Fear of immigration enforcement policies is generalized across counties. Interventions are needed to increase immigrant Hispanics/Latinos' understanding of their rights and eligibility to utilize health services. Policy-level initiatives are also needed (e.g., driver's licenses) to help undocumented persons access and utilize these services.

This systematic review and network meta-analysis synthesized evidence on the effects of third-wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity.Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre-intervention and ≥ 3 months postbaseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science).Thirty-seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta-analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random-effects pairwise meta-analysis found moderate-to high-quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post-intervention (standardized mean difference [SMD]: −0.09, 95% confidence interval [CI]: −0.22, 0.04; N = 19; I 2 = 32%), 12 months (SMD: −0.17, 95% CI: −0.36, 0.02; N = 5; I 2 = 33%), and 24 months (SMD: −0.21, 95% CI: −0.42, 0.00; N = 2; I 2 = 0%). Network meta-analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head-to-head trials up to 18 months. Acceptance and commitment therapy (ACT)-based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta-regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long-term follow-up are needed to identify who these interventions work for, their most effective components, and the most cost-effective method of delivery. network meta-analysis, obesity, third-wave behavioural therapy, weight loss 1 | BACKGROUND Although behavioural interventions are effective at helping people to lose weight, many people struggle to sustain effective weight management behaviours over extended periods due to a combination of biological, psychological, social, and environmental factors that drive weight gain. 1,2 Standard behavioural programmes can be effective in the short term, but less so in the longer term. 3-6 These usually combine diet and physical activity advice with core behavioural change techniques including goal setting, self-monitoring, problem solving, and planned social support. 7 It has been proposed that third-wave cognitive behaviour therapies (3wCBT), including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), mindfulness-based cognitive behavioural ther- Nazrul Islamhttps://orcid.org/0000-0003-3982-4325

Summary There is good evidence that behavioural weight management interventions improve physical health; however, the impact on mental health remains unclear. We evaluated the impact of behavioural weight management interventions on mental health‐related outcomes in adults with overweight or obesity at intervention‐end and 12 months from baseline. Eligible studies were randomized controlled trials (RCTs) or cluster RCTs of adult behavioural weight loss interventions reporting affect, anxiety, binge eating, body image, depression, emotional eating, quality of life, self‐esteem and stress. We searched seven databases from inception to 7 May 2019 and included 43 articles reporting 42 RCTs. Eighteen studies were deemed to be at high risk of bias. We conducted random‐effects meta‐analyses, stratified analyses and meta‐regression using Stata. Interventions generated greater improvements than comparators for depression, mental health‐related quality of life and self‐efficacy at intervention‐end and 12 months from baseline. There was no difference between groups for anxiety, overall quality of life, self‐esteem or stress at intervention‐end. There was insufficient evidence to assess the impact on anxiety, binge eating, body image, emotional eating, affect, life satisfaction, self‐esteem or stress at intervention‐end and/or 12 months from baseline. Although evidence suggests that interventions benefit some aspects of mental health, high‐quality, transparently reported RCTs measuring a range of mental health outcomes over longer durations are required to strengthen the evidence base.

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Aims/hypothesis Weight loss is often recommended in the treatment of type 2 diabetes. While evidence has shown that large weight loss may lead to diabetes remission and improvement in cardiovascular risk factors, long-term impacts are unclear. We performed a systematic review of studies of weight loss and other weight changes and incidence of CVD among people with type 2 diabetes. Methods Observational studies of behavioural (non-surgical and non-pharmaceutical) weight changes and CVD events among adults with type 2 diabetes, and trials of behavioural interventions targeting weight loss, were identified through searches of MEDLINE, EMBASE, Web of Science, CINAHL, and The Cochrane Library (CENTRAL) until 9 July 2019. Included studies reported change in weight and CVD and/or mortality outcomes among adults with type 2 diabetes. We performed a narrative synthesis of observational studies and meta-analysis of trial data. Results Of 13,227 identified articles, 17 (14 observational studies, three trials) met inclusion criteria. Weight gain (vs no change) was associated with higher hazard of CVD events (HRs [95% CIs] ranged from 1.13 [1.00, 1.29] to 1.63 [1.11, 2.39]) and all-cause mortality (HRs [95% CIs] ranged from 1.26 [1.12, 1.41] to 1.57 [1.33, 1.85]). Unintentional weight loss (vs no change) was associated with higher risks of all-cause mortality, but associations with intentional weight loss were unclear. Behavioural interventions targeting weight loss showed no effect on CVD events (pooled HR [95% CI] 0.95 [0.71, 1.27]; I2 = 50.1%). Risk of bias was moderate in most studies and was high in three studies, due to potential uncontrolled confounding and method of weight assessment. Conclusions/interpretation Weight gain is associated with increased risks of CVD and mortality, although there is a lack of data supporting behavioural weight-loss interventions for CVD prevention among adults with type 2 diabetes. Long-term follow-up of behavioural intervention studies is needed to understand effects on CVD and mortality and to inform policy concerning weight management advice and support for people with diabetes. PROSPERO registration CRD42019127304. Graphical abstract

