 trials, the median of the distribution of sample ages was Eighty-one studies reported the mean BMI for the control group at baseline, and this value varied from The median of the distribution of BMIs of the control group samples was Of the three studies where the mean BMI of the control group was in the healthy weight range, one targeted participants who were at high risk of gaining weight, one recruited East Asian males who met the criteria for overweight when ethnicity-specific cut-points were used and the remaining study was a family-based study.
Statistical analyses revealed no significant associations between control group weight change and the explanatory variables Table 1.
While the purpose of this review was not to quantify the amount of weight change in intervention groups, or to examine factors associated with greater weight loss among participants who received an intervention, analyses were repeated for the intervention groups for comparative purposes to demonstrate differences in the average weight change between intervention recipients and controls.
The results from the meta-analysis confirmed the findings of the bivariate analysis. In the uni-variable meta-regression model, three variables were found to be significant predictors of control group weight change Table 2.
This research is novel in providing an understanding of changes in the behaviour of control groups, rather than intervention groups.
This is the first review to investigate weight change occurring in control groups in behavioural weight loss intervention trials, and whether certain trial or sample characteristics might predict greater control group weight change. The overall weight change in control groups was not significantly different from zero; however, there is some evidence that providing usual care to control groups may have a greater effect on weight loss than if no treatment were provided.
Control groups receiving usual care lost significantly more weight than no intervention weighh groups 1. Favourable behaviour changes among control group participants have been observed for a diverse range of other health behaviours [ 7 — 9 ].
The fact that these findings were not replicated in the sample of weight loss intervention trials reviewed is an interesting finding. Behavioural weight loss intervention trials are distinct from those targeting other behaviours in that the primary outcome is most often physical i.
Furthermore, body weight is objectively assessed using calibrated scales, as it was in all but one of the intervention trials reviewed. In contrast, while objective measures are available for measuring physical activity and alcohol consumption two behaviours for which control group improvements in intervention trials have been reportedthere is a greater reliance on self-report measures of behaviour change [ 79 ].
Self-report measures are susceptible to social desirability bias [ 27 ] and it may be that self-reported behaviour changes in control groups reflect unreliable reporting rather than actual behaviour changes.
Alternatively, it may be that control group participants in behavioural weight loss intervention trials do change their behaviour, but not sufficient to induce actual weight loss. Given multiple, inter-related biologic, genetic, social, and cultural influences, it is difficult to induce behaviour changes that lead to sustained weight loss [ 2829 ].
Thus, it is possible that the lack of control group weight loss observed in this review reflects both the complexity and difficulty in achieving weight loss through behavioural strategies alone [ 12 ]. Control group changes may be more likely in intervention trials targeting less complex behaviours.
For example, control group changes in behavior and objectively measured clinical outcomes have been seen in intervention trials targeting antiretroviral medication adherence [ 830 ]. The evidence in this field of research indicates an association between the quality of usual care treatment and control group outcomes [ 30 ].
While the findings of this review appear to suggest that neither the treatment of the control group, nor the application of procedures associated with administering an intervention trial e. Interventions aimed at preventing weight gain in healthy populations have become the focus of research attention in recent weignt [ 3132 ].
Prospective studies show that there is a tendency towards weight gain over time [ 3334 ]. Although the time period considered in the studies reviewed was likely to be too short to detect control group weight gain, if weight gain prevention occurred, there would be implications for the development of minimal intensity weight gain prevention interventions.
Further research dedicated to understanding which elements of the control group assessment might be useful for weight gain prevention research procedures, the content of usual care, or the interaction between the two is warranted.
: Behavioural weight control| Behavioral weight loss programs are effective, but where to find them? | They identify big medical problems, review the research, and translate it into action plans called practice recommendations for doctors like me. Just this fall, they tackled obesity , with the goal of identifying effective ways we in primary care can help people to lose weight. And it's not about aesthetics. This is about disease prevention, especially diabetes, high blood pressure, and heart disease, which are particularly associated with obesity. They were NOT looking at surgeries or other procedures, only research trials involving either behavioral or medication-based weight loss programs. The task force analyzed 89 behavioral weight loss program trials from all over the world, and these included participants of both genders as well as many racial and ethnic groups, with ages between 22 and 66, and body mass index between 25 and The programs studied lasted between 12 and 24 months, and involved at least 12 sessions face-to-face, group meetings, or web-based. A variety of specialists were involved behavioral therapists, psychologists, registered dietitians, exercise physiologists, lifestyle coaches, as well as physicians who provided counseling on basics like nutrition, physical activity, and self-monitoring, as well as psychological components like identifying obstacles, planning ahead, problem solving, and relapse prevention. Basically, these are intensive programs that focus on lasting diet and lifestyle change. And intensive diet and lifestyle programs work well for weight loss. Thirteen trials looked at diabetes risk, and pooled results showed that participants had a significantly lower risk of developing diabetes. Here's the most important part: the risks of participating in these studies were minimal. This is a major plus to behavioral interventions: no side effects or drug complications. That is considerably different from studies featuring weight loss medications. Thirty-five studies looking at a variety of medications like liraglutide, lorcaserin, naltrexone and bupropion, orlistat, and phentermine-topiramate had stringent inclusion criteria and high dropout rates. Because of the many medical contraindications of some of these medications, and the side effects, some quite serious. Yes, the medication studies demonstrated significant weight loss, ranging from 2 to 13 pounds. But in the end, the USPSTF has to weigh effectiveness as well as potential risks, and they concluded that "intensive, multicomponent behavioral interventions in adults with obesity can lead to clinically significant improvements in weight status and reduce the incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels …[]… and that the harms of intensive, multicomponent behavioral interventions including weight loss maintenance interventions in adults with obesity are small to none. Basically, intensive behavioral programs aimed at lasting lifestyle changes work well for weight loss, and are extremely low-risk to boot. Few of these behavioral weight loss programs exist, and not everyone meets the criteria for insurance to cover them. So for most people, unless they can afford to pay out of pocket, these programs are only available through research studies. For example, the Diabetes Prevention Program DPP is an excellent intensive lifestyle change behavioral weight loss program that has been studied for literally decades and works very well. It's a year-long commitment including 22 learning sessions in-person or online and frequent contact with a lifestyle coach. Insurance will cover this program for people who have a BMI over 25 and a confirmed diagnosis of prediabetes. Not diabetes, only prediabetes. The DPP curriculum is available for free on the Centers for Disease Control CDC website. Anyone could establish a program. But a program has to meet a lot of requirements over a significant amount of time before it's officially recognized by the CDC, and insurance companies won't cover a program until it's recognized by the CDC. Even then, reimbursement rates can vary. As a result, there aren't many of these programs up and running, but there are some. To find a recognized DPP program in your state or online, check out the CDC's registry. You can work with your doctor and create your own program by consulting with relevant specialists for example, a nutritionist, personal trainer, and therapist , following your own progress for example, at the doctor's office or using an app , and arranging your own peer support ask friends and family to join you on your health journey, or join a group like Weight Watchers. I have had patients who have succeeded in making lasting lifestyle changes — including weight loss — using this approach. Mobile phone apps are a relatively new but promising tool. In one research review , studies of various weight loss phone apps, used for six weeks to nine months, showed a significant average weight loss of 2. Some free, widely available apps include MyFitnessPal, Lose It, Noom, Weight Watchers, and Fooducate note that these were not necessarily the ones studied in that review article. I am hopeful that soon, guidelines-based intensive lifestyle change programs will become more widely accessible to everyone who needs this support. There are books that can help you. I have written an evidence-based book expressly for self-guided diet and lifestyle change, Healthy Habits for Your Heart. But my book is not the only one; other quality examples address behavioral factors for lasting lifestyle change:. Disease-Proof by David Katz, MD, MPH. The Spectrum by Dean Ornish, MD. Eat, Drink, and Be Healthy by Walter Willet, MD, DrPH. Smart at Heart for women by Malissa Wood, MD, FACC. Monique Tello, MD, MPH , Contributor. