Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials

S U Dombrowski; K Knittle; A Avenell; V Araújo-Soares; F F Sniehotta

doi:10.1136/bmj.g2646

Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials

S U Dombrowski, K Knittle, A Avenell, V Araújo-Soares, F F Sniehotta

Newcastle University

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Abstract

OBJECTIVE: To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions.

DESIGN: Systematic review with meta-analysis.

DATA SOURCES: Medline, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials.

STUDY SELECTION: Studies were identified through to January 2014. Randomised trials of interventions to maintain weight loss provided to initially obese adults (aged ≥18) after weight loss of ≥5% body weight with long term (≥12 months) follow-up of weight change (main outcome) were included.

STUDY APPRAISAL AND SYNTHESIS: Potential studies were screened independently and in duplicate; study characteristics and outcomes were extracted. Meta-analyses were conducted to estimate the effects of interventions on weight loss maintenance with the inverse variance method and a random effects model. Results are presented as mean differences in weight change, with 95% confidence intervals.

RESULTS: 45 trials involving 7788 individuals were included. Behavioural interventions focusing on both food intake and physical activity resulted in an average difference of -1.56 kg (95% confidence interval -2.27 to -0.86 kg; 25 comparisons, 2949 participants) in weight regain compared with controls at 12 months. Orlistat combined with behavioural interventions resulted in a -1.80 kg (-2.54 to -1.06; eight comparisons, 1738 participants) difference compared with placebo at 12 months. All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups. A dose-response relation for orlistat treatment was found, with 120 mg doses three times a day leading to greater weight loss maintenance (-2.34 kg, -3.03 to -1.65) compared with 60 mg and 30 mg three times a day (-0.70 kg, 95% confidence interval -1.92 to 0.52), P=0.02.

CONCLUSIONS: Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance.

Original language	English
Article number	g2646
Journal	BMJ
Volume	348
DOIs	https://doi.org/10.1136/bmj.g2646
Publication status	Published - 14 May 2014

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10.1136/bmj.g2646Licence: CC BY-NC

Dombrowski 2014
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/3.0/.
Final published version, 1.05 MBLicence: CC BY-NC

Alison Avenell
- School of Medicine, Medical Sciences & Nutrition, Health Services Research Unit (HSRU) - Clinical Chair in Health Services Research
- Institute of Applied Health Sciences
Person: Clinical Academic

Cite this

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title = "Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials",

abstract = "OBJECTIVE: To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions.DESIGN: Systematic review with meta-analysis.DATA SOURCES: Medline, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials.STUDY SELECTION: Studies were identified through to January 2014. Randomised trials of interventions to maintain weight loss provided to initially obese adults (aged ≥18) after weight loss of ≥5% body weight with long term (≥12 months) follow-up of weight change (main outcome) were included.STUDY APPRAISAL AND SYNTHESIS: Potential studies were screened independently and in duplicate; study characteristics and outcomes were extracted. Meta-analyses were conducted to estimate the effects of interventions on weight loss maintenance with the inverse variance method and a random effects model. Results are presented as mean differences in weight change, with 95% confidence intervals.RESULTS: 45 trials involving 7788 individuals were included. Behavioural interventions focusing on both food intake and physical activity resulted in an average difference of -1.56 kg (95% confidence interval -2.27 to -0.86 kg; 25 comparisons, 2949 participants) in weight regain compared with controls at 12 months. Orlistat combined with behavioural interventions resulted in a -1.80 kg (-2.54 to -1.06; eight comparisons, 1738 participants) difference compared with placebo at 12 months. All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups. A dose-response relation for orlistat treatment was found, with 120 mg doses three times a day leading to greater weight loss maintenance (-2.34 kg, -3.03 to -1.65) compared with 60 mg and 30 mg three times a day (-0.70 kg, 95% confidence interval -1.92 to 0.52), P=0.02.CONCLUSIONS: Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance.",

author = "Dombrowski, {S U} and K Knittle and A Avenell and V Ara{\'u}jo-Soares and Sniehotta, {F F}",

