Esophagus to Small Intestine

BMJ. 2022;377:e069719

Madigan CD, Graham HE, Sturgiss E, Kettle VE, Gokal K, Biddle G, Taylor GMJ, Daley AJ

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


Objective: To examine the effectiveness of behavioral weight management interventions for adults with obesity delivered in primary care.
Design: Systematic review and meta-analysis of randomized controlled trials. Eligibility criteria for selection of studies: Randomized controlled trials of behavioral weight management interventions for adults with a body mass index ≥ 25 delivered in primary care compared with no treatment, attention control, or minimal intervention and weight change at ≥ 12 months follow-up. Data sources: Trials from a previous systematic review were extracted and the search completed using the Cochrane Central Register of Controlled Trials, Medline, PubMed, and PsychINFO from January 1, 2018, to August 19, 2021. Data extraction and synthesis: Two reviewers independently identified eligible studies, extracted data, and assessed risk of bias using the Cochrane risk of bias tool. Meta-analyses were conducted with random effects models, and a pooled mean difference for both weight (kg) and waist circumference (cm) were calculated.
Main outcome measures: Primary outcome was weight change from baseline to 12 months. Secondary outcome was weight change from baseline to ≥ 24 months. Change in waist circumference was assessed at 12 months.
Results: 34 trials were included: 14 were additional, from a previous review. 27 trials (n = 8000) were included in the primary outcome of weight change at 12-month follow-up. The mean difference between the intervention and comparator groups at 12 months was -2.3 kg (95% confidence interval [CI]: -3.0 to -1.6 kg, I² = 88%; p < 0.001), favoring the intervention group. At ≥ 24 months (13 trials, n = 5011) the mean difference in weight change was -1.8 kg (95% CI: -2.8 to -0.8 kg, I² = 88%; p < 0.001) favoring the intervention. The mean difference in waist circumference (18 trials, n = 5288) was -2.5 cm (95% CI: -3.2 to -1.8 cm, I² = 69%; p < 0.001) in favor of the intervention at 12 months.

Conclusions: Behavioral weight management interventions for adults with obesity delivered in primary care are effective for weight loss and could be offered to members of the public.

Dr. C.D. Madigan, Center for Lifestyle Medicine and Behavior (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK,
E-Mail: c.madigan@lboro.ac.uk

DOI: 10.1136/bmj-2021-069719

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