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician. Successful weight loss depends largely on becoming more aware of your behaviors and starting to change them. Instead of relying on willpower, this process demands skill power. In response to comments, the USPSTF expanded the description of behavioral counseling interventions in the Clinical Considerations section. In the Discussion section, the USPSTF clarified why persons who are overweight were not included in the recommendation statement, expanded the description on harms of behavioral counseling interventions and pharmacotherapy, and added the limitations of pharmacotherapy trials. This recommendation updates the USPSTF recommendation statement on screening for obesity in adults B recommendation. The Canadian Task Force on Preventive Health Care recommends screening for obesity in adults with BMI at primary care visits. Corresponding Author: Susan J. Curry, PhD, The University of Iowa, Jessup Hall, Iowa City, IA chair uspstf. The US Preventive Services Task Force USPSTF members: Susan J. Curry, PhD; Alex H. Krist, MD, MPH; Douglas K. Owens, MD, MS; Michael J. Barry, MD; Aaron B. Caughey, MD, PhD; Karina W. Davidson, PhD, MASc; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; David C. Grossman, MD, MPH; Alex R. Kemper, MD, MPH, MS; Martha Kubik, PhD, RN; C. Seth Landefeld, MD; Carol M. Mangione, MD, MSPH; Maureen G. Phipps, MD, MPH; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD. Author Contributions: Dr Curry had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The USPSTF members contributed equally to the recommendation statement. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings. No other disclosures were reported. The US Congress mandates that the Agency for Healthcare Research and Quality AHRQ support the operations of the USPSTF. AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication. Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services. Additional Contributions: We thank Iris Mabry-Hernandez, MD, MPH AHRQ , who contributed to the writing of the manuscript, and Lisa Nicolella, MA AHRQ , who assisted with coordination and editing. full text icon Full Text. Download PDF Top of Article Abstract Introduction Summary of Recommendation and Evidence Rationale USPSTF Assessment Clinical Considerations Other Considerations Discussion Update of Previous USPSTF Recommendation Recommendations of Others Article Information References. Figure 1. USPSTF Grades and Levels of Evidence. View Large Download. USPSTF indicates US Preventive Services Task Force. Figure 2. Clinical Summary: Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults. a Calculated as weight in kilograms divided by height in meters squared. Summary of Related USPSTF Recommendations. Audio Author Interview USPSTF Recommendation: Behavioral Interventions to Prevent Adult Obesity-Related Outcomes. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the US Preventive Services Task Force: Evidence Synthesis No. Rockville, MD: Agency for Healthcare Research and Quality; AHRQ publication EF Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, NCHS Data Brief. PubMed Google Scholar. Bogers RP, Bemelmans WJ, Hoogenveen RT, et al; BMI-CHD Collaboration Investigators. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than persons. Arch Intern Med. doi: Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review of the literature. j PubMed Google Scholar Crossref. Afshin A, Forouzanfar MH, Reitsma MB, et al; GBD Obesity Collaborators. Health effects of overweight and obesity in countries over 25 years. N Engl J Med. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health. Dobbins M, Decorby K, Choi BC. The association between obesity and cancer risk: a meta-analysis of observational studies from to ISRN Prev Med. Whitlock G, Lewington S, Sherliker P, et al; Prospective Studies Collaboration. Body-mass index and cause-specific mortality in adults: collaborative analyses of 57 prospective studies. Siu AL; U S Preventive Services Task Force. Screening for abnormal blood glucose and type 2 diabetes mellitus: U. Preventive Services Task Force recommendation statement. Siu AL; U. Preventive Services Task Force. Screening for high blood pressure in adults: U. Bibbins-Domingo K, Grossman DC, Curry SJ, et al; US Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U. Bibbins-Domingo K; U. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U. LeFevre ML; U. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U. Grossman DC, Bibbins-Domingo K, Curry SJ, et al; US Preventive Services Task Force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force recommendation statement. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Community Preventive Services Task Force CPSTF. CPSTF findings for obesity. The Community Guide website. Accessed July 31, Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, National Center for Health Statistics. Health, United States, With Chartbook on Long-term Trends in Health. Hyattsville, MD: National Center for Health Statistics; Report Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, to Echeverria SE, Mustafa M, Pentakota SR, et al. Social and clinically-relevant cardiovascular risk factors in Asian American adults: NHANES Prev Med. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: evidence report and systematic review for the US Preventive Services Task Force [published September 18, ]. Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Tuomilehto J, Lindström J, Eriksson JG, et al; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Lindström J, Peltonen M, Eriksson JG, et al; Finnish Diabetes Prevention Study DPS. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study DPS. Ochner CN, Barrios DM, Lee CD, Pi-Sunyer FX. Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. Rosenbaum M, Kissileff HR, Mayer LE, Hirsch J, Leibel RL. Energy intake in weight-reduced humans. Brain Res. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res. x PubMed Google Scholar. Moyer VA; U. Screening for and management of obesity in adults: U. Brauer P, Connor Gorber S, Shaw E, et al; Canadian Task Force on Preventive Health Care. Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care. Jortberg B, Myers E, Gigliotti L, et al. Academy of Nutrition and Dietetics: standards of practice and standards of professional performance for registered dietitian nutritionists competent, proficient, and expert in adult weight management. J Acad Nutr Diet. J Am Coll Cardiol. Garvey WT, Garber AJ, Mechanick JI, et al; The Aace Obesity Scientific Committee. American Association of Clinical Endocrinologists and American College of Endocrinology position statement on the advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract. PS PubMed Google Scholar Crossref. Stegenga H, Haines A, Jones K, Wilding J; Guideline Development Group. Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance. g PubMed Google Scholar Crossref. American Academy of Family Physicians AAFP. Clinical Preventive Service Recommendation: obesity. AAFP website. USPSTF Evidence Report: Behavioral Interventions to Prevent Adult Obesity-Related Outcomes. This systematic review to support the US Preventive Services Task Force Recommendation Statement on interventions to prevent obesity-related morbidity and mortality summarizes published evidence on the benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults. Erin S. LeBlanc, MD, MPH; Carrie D. Patnode, PhD, MPH; Elizabeth M. Webber, MS; Nadia Redmond, MSPH; Megan Rushkin, MPH; Elizabeth A. Adam G. Tsai, MD, MSCE; Caroline Apovian, MD; Lee Kaplan, MD, PhD. Susan J. Curry, PhD; Douglas K. Owens, MD, MS; Alex H. Krist, MD, MPH. Effect of Behavioral Therapy With In-Clinic or Telephone Group Visits vs In-Clinic Individual Visits on Weight Loss in Obesity. This randomized trial compares the effects on month weight change of behavioral therapy delivered at US rural clinics via in-clinic individual visits or in-clinic group visits vs telephone group visits to patients with obesity. Christie A. Befort, PhD; Jeffrey J. VanWormer, PhD; Cyrus Desouza, MD; Edward F. Ellerbeck, MD; Byron Gajewski, PhD; Kim S. Kimminau, PhD; K. Allen Greiner, MD; Michael G. |
| Obesity in adults: Behavioral therapy - UpToDate | What parents need to know. Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. CAS PubMed Google Scholar Thomson CA, Rock CL, Giuliano AR, Newton TR, Cui H, Reid PM, Green TL, Alberts DS, Women's Healthy E, Living Study G: Longitudinal changes in body weight and body composition among women previously treated for breast cancer consuming a high-vegetable, fruit and fiber, low-fat diet. Given the similarities in the duration and mode of delivery, the findings indicate that the different BCTs used, and mechanisms of action targeted, resulted in differences in weight change. The percentage of variation attributable to heterogeneity I 2 was computed from Cochran Q statistic. American Academy of Family Physicians AAFP. |
| Summary of Recommendation and Evidence | Assuncao MCF, Gigante DP, Cardoso MA, Sartorelli DS, Santos IS: Randomized, controlled trial promotes physical activity and reduces consumption of sweets and sodium among overweight and obese adults. Atlantis E, Chow CM, Kirby A: Fiatarone Singh MA: Worksite intervention effects on physical health: a randomized controlled trial. Health Prom Int. Azadbakht L, Mirmiran P, Esmaillzadeh A, Azizi T, Azizi F: Beneficial effects of a dietary approaches to stop hypertension eating plan on features of the metabolic syndrome. Diabetes Care. Balcazar HG, de Heer H, Rosenthal L, Aguirre M, Flores L, Puentes FA, Cardenas VM, Duarte MO, Ortiz M, Schulz LO: A promotores de salud intervention to reduce cardiovascular disease risk in a high-risk Hispanic border population, — Prev Chron Dis. Belalcazar LM, Reboussin DM, Haffner SM, Hoogeveen RC, Kriska AM, Schwenke DC, Tracy RP, Pi-Sunyer FX, Ballantyne CM, Look ARG: A 1-Year lifestyle intervention for weight loss in individuals with type 2 diabetes reduces high C-reactive protein levels and identifies metabolic predictors of change. Bouchard DR, Soucy L, Senechal M, Dionne IJ, Brochu M: Impact of resistance training with or without caloric restriction on physical capacity in obese older women. Brown C, Goetz J, Van Sciver A, Sullivan D, Hamera E: A psychiatric rehabilitation approach to weight loss. Psychiatr Rehabil J. Burke V, Beilin LJ, Cutt HE, Mansour J, Wilson A, Mori TA: Effects of a lifestyle programme on ambulatory blood pressure and drug dosage in treated hypertensive patients: a randomized controlled trial. J Hypertension. Carroll S, Borkoles E, Polman R: Short-term effects of a non-dieting lifestyle intervention program on weight management, fitness, metabolic risk, and psychological wellbeing in obese premenopausal females with the metabolic syndrome. de Mello VD, Kolehmainen M, Schwab U, Mager U, Laaksonen DE, Pulkkinen L, Niskanen L, Gylling H, Atalay M, Rauramaa R, Uusitupa M: Effect of weight loss on cytokine messenger RNA expression in peripheral blood mononuclear cells of obese subjects with the metabolic syndrome. Eiben G, Lissner L: Health Hunters - An intervention to prevent overweight and obesity in young high-risk women. Elliot DL, Goldberg L, Kuehl KS, Moe EL, Breger RK, Pickering MA: The PHLAME Promoting Healthy Lifestyles: Alternative Models' Effects firefighter study: outcomes of two models of behavior change. J Occup Environ Med. Eriksson KM, Westborg CJ, Eliasson MC: A randomized trial