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T1 - Long term maintenance of weight loss with non-surgical interventions in obese adults

T2 - systematic review and meta-analyses of randomised controlled trials

AU - Dombrowski, S U

AU - Knittle, K

AU - Avenell, A

AU - Araújo-Soares, V

AU - Sniehotta, F F

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N2 - OBJECTIVE: To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions.DESIGN: Systematic review with meta-analysis.DATA SOURCES: Medline, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials.STUDY SELECTION: Studies were identified through to January 2014. Randomised trials of interventions to maintain weight loss provided to initially obese adults (aged ≥18) after weight loss of ≥5% body weight with long term (≥12 months) follow-up of weight change (main outcome) were included.STUDY APPRAISAL AND SYNTHESIS: Potential studies were screened independently and in duplicate; study characteristics and outcomes were extracted. Meta-analyses were conducted to estimate the effects of interventions on weight loss maintenance with the inverse variance method and a random effects model. Results are presented as mean differences in weight change, with 95% confidence intervals.RESULTS: 45 trials involving 7788 individuals were included. Behavioural interventions focusing on both food intake and physical activity resulted in an average difference of -1.56 kg (95% confidence interval -2.27 to -0.86 kg; 25 comparisons, 2949 participants) in weight regain compared with controls at 12 months. Orlistat combined with behavioural interventions resulted in a -1.80 kg (-2.54 to -1.06; eight comparisons, 1738 participants) difference compared with placebo at 12 months. All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups. A dose-response relation for orlistat treatment was found, with 120 mg doses three times a day leading to greater weight loss maintenance (-2.34 kg, -3.03 to -1.65) compared with 60 mg and 30 mg three times a day (-0.70 kg, 95% confidence interval -1.92 to 0.52), P=0.02.CONCLUSIONS: Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance.

AB - OBJECTIVE: To systematically review and describe currently available approaches to supporting maintenance of weight loss in obese adults and to assess the evidence for the effectiveness of these interventions.DESIGN: Systematic review with meta-analysis.DATA SOURCES: Medline, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials.STUDY SELECTION: Studies were identified through to January 2014. Randomised trials of interventions to maintain weight loss provided to initially obese adults (aged ≥18) after weight loss of ≥5% body weight with long term (≥12 months) follow-up of weight change (main outcome) were included.STUDY APPRAISAL AND SYNTHESIS: Potential studies were screened independently and in duplicate; study characteristics and outcomes were extracted. Meta-analyses were conducted to estimate the effects of interventions on weight loss maintenance with the inverse variance method and a random effects model. Results are presented as mean differences in weight change, with 95% confidence intervals.RESULTS: 45 trials involving 7788 individuals were included. Behavioural interventions focusing on both food intake and physical activity resulted in an average difference of -1.56 kg (95% confidence interval -2.27 to -0.86 kg; 25 comparisons, 2949 participants) in weight regain compared with controls at 12 months. Orlistat combined with behavioural interventions resulted in a -1.80 kg (-2.54 to -1.06; eight comparisons, 1738 participants) difference compared with placebo at 12 months. All orlistat studies reported higher frequencies of adverse gastrointestinal events in the experimental compared with placebo control groups. A dose-response relation for orlistat treatment was found, with 120 mg doses three times a day leading to greater weight loss maintenance (-2.34 kg, -3.03 to -1.65) compared with 60 mg and 30 mg three times a day (-0.70 kg, 95% confidence interval -1.92 to 0.52), P=0.02.CONCLUSIONS: Behavioural interventions that deal with both diet and physical activity show small but significant benefits on weight loss maintenance.

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DO - 10.1136/bmj.g2646

M3 - Article

C2 - 25134100

SN - 0959-8146

VL - 348

JO - BMJ

JF - BMJ

M1 - g2646

ER -

Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials

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Alison Avenell

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