of lifestyle intervention in primary healthcare for the modification of cardiovascular risk factors. Scand J Pub Health. Faucher MA, Mobley J: A community intervention on portion control aimed at weight loss in low-income Mexican American women. J Midwifery Womens Health. Fenkci S, Sarsan A, Rota S, Ardic F: Effects of resistance or aerobic exercises on metabolic parameters in obese women who are not on a diet. Adv Ther. Folta SC, Lichtenstein AH, Seguin RA, Goldberg JP, Kuder JF, Nelson ME: The StrongWomen-Healthy Hearts program: reducing cardiovascular disease risk factors in rural sedentary, overweight, and obese midlife and older women. Ghroubi S, Elleuch H, Chikh T, Kaffel N, Abid M, Elleuch MH: Physical training combined with dietary measures in the treatment of adult obesity. A comparison of two protocols. Ann Phys Rehabil Med. Gorin AA, Wing RR, Fava JL, Jakicic JM, Jeffery R, West DS, Brelje K, Dilillo VG, Look AHERG: Weight loss treatment influences untreated spouses and the home environment: evidence of a ripple effect. Groeneveld IF, Proper KI, van der Beek AJ, van Mechelen W: Sustained body weight reduction by an individual-based lifestyle intervention for workers in the construction industry at risk for cardiovascular disease: Results of a randomized controlled trial. Gutschall MD, Miller CK, Mitchell DC, Lawrence FR: A randomized behavioural trial targeting glycaemic index improves dietary, weight and metabolic outcomes in patients with type 2 diabetes. Pub Health Nutr. Haapala I, Barengo NC, Biggs S, Surakka L, Manninen P: Weight loss by mobile phone: a 1-year effectiveness study. Hardcastle S, Taylor A, Bailey M, Castle R: A randomised controlled trial on the effectiveness of a primary health care based counselling intervention on physical activity, diet and CHD risk factors. Patient Educ Couns. Howard BV, Manson JE, Stefanick ML, Beresford SA, Frank G, Jones B, Rodabough RJ, Snetselaar L, Thomson C, Tinker L, et al: Low-fat dietary pattern and weight change over 7 years: the Women's Health Initiative Dietary Modification Trial. Hoy MK, Winters BL, Chlebowski RT, Papoutsakis C, Shapiro A, Lubin MP, Thomson CA, Grosvenor MB, Copeland T, Falk E, et al: Implementing a low-fat eating plan in the Women's Intervention Nutrition Study. Ibanez J, Izquierdo M, Martinez-Labari C, Ortega F, Grijalba A, Forga L, Idoate F, Garcia-Unciti M, Fernandez-Real JM, Gorostiaga EM: Resistance training improves cardiovascular risk factors in obese women despite a significative decrease in serum adiponectin levels. Jiang X, Sit JW, Wong TK: A nurse-led cardiac rehabilitation programme improves health behaviours and cardiac physiological risk parameters: evidence from Chengdu, China. J Clin Nursing. Kattelmann KK, Conti K, Ren C: The medicine wheel nutrition intervention: a diabetes education study with the Cheyenne River Sioux Tribe. Kim KH, Linnan L, Campbell MK, Brooks C, Koenig HG, Wiesen C: The WORD wholeness, oneness, righteousness, deliverance : a faith-based weight-loss program utilizing a community-based participatory research approach. Health Educ Behav. Int J Food Sci Nutr. Lally P, Chipperfield A, Wardle J: Healthy habits: efficacy of simple advice on weight control based on a habit-formation model. Ledikwe JH, Rolls BJ, Smiciklas-Wright H, Mitchell DC, Ard JD, Champagne C, Karanja N, Lin PH, Stevens VJ, Appel LJ: Reductions in dietary energy density are associated with weight loss in overweight and obese participants in the PREMIER trial. Levine MD, Klem ML, Kalarchian MA, Wing RR, Weissfeld L, Qin L, Marcus MD: Weight gain prevention among women. Lutes LD, Winett RA, Barger SD, Wojcik JR, Herbert WG, Nickols-Richardson SM, Anderson ES: Small changes in nutrition and physical activity promote weight loss and maintenance: 3-month evidence from the ASPIRE randomized trial. Mahon AK, Flynn MG, Stewart LK, McFarlin BK, Iglay HB, Mattes RD, Lyle RM, Considine RV, Campbell WW: Protein intake during energy restriction: effects on body composition and markers of metabolic and cardiovascular health in postmenopausal women. J Am Coll Nutr. Masley SC, Weaver W, Peri G, Phillips SE: Efficacy of lifestyle changes in modifying practical markers of wellness and aging. Altern Ther Health Med. McConnon A, Kirk SF, Cockroft JE, Harvey EL, Greenwood DC, Thomas JD, Ransley JK, Bojke L: The Internet for weight control in an obese sample: results of a randomised controlled trial. BMC Health Serv Res. McDoniel SO, Wolskee P, Shen J: Treating obesity with a novel hand-held device, computer software program, and Internet technology in primary care: the SMART motivational trial. McKibbin CL, Patterson TL, Norman G, Patrick K, Jin H, Roesch S, Mudaliar S, Barrio C, O'Hanlon K, Griver K, et al: A lifestyle intervention for older schizophrenia patients with diabetes mellitus: a randomized controlled trial. Mefferd K, Nichols JF, Pakiz B, Rock CL: A cognitive behavioral therapy intervention to promote weight loss improves body composition and blood lipid profiles among overweight breast cancer survivors. Breast Cancer Res Treat. Milano W, Grillo F, Del Mastro A, De Rosa M, Sanseverino B, Petrella C, Capasso A: Appropriate intervention strategies for weight gain induced by olanzapine: a randomized controlled study. Oldroyd JC, Unwin NC, White M, Mathers JC, Alberti KG: Randomised controlled trial evaluating lifestyle interventions in people with impaired glucose tolerance. Paineau DL, Beaufils F, Boulier A, Cassuto DA, Chwalow J, Combris P, Couet C, Jouret B, Lafay L, Laville M, et al: Family dietary coaching to improve nutritional intakes and body weight control: a randomized controlled trial. Arch Pediatr Adolesc Med. Porsdal V, Beal C, Kleivenes OK, Martinsen EW, Lindstrom E, Nilsson H, Svanborg P: The Scandinavian Solutions for Wellness study - a two-arm observational study on the effectiveness of lifestyle intervention on subjective well-being and weight among persons with psychiatric disorders. BMC Psychiatry. Poulin MJ, Chaput JP, Simard V, Vincent P, Bernier J, Gauthier Y, Lanctot G, Saindon J, Vincent A, Gagnon S, Tremblay A: Management of antipsychotic-induced weight gain: prospective naturalistic study of the effectiveness of a supervised exercise programme. Aust NZ J Psychiatry. Racette SB, Weiss EP, Villareal DT, Arif H, Steger-May K, Schechtman KB, Fontana L, Klein S, Holloszy JO, Washington University School of Medicine CG: One year of caloric restriction in humans: feasibility and effects on body composition and abdominal adipose tissue. J Gerontol A Biol Sci Med Sci. Racette SB, Deusinger SS, Inman CL, Burlis TL, Highstein GR, Buskirk TD, Steger-May K, Peterson LR: Worksite opportunities for wellness WOW : effects on cardiovascular disease risk factors after 1 year. Rodearmel SJ, Wyatt HR, Barry MJ, Dong F, Pan D, Israel RG, Cho SS, McBurney MI, Hill JO: A family-based approach to preventing excessive weight gain. Roumen C, Corpeleijn E, Feskens EJ, Mensink M, Saris WH, Blaak EE: Impact of 3-year lifestyle intervention on postprandial glucose metabolism: the SLIM study. Diabetes Med. Samuel-Hodge CD, Keyserling TC, Park S, Johnston LF, Gizlice Z, Bangdiwala SI: A randomized trial of a church-based diabetes self-management program for African Americans with type 2 diabetes. Diabetes Educ. Sarsan A, Ardic F, Ozgen M, Topuz O, Sermez Y: The effects of aerobic and resistance exercises in obese women. Clin Rehabil. Sartorelli DS, Sciarra EC, Franco LJ, Cardoso MA: Beneficial effects of short-term nutritional counselling at the primary health-care level among Brazilian adults. Schwab U, Seppanen-Laakso T, Yetukuri L, Agren J, Kolehmainen M, Laaksonen DE, Ruskeepaa AL, Gylling H, Uusitupa M, Oresic M, Group GS: Triacylglycerol fatty acid composition in diet-induced weight loss in subjects with abnormal glucose metabolism—the GENOBIN study. PLos One. Stahre L, Hallstrom T: A short-term cognitive group treatment program gives substantial weight reduction up to 18 months from the end of treatment. A randomized controlled trial. Eating Weight Disord. Straznicky NE, Lambert EA, Nestel PJ, McGrane MT, Dawood T, Schlaich MP, Masuo K, Eikelis N, de Courten B, Mariani JA, et al: Sympathetic neural adaptation to hypocaloric diet with or without exercise training in obese metabolic syndrome subjects. Subak LL, Whitcomb E, Shen H, Saxton J, Vittinghoff E, Brown JS: Weight loss: a novel and effective treatment for urinary incontinence. J Urology. Svendsen M, Blomhoff R, Holme I, Tonstad S: The effect of an increased intake of vegetables and fruit on weight loss, blood pressure and antioxidant defense in subjects with sleep related breathing disorders. Eur J Clin Nutr. Thomson CA, Rock CL, Giuliano AR, Newton TR, Cui H, Reid PM, Green TL, Alberts DS, Women's Healthy E, Living Study G: Longitudinal changes in body weight and body composition among women previously treated for breast cancer consuming a high-vegetable, fruit and fiber, low-fat diet. Eur J Nutr. Thoolen BJ, de Ridder D, Bensing J, Gorter K, Rutten G: Beyond good intentions: The role of proactive coping in achieving sustained behavioural change in the context of diabetes management. Psychol Health. Toobert DJ, Strycker LA, Glasgow RE, Barrera M, Angell K: Effects of the mediterranean lifestyle program on multiple risk behaviors and psychosocial outcomes among women at risk for heart disease. Torres SJ, Nowson CA: Effect of a weight-loss program on mental stress-induced cardiovascular responses and recovery. Tully MA, Cupples ME, Chan WS, McGlade K, Young IS: Brisk walking, fitness, and cardiovascular risk: a randomized controlled trial in primary care. Tuomilehto HP, Seppa JM, Partinen MM, Peltonen M, Gylling H, Tuomilehto JO, Vanninen EJ, Kokkarinen J, Sahlman JK, Martikainen T, et al: Lifestyle intervention with weight reduction: first-line treatment in mild obstructive sleep apnea. Am J Respir Crit Care Med. Vissers D, Verrijken A, Mertens I, Van Gils C, Van de Sompel A, Truijen S, Van Gaal L: Effect of long-term whole body vibration training on visceral adipose tissue: a preliminary report. Obesity Facts. von Gruenigen VE, Coumeya KS, GibbonS HE, Kavanagh MB, Waggoner SE, Lemer E: Feasibility and effectiveness of a lifestyle intervention program in obese endometrial cancer patients: A randomized trial. Gynecol Oncol. Weiss EP, Villareal DT, Racette SB, Steger-May K, Premachandra BN, Klein S, Fontana L: Caloric restriction but not exercise-induced reductions in fat mass decrease plasma triiodothyronine concentrations: a randomized controlled trial. Rejuvenation Res. Werkman A, Hulshof PJM, Stafleu A, Kremers SPJ, Kok FJ, Schouten EG, Schuit AJ: Effect of an individually tailored one-year energy balance programme on body weight, body composition and lifestyle in recent retirees: a cluster randomised controlled trial. BMC Public Health. Download references. Cancer Prevention Research Centre, School of Population Health, The University of Queensland, Herston, Brisbane, QLD, , Australia. Prevention Research Collaboration, School of Public Health, The University of Sydney, Sydney, NSW, , Australia. You can also search for this author in PubMed Google Scholar. Correspondence to Lauren Waters. All four authors contributed to the conception and design of the study. LW carried out the literature search. LW and ASG reviewed articles for inclusion in the review and abstracted data. LW conducted the descriptive data analysis and TC completed the meta-regression analysis. All authors helped to draft the manuscript and all authors read and approved the final manuscript. Additional file 1: Appendix. DOCX 28 KB. This article is published under license to BioMed Central Ltd. Reprints and permissions. Waters, L. et al. Weight change in control group participants in behavioural weight loss interventions: a systematic review and meta-regression study. BMC Med Res Methodol 12 , Download citation. Received : 07 November Accepted : 23 July Published : 08 August Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Background Unanticipated control group improvements have been observed in intervention trials targeting various health behaviours. Methods Database searches identified reports of intervention trials meeting the inclusion criteria. Results 85 trials were reviewed and 72 were included in the meta-regression. Conclusions There are several possible explanations why control group changes occur in intervention trials targeting other behaviours, but not for weight loss. Background The increasing prevalence of overweight and obesity has become a cause for concern over the past decade [ 1 ] with overweight and obesity being major determinants of a number of chronic health conditions including hypertension, cardiovascular disease, diabetes and cancer [ 2 ]. Methods Criteria for inclusion Reports of randomised controlled trials or quasi-experimental trials evaluating behavioural weight loss interventions targeting adult participants, and that were published in English between and were potentially eligible for inclusion in this review. Study selection One person, LW, screened the titles and abstracts of articles identified through electronic database searches. Data abstraction Data was abstracted and coded by two reviewers LW and AS. Trial design and methodology Weight loss interventions were evaluated using randomised controlled trials or quasi-experimental non-randomised controlled trials. Data analysis Bivariate analysis A simple, descriptive bivariate analysis was conducted to assess the associations between control group weight change in kilograms, and variables hypothesized to be potentially associated with control group change PASW v. Meta-analysis and meta-regression The study protocol adhered to PRISMA guidelines for reporting systematic reviews and meta-analyses. Results Following the removal of duplicates, the total number of references identified through electronic database searching was 1,; of which 1, were intervention trials targeting weight loss. Figure 1. Flow diagram of studies included in the review. Full size image. Table 1 Bivariate associations between explanatory variables and control group weight change kg Full size table. Figure 2. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review of the literature. j PubMed Google Scholar Crossref. Afshin A, Forouzanfar MH, Reitsma MB, et al; GBD Obesity Collaborators. Health effects of overweight and obesity in countries over 25 years. N Engl J Med. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health. Dobbins M, Decorby K, Choi BC. The association between obesity and cancer risk: a meta-analysis of observational studies from to ISRN Prev Med. Whitlock G, Lewington S, Sherliker P, et al; Prospective Studies Collaboration. Body-mass index and cause-specific mortality in adults: collaborative analyses of 57 prospective studies. Siu AL; U S Preventive Services Task Force. Screening for abnormal blood glucose and type 2 diabetes mellitus: U. Preventive Services Task Force recommendation statement. Siu AL; U. Preventive Services Task Force. Screening for high blood pressure in adults: U. Bibbins-Domingo K, Grossman DC, Curry SJ, et al; US Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U. Bibbins-Domingo K; U. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U. LeFevre ML; U. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U. Grossman DC, Bibbins-Domingo K, Curry SJ, et al; US Preventive Services Task Force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force recommendation statement. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Community Preventive Services Task Force CPSTF. CPSTF findings for obesity. The Community Guide website. Accessed July 31, Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, National Center for Health Statistics. Health, United States, With Chartbook on Long-term Trends in Health. Hyattsville, MD: National Center for Health Statistics; Report Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL. Trends in obesity among adults in the United States, to Echeverria SE, Mustafa M, Pentakota SR, et al. Social and clinically-relevant cardiovascular risk factors in Asian American adults: NHANES Prev Med. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: evidence report and systematic review for the US Preventive Services Task Force [published September 18, ]. Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. Tuomilehto J, Lindström J, Eriksson JG, et al; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Lindström J, Peltonen M, Eriksson JG, et al; Finnish Diabetes Prevention Study DPS. Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study DPS. Ochner CN, Barrios DM, Lee CD, Pi-Sunyer FX. Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. Rosenbaum M, Kissileff HR, Mayer LE, Hirsch J, Leibel RL. Energy intake in weight-reduced humans. Brain Res. National Institutes of Health. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res. x PubMed Google Scholar. Moyer VA; U. Screening for and management of obesity in adults: U. Brauer P, Connor Gorber S, Shaw E, et al; Canadian Task Force on Preventive Health Care. Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care. Jortberg B, Myers E, Gigliotti L, et al. Academy of Nutrition and Dietetics: standards of practice and standards of professional performance for registered dietitian nutritionists competent, proficient, and expert in adult weight management. J Acad Nutr Diet. J Am Coll Cardiol. Garvey WT, Garber AJ, Mechanick JI, et al; The Aace Obesity Scientific Committee. American Association of Clinical Endocrinologists and American College of Endocrinology position statement on the advanced framework for a new diagnosis of obesity as a chronic disease. Endocr Pract. PS PubMed Google Scholar Crossref. Stegenga H, Haines A, Jones K, Wilding J; Guideline Development Group. Identification, assessment, and management of overweight and obesity: summary of updated NICE guidance. g PubMed Google Scholar Crossref. American Academy of Family Physicians AAFP. Clinical Preventive Service Recommendation: obesity. AAFP website. USPSTF Evidence Report: Behavioral Interventions to Prevent Adult Obesity-Related Outcomes. This systematic review to support the US Preventive Services Task Force Recommendation Statement on interventions to prevent obesity-related morbidity and mortality summarizes published evidence on the benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults. Erin S. LeBlanc, MD, MPH; Carrie D. Patnode, PhD, MPH; Elizabeth M. Webber, MS; Nadia Redmond, MSPH; Megan Rushkin, MPH; Elizabeth A. Adam G. Tsai, MD, MSCE; Caroline Apovian, MD; Lee Kaplan, MD, PhD. Susan J. Curry, PhD; Douglas K. Owens, MD, MS; Alex H. Krist, MD, MPH. Effect of Behavioral Therapy With In-Clinic or Telephone Group Visits vs In-Clinic Individual Visits on Weight Loss in Obesity. This randomized trial compares the effects on month weight change of behavioral therapy delivered at US rural clinics via in-clinic individual visits or in-clinic group visits vs telephone group visits to patients with obesity. Christie A. Befort, PhD; Jeffrey J. VanWormer, PhD; Cyrus Desouza, MD; Edward F. Ellerbeck, MD; Byron Gajewski, PhD; Kim S. Kimminau, PhD; K. Allen Greiner, MD; Michael G. Perri, PhD; Alexandra R. Brown, MS; Ram D. Pathak, MD; Terry T. Huang, PhD; Leslie Eiland, MD; Andjela Drincic, MD. Using only two time points, especially the start and end of a study means that the model does not represent the trajectory of weight throughout the intervention and follow-up [ 36 ]. Latent growth curve analysis LGCA enables the analysis of the full trajectory of a variable over time. This is particularly important when individual changes follow a nonlinear trajectory, which is likely in a weight-management intervention in which a greater change during the active intervention than during follow-up is often expected [ 6 ]. LGCA also enables variables to be both outcomes and predictors so that the trajectory of a potential mediator can be conditional on demographics factors while also being a predictor of an outcome. This method allows a greater understanding of the complex associations between treatment, mechanisms of action, and outcomes over time [ 36 ]. Secondary mediation analysis was conducted on data from the Weight loss Referrals for Adults in Primary care trial the weight loss referrals for adults in primary care [WRAP] trial , which examined the effectiveness and cost-effectiveness of a 52 week referral to an open-group behavioral weight-management program WW, formerly Weight Watchers compared to a 12 week referral to the same program and a brief intervention written materials on how to lose weight [ 37 ]. Participants assigned to the 12 and 52week weight-management programs lost significantly more weight than the control group at 3 and 12 months and those assigned to the 52 week program lost significantly more weight than the 12 week program and the brief intervention at 12 and 24 months. The full results are reported in Ahern et al. The aim of the present study was to investigate whether the trajectories of dietary restraint, habit strength, and autonomous, controlled, and amotivation self-regulation of diet mediated the effect of the weight-management program on BMI trajectory over 24 months using LGCA, a method that incorporates the full trajectory of the mediators and BMI. Eligible individuals were identified by their primary care providers. Patients who were pregnant or were planning pregnancy within 2 years, had past or planned bariatric surgery, were already participating in a structured monitored weight-management program, were taking part in other research that would impact on the study outcomes, had a diagnosed eating disorder, or were unable to understand study information were excluded. Practices also excluded patients considered ineligible for other reasons not stated above, such as terminal illness or a mental health diagnosis. Eligible participants were then invited to take part in the study by letter and asked to contact a study coordinator for a telephone screening if interested in participating. Eligible and willing participants were given an appointment where weight and height were measured to confirm eligibility. All participants gave written informed consent [ 37 ]. Participants were randomly assigned to either a brief intervention, a 12 week referral to an open-group behavioral weight-management program WW, formerly Weight Watchers or a 52 week referral to the same program in a allocation stratified by center and gender using a randomization sequence generated by the trial statistician. The brief intervention included the recognition of the problem by the GP in the form of a letter and written information on self-help weight loss strategies British Heart Foundation Booklet: So you want to lose weight…for good. At the baseline visit, participants were read a scripted introduction that drew attention to each section of this booklet. The 12 and 52 week behavioral weight-management programs were group based and led by an individual who had personal experience of successful weight management. It included one-to-one discussions with participants at their first session and during the part of the session when participants were weighed [ 38 ]. Sessions were held once a week at community-based venues and were an hour long. Sessions also included information about recipes, health and nutrition, and physical activity. Weight loss goals were between 0. Participants were encouraged to be physically active and work toward a goal of 10, steps per day. The intervention used food and activity diaries, goal setting, evaluation of progression and the provision of rewards for reaching weight loss targets. Using the taxonomy described by Michie et al. Participants assigned to the behavioral weight-management programs were given vouchers to attend weekly sessions and use online tools for the duration of their intervention. Those allocated to the 12 week referral received vouchers to attend 12 group sessions and access to internet resources for 16 weeks and those allocated to the 52 week referral received vouchers for 52 sessions and access to internet resources for 12 months [ 42 ]. The vouchers covered the full cost of the sessions and access to online resources. BMI and potential mediators were collected at baseline and 3, 12 and 24 months. Height was measured at baseline to the nearest 0. A item subscale of the Three-Factor Eating Questionnaire [ 12 , 43 ] was used to assess two types of restraint: rigid control, which refers to an all-or-nothing perception of weight control, and flexible control, which refers to more adaptability in eating behaviors to control weight. This reflects findings from other studies in which dieting behavior and weight loss are associated with similar increases in both rigid and flexible dietary restraint [ 44 , 45 ]. Higher scores on this measure represent greater control over dietary behaviors [ 11 , 43 ]. The self-report habit index [ 46 ] was used to measure habit strength. Higher scores indicate that the behavior is more habitual. The measure of diet self-regulation was adapted from the treatment self-regulation questionnaire [ 47 ] to assess self-regulation of eating a healthy diet. To examine the longitudinal associations between the potential mediators and BMI, LGCA was conducted. This type of analysis, in which a curve is fitted to the variable at each of the four time points, allows examination of the trajectory of variables over the 2 years. More detail about this analysis method can be found in the Supplementary Material. All analyses were conducted using Mplus8, Version 1. Maximum likelihood estimation was used for all models. The analysis was conducted in three stages. Scores at baseline and 3, 12, and 24 months were used to fit a curve to BMI, dietary restraint, habit strength, and the three subscales of diet self-regulation: autonomous, controlled, and amotivation. The intercept factor represented the values at baseline and the slope and quadratic factors represented the change in variables between baseline and 24 months. The means of each variable over the four time points were examined to determine the likely shape of the curve i. First, a simple model was fitted in which there was a single growth factor with a variance of zero. Then, as recommended [ 48 ], increasingly complex models were fitted and compared. At each stage, if the simpler model had a better or equal fit to the more complex model, it was chosen for analysis. An example of the path diagram for the unconditional model is in Supplementary Fig. Once the best fitting unconditional model was chosen, variables were added to form the conditional model [ 36 ]. Age, gender, and treatment group were included as control variables for each latent growth factor. For the BMI curve, income and education were also controlled based on evidence that these demographic factors are associated with BMI [ 49 ]. These additional factors were not included in the curve for the potential mediators due to the lack of evidence supporting an association. Path diagrams for the conditional models are in Supplementary Figs. A piecewise analysis was also fitted, splitting the trajectories of BMI and potential mediators into two latent growth curves based on the initial change baseline to either 3 or 12 months depending on the trajectory of the variable; Figs. This analysis was conducted to determine whether piecewise models resulted in a better fit to the variables and to explore the relationships between BMI and potential mediators at different time points in the trial. Mean change in habit strength, dietary restraint, and diet self-regulation subscales in each treatment group over 24 months. Parallel processes models were developed for each of the potential mediator variables and BMI. These models allow the examination of the correlation between the growth curves fitted in step one. Specifically, the curve fitted to the potential mediators in the previous step was individually combined with the curve fitted to the BMI trajectory to determine the correlations between the latent growth factors of the two variables. If the trajectory of a potential mediator was associated with group allocation identified in Step 1 and with the BMI trajectory Step 2 , then it was included in the full mediation model. The curves fitted to the potential mediators and BMI in Step 1 were combined in a single model in which the trajectory of BMI was conditional on the trajectory of potential mediators. The significance of the individual indirect effects of each mediator, total indirect effect, and the direct effect between the intervention and the BMI was examined to determine whether the intervention effect was mediated. Model fit was checked at each stage. The criteria used to make a judgment on model fit were a comparative fit index CFI above or equal to 0. The fit of each model was assessed using all criteria. The percentage of missing data for each treatment group and specifically for BMI and the measures are reported in Supplementary Tables 3 and 4. The pattern of missing data was assessed and was treated as missing not at random. There was an increasing number of missing values at later time points and it is probable that dropout was linked to treatment effectiveness [ 50 ]. Multiple imputation was conducted using R. For each variable, the missing values were predicted; the variables selected for prediction were based on the strategy outlined by van Buuren et al. A prediction matrix Supplementary Fig. Full details of the method used are in the Supplementary Material. Convergence plots confirmed that convergence had been achieved and strip plots showed that the imputed values did not go out of the range of the actual values and that they followed the same distribution. Between 18 October and 10 February , participants were screened and 1, were eligible and were randomly allocated to a condition [ 37 ]. Additional participant characteristics can be found in the original reporting of the study [ 37 ]. There were no significant differences between the treatment groups at baseline on BMI or the potential mediators determined by one-way analysis of variance tests. BMI and the mediator variables showed change between baseline and 3 or 12 months before a stabilization or return toward baseline between 12 and 24 months. Autonomous diet self-regulation decreased over the 24 months for all intervention groups. BMI body mass index; SD standard deviation; GCSE general certificate of secondary education. A latent growth curve was fitted to the four time points baseline and 3, 12, and 24 months for BMI, dietary restraint, habit strength, and the three subscales of diet self-regulation autonomous, controlled, and amotivation. A quadratic growth curve was the best fitting model for all variables other than the amotivation subscale of diet self-regulation for which an intercept-only model was the best fit. For the other four potential mediators dietary restraint, habit strength, and autonomous and controlled diet self-regulation , the model was able to converge and fitted best when the variance of the quadratic factor was set to 0. The model for BMI fitted well without this restriction. The results from the increasingly complex unconditional models are reported in Supplementary Tables 5— Once the best fitting unconditional model was established, the conditional factors were added. The values for each of the latent growth factors along with fit statistics of the conditional model are shown in Table 2. The model fit for all variables was good for all the criteria other than the model for BMI, which did not meet the cutoff criteria for CFI and RMSEA. However, the values were close to the criteria, indicating that the model provided a reasonable description of the data. BMI body mass index; CFI comparative fit index; DSR diet self-regulation; RMSEA root mean square error of approximation; SRMR standardized root mean square residual. Table 3 shows the full details of the associations between the latent growth factors of each variable and age, gender, and treatment group in the conditional models. There were significant effects of both the 12 and 52 week program on the slope and quadratic of the BMI trajectory, controlling for age, gender, income, and education. There were significant effects of both the 12 and 52 week program on the slope and quadratic factors of dietary restraint and habit strength but only the 52 week intervention significantly impacted autonomous diet self-regulation. Age and gender were controlled for in all models. Gender was associated with the slope and quadratic of dietary restraint and controlled diet self-regulation, and age was associated with the slope and quadratic of autonomous diet self-regulation. Coefficients of age, gender, and group allocation on trajectories of BMI and potential mediators. Piecewise latent growth curves were fitted to the trajectories of BMI and the potential mediators; however, this resulted in a poorer fit than the quadratic model. Full results are in the Supplementary Tables 11— The associations between each of the latent growth factors of the potential mediator variables and the latent growth factors of BMI along with the model fit statistics are in Table 4. Increases in these potential mediators were associated with decreases in BMI. The amotivation subscale of diet self-regulation was specified as an intercept-only model, so the correlation of the change over time in this variable with change in BMI could not be examined. Although the curve of the potential mediator variables were quadratic, the quadratic growth factors were fixed to 0 and, therefore, the correlation between this and the BMI growth factors could not be calculated. Although three models fell slightly below the criteria recommended for the CFI, all were close and met other measures of fit. Correlations between the latent growth factors of BMI and potential mediators. BMI body mass index; CFI comparative fit index; RMSEA root mean square error of approximation; SRMR standardized root mean square residual. In the piecewise analyses, associations between the slopes of the mediators in the intervention 0—12 months and maintenance phases 12—24 months were examined. In the intervention phase, the BMI slope was associated with the slopes of dietary restraint, habit strength, and autonomous diet self-regulation. The BMI slope in the maintenance phase was associated with the slope of autonomous diet self-regulation in the intervention phase and the slope of habit in the maintenance phase. However, the fit of the piecewise models was poor based on model fit statistics Supplementary Table Therefore, these results should be interpreted with caution and a full mediation model was not examined. In Step 1, it was determined that there were treatment effects of both the 12 and 52 week intervention on BMI trajectory compared to the control group. Of the potential mediators, dietary restraint, habit strength, and autonomous diet self-regulation were associated with both treatment group Step 1 and BMI trajectory Step 2. The amotivation and controlled subscales of diet self-regulation did not fit these criteria and, therefore, were not included. Mediation models were tested to determine whether the impact of the intervention on BMI slope was mediated by the slope of dietary restraint, habit strength, and autonomous diet self-regulation the variance of the quadratic variables was restricted to 0 and, therefore, could not be included as a mediator. The results of the separate models for each of the potential mediators are in Supplementary Table 16 and indicate that dietary restraint and habit strength were significant mediators of the 12 week intervention and that all three variables were significant mediators of the 52 week intervention. A full mediation model with all three mechanisms of action was then tested. When fitted, the total effects of both interventions on BMI slope were significant and the direct effects became nonsignificant Table 5. The total indirect effect via the three mediator variables was significant; for the 12 week intervention effect, only the individual indirect effect of dietary restraint was statistically significant, whereas for the 52 week intervention, the individual indirect of all three variables were significant. Effect sizes were larger for the 52 week program than the 12 week program on all mediators but only significantly larger for dietary restraint and habit strength. Model fit statistics indicate an adequate fit on RMSEA 0. The results of this are shown in Table 5 and a simplified model is included in Fig. Total, direct, and indirect effects via mediating variables of the 12 and 52 week intervention on BMI. Dietary restraint, habit strength, and autonomous diet self-regulation mediated the effect of a weight-management program on BMI change. The 12 and 52 week programs were both associated with increases in dietary restraint and habit strength and the 52 week program was also associated with a lower reduction in autonomous diet self-regulation. These changes were associated with decreases in BMI over the 2 years. When controlling for change in habit strength, dietary restraint, and autonomous diet self-regulation, the impact of both the 12 and 52 week programs on the slope of BMI became nonsignificant. Although the combined indirect effect was significant for both the 12 and 52 week interventions, for the shorter intervention, only the individual direct effect of dietary restraint was significant, whereas the indirect direct effect of all three variables were significant for the 52 week intervention. This intervention included several BCTs and so it is not possible to establish which specific BCTs or combination of BCTs resulted in the increases in dietary restraint and habit strength observed during the 12 and 52 week weight-management programs. However, the intervention included several BCTs that have been linked with behavioral regulation, including self-monitoring of behavior and outcomes, through food and activity diaries and regular weight measurement, goal setting, and action planning [ 52 , 53 ]. Given that dietary restraint can be considered as behavioral and cognitive control of eating behavior, these BCTs may have contributed to the observed increase in dietary restraint. The BCTs that may have contributed to the increase in habit strength are social support, restricting the food environment and general information on behavior-health link. These have all been linked to behavioral cueing, a construct that promotes the formation of habits [ 52 , 53 ]. However, the finding that habit strength was a significant independent mediator for the 52 week intervention but not the 12 week intervention indicates that the intervention length might be an influential moderating factor. This formation of stronger habits may be particularly important as piecewise analysis indicated that a reduction in habit strength following the intervention was associated with an increase in BMI. Given that the content of the weight-management programs were the same other than their length, the 52 week intervention provided participants with continued social support from the group leader and other attendees, as well as more opportunity to perform behaviors frequently in a stable context compared to the 12 week intervention; this may have enabled the transition of diet monitoring behavior from deliberative to automatic control [ 54 ], which, in turn, supported weight loss maintenance. Such an interpretation is in line with dual-process theories. These theories outline deliberative or reflective processes that involve conscious and rational decision-making and automatic or impulsive processes that involve nonconscious, learned reactions [ 55—57 ]. This is particularly important in health behaviors when individuals aiming to perform healthy behaviors often have to overcome unhealthy habitual behaviors and make conscious and reasoned healthier decisions [ 56 ]. These findings support the use of long-term interventions that may facilitate the transition from deliberative attempts to control eating dietary restraint to more automatic and less effortful self-regulation of eating behavior habit strength. Although autonomous self-regulation was identified as an independent significant mediator for the 52 week intervention, all groups actually experienced a decrease in autonomous motivation throughout the trial and follow-up. This indicates that, although the lesser reduction experienced by the individuals in the 52 week intervention compared to the other two groups was beneficial for weight loss , all interventions including the brief intervention had a negative effect on autonomous self-regulation. It is possible that this, and other, weight-management interventions may have a negative impact on autonomous self-regulation through implicitly promoting the message that participants need to be told what to do by people with expertise in order to manage their weight [ 28 ]. This is supported by qualitative findings from the WRAP trial that suggested that participants felt a sense of obligation to the leader of the group sessions [ 58 ]. The weight loss and weight loss maintenance achieved in both the 12 and 52 week intervention may have been greater if autonomous self-regulation had been maintained or increased during the intervention. The findings have implications for the content of future interventions. Given that dietary restraint, habit strength, and autonomous diet self-regulation mediated the effect of the weight-management program on weight loss and maintenance over 2 years, researchers should consider including BCTs that are hypothesized to target these mechanisms of action in future interventions. Recent research that has sought to link specific BCTs and mechanisms of action could be used to identify further BCTs to increase dietary restraint, habit strength, and autonomous diet self-regulation [ 52 , 53 ]. For example, expert consensus exercises have indicated that the BCTs of introducing prompts and cues for a desired behavior and avoiding or reducing exposure to cues for an unhealthy behavior may be linked to behavioral cueing [ 52 ], a mechanism of action that is likely to support the formation of new habits. Similarly, self-monitoring and goal setting have been linked to behavioral regulation [ 53 ] and could be used as strategies to support dietary restraint. Although a range of BCTs have been linked with motivation as a mechanism of action, including the use of rewards and the consideration of pros and cons [ 52 , 53 ], particular attention needs to be given to how to specifically target autonomous motivation. For example, interventions implementing an autonomy-supportive environment, in which individuals are encouraged to engage in health-related behaviors for their own reasons, are supported in overcoming barriers to change, and are made to feel accepted and respected, have been found to be associated with higher autonomous self-regulation, a healthier diet, and greater weight loss in a meta-analysis [ 59 ]. In contrast, techniques such as the use of rewards may foster more extrinsic or controlled forms of motivation, which, although may promote initial behavior change, may not be sufficient to support the maintenance of behavior change [ 60 , 61 ]. In addition, given that the longer duration of intervention was associated with larger changes in dietary restraint and habit strength, researchers should consider interventions that provide support over an extended period of time to promote sustained changes in those mechanisms of action that contribute to weight loss maintenance. A key strength of this study compared to previous studies was the use of LGCA to disentangle the complex system of interactions between behavioral weight-management interventions, mechanisms of action, and the trajectory of weight change. This method enabled a mediation analysis that accounted for changes at every time point rather than just two time points that are often considered in traditional regression methods. |
| 3 behavioral psychology tips for weight loss | CNN | Remember it takes about 20 minutes for your stomach to send a message to your brain that it is full. Don't let fake hunger make you think you need more. The ideal way to eat is to take a bite, put your utensil down, take a sip of water, cut your next bite, take a bit, put your utensil down and so on. Do not cut your food all at one time. Cut only as needed. Take small bites and chew your food well. Stop eating for a minute or two at least once during a meal or snack. Take breaks to reflect and have conversation. Cleanup and Leftovers Label leftovers for a specific meal or snack. Freeze or refrigerate individual portions of leftovers. Do not clean up if you are still hungry. Eating Out and Social Eating Do not arrive hungry. Eat something light before the meal. Try to fill up on low-calorie foods, such as vegetables and fruit, and eat smaller portions of the high-calorie foods. Eat foods that you like, but choose small portions. If you want seconds, wait at least 20 minutes after you have eaten to see if you are actually hungry or if your eyes are bigger than your stomach. Limit alcoholic beverages. Try a soda water with a twist of lime. Do not skip other meals in the day to save room for the special event. At Restaurants Order à la carte rather than buffet style. Order some vegetables or a salad for an appetizer instead of eating bread. If you order a high-calorie dish, share it with someone. Try an after-dinner mint with your coffee. If you do have dessert, share it with two or more people. Don't overeat because you do not want to waste food. Ask for a doggie bag to take extra food home. Tell the server to put half of your entree in a to go bag before the meal is served to you. Ask for salad dressing, gravy or high-fat sauces on the side. Dip the tip of your fork in the dressing before each bite. If bread is served, ask for only one piece. Try it plain without butter or oil. At Italian restaurants where oil and vinegar is served with bread, use only a small amount of oil and a lot of vinegar for dipping. At a Friend's House Offer to bring a dish, appetizer or dessert that is low in calories. Serve yourself small portions or tell the host that you only want a small amount. Stand or sit away from the snack table. Stay away from the kitchen or stay busy if you are near the food. Limit your alcohol intake. Use a salad plate instead of a dinner plate. After eating, clear away your dishes before having coffee or tea. Entertaining at Home Explore low-fat, low-cholesterol cookbooks. Use single-serving foods like chicken breasts or hamburger patties. Prepare low-calorie appetizers and desserts. Holidays Keep tempting foods out of sight. Decorate the house without using food. Have low-calorie beverages and foods on hand for guests. Allow yourself one planned treat a day. Don't skip meals to save up for the holiday feast. Eat regular, planned meals. Exercise Well Make exercise a priority and a planned activity in the day. If possible, walk the entire or part of the distance to work. Get an exercise buddy. Go for a walk with a colleague during one of your breaks, go to the gym, run or take a walk with a friend, walk in the mall with a shopping companion. Park at the end of the parking lot and walk to the store or office entrance. Always take the stairs all of the way or at least part of the way to your floor. If you have a desk job, walk around the office frequently. Do leg lifts while sitting at your desk. Do something outside on the weekends like going for a hike or a bike ride. Have a Healthy Attitude Make health your weight management priority. Be realistic. Have a goal to achieve a healthier you, not necessarily the lowest weight or ideal weight based on calculations or tables. Focus on a healthy eating style, not on dieting. Dieting usually lasts for a short amount of time and rarely produces long-term success. Based on current studies, there are very little to no potential harms of providing behavioral interventions to promote weight loss. How Strong Is the Recommendation to Provide Behavioral Interventions for Weight Loss? The USPSTF concludes with moderate certainty that providing adults who are obese with intensive, multicomponent behavioral interventions has a moderate net benefit. To find this and other JAMA Patient Pages, go to the For Patients collection at jamanetworkpatientpages. Source: US Preventive Services Task Force. Behavioral weight loss interventions to prevent obesity-related morbidity and mortality in adults: US Preventive Services Task Force recommendation statement [published September 18, ]. doi: Jin J. Behavioral Interventions for Weight Loss. Artificial Intelligence Resource Center. Featured Clinical Reviews Screening for Atrial Fibrillation: US Preventive Services Task Force Recommendation Statement JAMA. Select Your Interests Customize your JAMA Network experience by selecting one or more topics from the list below. Save Preferences. Privacy Policy Terms of Use. X Facebook LinkedIn. This Issue. Views 20, Citations 0. View Metrics. Share X Facebook Email LinkedIn. JAMA Patient Page. September 18, Jill Jin, MD, MPH. Article Information. visual abstract icon Visual Abstract. Treating Obesity—Moving From Recommendation to Implementation. US Preventive Services Task Force. USPSTF Evidence Report: Behavioral Interventions to Prevent Adult Obesity-Related Outcomes. Erin S. LeBlanc, MD, MPH; Carrie D. Patnode, PhD, MPH; Elizabeth M. Webber, MS; Nadia Redmond, MSPH; Megan Rushkin, MPH; Elizabeth A. USPSTF Recommendation: Behavioral Interventions to Prevent Adult Obesity-Related Outcomes. US Preventive Services Task Force; Susan J. Curry, PhD; Alex H. Krist, MD, MPH; Douglas K. Owens, MD, MS; Michael J. Barry, MD; Aaron B. Caughey, MD, PhD; Karina W. Davidson, PhD, MASc; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; David C. Grossman, MD, MPH; Alex R. Kemper, MD, MPH, MS; Martha Kubik, PhD, RN; C. Seth Landefeld, MD; Carol M. Mangione, MD, MSPH; Maureen G. Phipps, MD, MPH; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD. |
| Behavioral weight loss interventions: Do they work in primary care? - Harvard Health | Predictors of long-term weight maintenance. Verhoeven AA , Adriaanse MA , Evers C , de Ridder DT. What Are Behavioral Interventions for Weight Loss? Most of the individual-based interventions provided individual counseling sessions, with or without ongoing telephone support. As a service to our readers, Harvard Health Publishing provides access to our library of archived content. |
Video
CBT Role-Play - The Premack Principle with Weight LossBehavioural weight control -
Participants in behavior-based weight loss intervention groups demonstrated greater weight loss and decreased waist circumference compared with those in control groups at 24 months of follow-up.
Pharmacotherapy trials evaluated liraglutide 4 trials , lorcaserin 4 trials , naltrexone and bupropion 3 trials , orlistat 21 trials , and phentermine-topiramate 3 trials in combination with behavioral counseling. All trials were fair quality. Across all trials, both study groups ie, placebo and pharmacotherapy groups received the same behavioral interventions.
The trials were conducted in the United States, Europe, Australia, New Zealand, and other regions. Participant characteristics were similar to those in the behavioral intervention trials. Many trials required participants to demonstrate medication adherence, meet weight loss goals before enrollment, or both.
The more narrowly defined inclusion criteria of these trials resulted in more selective populations enrolled as study participants. Pharmacotherapy-based weight loss maintenance trials did not report any health outcomes. However, these trials were limited by high dropout rates.
The USPSTF looked for evidence on potential harms of behavioral weight-loss interventions, including increased risk for fractures, serious injuries resulting from increased physical activity, and an increased risk for eating disorders, weight stigma, and weight fluctuation.
Fifteen trials were good quality and 15 trials were fair quality. Intervention harms were sparsely reported. Overall, the trials showed no serious harms, and most trials observed no difference in the rate of adverse events between intervention and control groups. Three trials demonstrated mixed results for musculoskeletal problems.
Pharmacological agents for weight loss have multiple potential harms, including anxiety, pancreatitis, and gastrointestinal symptoms with liraglutide; dizziness and cognitive impairment with lorcaserin; nausea, constipation, headache, and dry mouth with naltrexone and bupropion; cramps, flatus, fecal incontinence, and oily spotting with orlistat; and mood disorders, elevated heart rate, and metabolic acidosis with phentermine-topiramate.
These harms have not been well studied. Serious adverse events were uncommon and similar between groups.
The higher rate of adverse events in the medication groups resulted in higher dropout rates than in the placebo groups. The USPSTF found adequate evidence that intensive, multicomponent behavioral interventions in adults with obesity can lead to clinically significant improvements in weight status and reduce the incidence of type 2 diabetes among adults with obesity and elevated plasma glucose levels; these interventions are of moderate benefit.
Quiz Ref ID The USPSTF found adequate evidence that the harms of intensive, multicomponent behavioral interventions including weight loss maintenance interventions in adults with obesity are small to none.
Various environmental and genetic factors play an important role in the development of obesity. As a result, weight loss can be challenging. Weight declines after the sixth decade of life. Losing weight may reduce the risk for illness and mortality and improve overall health.
A draft version of this recommendation statement was posted for public comment on the USPSTF website from February 20 to March 19, In response to comments, the USPSTF expanded the description of behavioral counseling interventions in the Clinical Considerations section.
In the Discussion section, the USPSTF clarified why persons who are overweight were not included in the recommendation statement, expanded the description on harms of behavioral counseling interventions and pharmacotherapy, and added the limitations of pharmacotherapy trials.
This recommendation updates the USPSTF recommendation statement on screening for obesity in adults B recommendation. The Canadian Task Force on Preventive Health Care recommends screening for obesity in adults with BMI at primary care visits.
Corresponding Author: Susan J. Curry, PhD, The University of Iowa, Jessup Hall, Iowa City, IA chair uspstf. The US Preventive Services Task Force USPSTF members: Susan J. Curry, PhD; Alex H. Krist, MD, MPH; Douglas K. Owens, MD, MS; Michael J. Barry, MD; Aaron B. Caughey, MD, PhD; Karina W.
Davidson, PhD, MASc; Chyke A. Doubeni, MD, MPH; John W. Epling Jr, MD, MSEd; David C. Grossman, MD, MPH; Alex R. Kemper, MD, MPH, MS; Martha Kubik, PhD, RN; C. Seth Landefeld, MD; Carol M. Mangione, MD, MSPH; Maureen G.
Phipps, MD, MPH; Michael Silverstein, MD, MPH; Melissa A. Simon, MD, MPH; Chien-Wen Tseng, MD, MPH, MSEE; John B. Wong, MD. Author Contributions: Dr Curry had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
The USPSTF members contributed equally to the recommendation statement. Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest.
All members of the USPSTF receive travel reimbursement and an honorarium for participating in USPSTF meetings. No other disclosures were reported. The US Congress mandates that the Agency for Healthcare Research and Quality AHRQ support the operations of the USPSTF.
AHRQ staff had no role in the approval of the final recommendation statement or the decision to submit for publication. Disclaimer: Recommendations made by the USPSTF are independent of the US government. They should not be construed as an official position of AHRQ or the US Department of Health and Human Services.
Additional Contributions: We thank Iris Mabry-Hernandez, MD, MPH AHRQ , who contributed to the writing of the manuscript, and Lisa Nicolella, MA AHRQ , who assisted with coordination and editing. full text icon Full Text. Download PDF Top of Article Abstract Introduction Summary of Recommendation and Evidence Rationale USPSTF Assessment Clinical Considerations Other Considerations Discussion Update of Previous USPSTF Recommendation Recommendations of Others Article Information References.
Figure 1. USPSTF Grades and Levels of Evidence. View Large Download. USPSTF indicates US Preventive Services Task Force. Figure 2. Clinical Summary: Behavioral Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults.
a Calculated as weight in kilograms divided by height in meters squared. Summary of Related USPSTF Recommendations. Audio Author Interview USPSTF Recommendation: Behavioral Interventions to Prevent Adult Obesity-Related Outcomes. Behavioral and Pharmacotherapy Weight Loss Interventions to Prevent Obesity-Related Morbidity and Mortality in Adults: An Updated Systematic Review for the US Preventive Services Task Force: Evidence Synthesis No.
Rockville, MD: Agency for Healthcare Research and Quality; AHRQ publication EF Ogden CL, Carroll MD, Fryar CD, Flegal KM. Prevalence of obesity among adults and youth: United States, NCHS Data Brief.
PubMed Google Scholar. Bogers RP, Bemelmans WJ, Hoogenveen RT, et al; BMI-CHD Collaboration Investigators. Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: a meta-analysis of 21 cohort studies including more than persons.
Arch Intern Med. doi: Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH.
The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults.
Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review of the literature.
j PubMed Google Scholar Crossref. Afshin A, Forouzanfar MH, Reitsma MB, et al; GBD Obesity Collaborators. Health effects of overweight and obesity in countries over 25 years.
N Engl J Med. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. Borrell LN, Samuel L. Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death.
Am J Public Health. Dobbins M, Decorby K, Choi BC. The association between obesity and cancer risk: a meta-analysis of observational studies from to ISRN Prev Med.
Whitlock G, Lewington S, Sherliker P, et al; Prospective Studies Collaboration. Body-mass index and cause-specific mortality in adults: collaborative analyses of 57 prospective studies. Siu AL; U S Preventive Services Task Force. Screening for abnormal blood glucose and type 2 diabetes mellitus: U.
Preventive Services Task Force recommendation statement. Siu AL; U. Preventive Services Task Force. Screening for high blood pressure in adults: U. Bibbins-Domingo K, Grossman DC, Curry SJ, et al; US Preventive Services Task Force.
Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement. Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U.
Bibbins-Domingo K; U. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U. LeFevre ML; U. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U.
Grossman DC, Bibbins-Domingo K, Curry SJ, et al; US Preventive Services Task Force. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force recommendation statement.
Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. Community Preventive Services Task Force CPSTF. CPSTF findings for obesity. The Community Guide website.
Accessed July 31, Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, National Center for Health Statistics. Health, United States, With Chartbook on Long-term Trends in Health. Hyattsville, MD: National Center for Health Statistics; Report Flegal KM, Kruszon-Moran D, Carroll MD, Fryar CD, Ogden CL.
Trends in obesity among adults in the United States, to Echeverria SE, Mustafa M, Pentakota SR, et al. Social and clinically-relevant cardiovascular risk factors in Asian American adults: NHANES Prev Med.
Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: evidence report and systematic review for the US Preventive Services Task Force [published September 18, ].
Knowler WC, Barrett-Connor E, Fowler SE, et al; Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.
Tuomilehto J, Lindström J, Eriksson JG, et al; Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. Lindström J, Peltonen M, Eriksson JG, et al; Finnish Diabetes Prevention Study DPS.
Improved lifestyle and decreased diabetes risk over 13 years: long-term follow-up of the randomised Finnish Diabetes Prevention Study DPS. Ochner CN, Barrios DM, Lee CD, Pi-Sunyer FX.
Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. Rosenbaum M, Kissileff HR, Mayer LE, Hirsch J, Leibel RL. Energy intake in weight-reduced humans. Brain Res. National Institutes of Health.
Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults—the evidence report. Obes Res. x PubMed Google Scholar. Moyer VA; U. Screening for and management of obesity in adults: U. Brauer P, Connor Gorber S, Shaw E, et al; Canadian Task Force on Preventive Health Care.
Recommendations for prevention of weight gain and use of behavioural and pharmacologic interventions to manage overweight and obesity in adults in primary care. Jortberg B, Myers E, Gigliotti L, et al. Academy of Nutrition and Dietetics: standards of practice and standards of professional performance for registered dietitian nutritionists competent, proficient, and expert in adult weight management.
J Acad Nutr Diet. J Am Coll Cardiol. Garvey WT, Garber AJ, Mechanick JI, et al; The Aace Obesity Scientific Committee. American Association of Clinical Endocrinologists and American College of Endocrinology position statement on the advanced framework for a new diagnosis of obesity as a chronic disease.
Endocr Pract. PS PubMed Google Scholar Crossref. Ann Intern Med. Guh DP, Zhang W, Bansback N, Amarsi Z, Birmingham CL, Anis AH. The incidence of co-morbidities related to obesity and overweight: a systematic review and meta-analysis. BMC Public Health. Bhaskaran K, Douglas I, Forbes H, dos-Santos-Silva I, Leon DA, Smeeth L.
Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5. Kyrgiou M, Kalliala I, Markozannes G, et al. Adiposity and cancer at major anatomical sites: umbrella review of the literature. Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in countries over 25 years.
N Engl J Med. Flegal KM, Kit BK, Orpana H, Graubard BI. Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis. Borrell LN, Samuel L.
Body mass index categories and mortality risk in US adults: the effect of overweight and obesity on advancing death. Am J Public Health. Dobbins M, Decorby K, Choi BC. The association between obesity and cancer risk: a meta-analysis of observational studies from to ISRN Prev Med.
Whitlock G, Lewington S, Sherliker P, et al. Body-mass index and cause-specific mortality in adults: collaborative analyses of 57 prospective studies. Preventive Services Task Force. Screening for abnormal blood glucose and type 2 diabetes mellitus: U.
Preventive Services Task Force recommendation statement. Screening for high blood pressure in adults: U. US Preventive Services Task Force. Statin use for the primary prevention of cardiovascular disease in adults: US Preventive Services Task Force recommendation statement.
Behavioral and pharmacotherapy interventions for tobacco smoking cessation in adults, including pregnant women: U. Aspirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.
Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults with cardiovascular risk factors: U. Behavioral counseling to promote a healthful diet and physical activity for cardiovascular disease prevention in adults without cardiovascular risk factors: US Preventive Services Task Force recommendation statement.
Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement.
Community Preventive Services Task Force CPSTF. CPSTF findings for obesity. Accessed July 31, This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.
search close. PREV Apr 15, NEXT. Summary of Recommendation and Evidence. Obesity is associated with health problems such as increased risk for coronary heart disease, type 2 diabetes mellitus, various types of cancer, gallstones, and disability.
Obesity is also associated with an increased risk for death, particularly among adults younger than 65 years. Clinical Considerations. USEFUL RESOURCES. This series is coordinated by Joanna Drowos, DO, contributing editor.
Continue Reading. More in AFP. More in Pubmed. Copyright © by the American Academy of Family Physicians. Copyright © American Academy of Family Physicians. All Rights Reserved. Offer or refer to intensive, multicomponent behavioral interventions.
A greater Garlic in Asian cuisine of the mechanisms Behavoural action of weight-management interventions is needed to inform the Sports nutrition plan of Garlic in Asian cuisine interventions. To investigate weihgt dietary restraint, habit strength, Garlic in Asian cuisine diet self-regulation mediated the impact Behavioural weight control a behavioral weight-management intervention on weight loss Bhavioural weight loss maintenance. Behavioural weight control estimated the Weigbt of the Behaviouraal over four time Enhance cognitive abilities baseline and 3, 12 and 24 months to assess whether potential mechanisms of action mediated the impact of the weight-management program on BMI. Participants randomized to the 12 and 52 week programs had a significantly greater decrease in BMI than the brief intervention. This direct effect became nonsignificant when dietary restraint, habit strength, and autonomous diet self-regulation were controlled for. Only the individual indirect effect for dietary restraint was significant for the 12 week intervention, whereas all three indirect effects were significant for the 52 week intervention. Behavior change techniques that target dietary restraint, habit strength, and autonomous diet self-regulation should be considered when designing weight loss and weight loss maintenance interventions.
Ich entschuldige mich, aber meiner Meinung nach sind Sie nicht recht. Ich biete es an, zu besprechen.
Ich wollte mit Ihnen reden, mir ist, was, in dieser Frage zu sagen.
Nach meiner Meinung lassen Sie den Fehler zu. Geben Sie wir werden es besprechen. Schreiben Sie mir in PM, wir werden reden.
Ich entschuldige mich, aber meiner Meinung nach lassen Sie den Fehler zu. Geben Sie wir werden besprechen. Schreiben Sie mir in PM.
Ganz und gar nicht.