Background Insufficient physical activity (PA) is a major public health issue. Whilst PA is an important contributor to disease prevention, engagement in PA decreases with age, particularly among women in socio-economically disadvantaged areas. Research using existing support networks to engage ‘hard to reach’ populations in PA interventions is sparse. We developed and tested the feasibility of a PA-promoting intervention for older women within existing community groups in socio-economically disadvantaged areas. Methods The Medical Research Council guidelines for complex interventions were used to guide the intervention’s development. We recruited participants ( n = 40) from older (aged ≥50 years) women’s groups from four different community centres. A 12-week programme was delivered during existing sessions, informed by Social Practice Theory. The sessions provided education about PA, social support in the form of a PA ‘buddy’, group discussion and follow-up telephone calls, as well as printed information about local opportunities to participate in PA. The main uncertainties tested were rates of participant recruitment, retention, and completion of assessments of PA by accelerometry and of mental health using the Hospital Anxiety and Depression Scale (HADS). Intervention acceptability was assessed by questionnaire, and focus group interviews elicited participants’ views about the intervention. Qualitative data were subjected to framework analysis. Results The recruitment rate was high; 87% ( n = 40/46) of women consented to participate, and 78% ( n = 31) attended all education sessions. Uptake of follow-up telephone calls and PA ‘buddies’ was low. Few participants provided valid accelerometer data, but 63% (n=25) completed the HADS questionnaire at all time points. The printed materials and education sessions were viewed positively; telephone calls and ‘buddy’ support were not valued. Participants believed that organised group activities would lead to increased PA engagement, and whilst participants disliked wearing a waist accelerometer, they thought that regular PA feedback would facilitate necessary goal-setting. Conclusions High recruitment and retention rates suggest that use of existing social support groups is an acceptable and attractive method of delivering a PA intervention to this population. A randomised controlled trial of the intervention appears feasible, but its design requires refinement of the social support component, facilitation of goal-setting and reconsideration of the assessment of PA. Trial registration ClinicalTrials.gov, NCT02880449 . Registered on 26 August 2016. Electronic supplementary material The online version of this article (10.1186/s13063-019-3312-9) contains supplementary material, which is available to authoriz...

Summary While many behavioural weight management programmes are effective in the short‐term, post‐programme weight regain is common. Overcoming “lapses” and preventing “relapse” has been highlighted as important in weight‐loss maintenance, but little is known on how this is achieved. This study aimed to compare the cognitive and behavioural strategies employed to overcome “lapses” and prevent “relapse” by people who had regained weight or maintained weight‐loss after participating in a weight management programme. By investigating differences between groups, we intended to identify strategies associated with better weight‐loss maintenance. Semi‐structured interviews were conducted with 26 participants (58% female) recruited from the 5‐year follow‐up of the Weight Loss Referrals for Adults in Primary Care (WRAP) trial (evaluation of a commercial weight‐loss programme). Participants who had lost ≥5% baseline weight during the active intervention were purposively sampled according to 5‐year weight trajectories (n = 16 'Regainers', n = 10 'Maintainers'). Interviews were audio‐recorded, transcribed verbatim, and analysed thematically. Key differences in strategies were that Maintainers continued to pay attention to their dietary intake, anticipated and planned for potential lapses in high‐risk situations, and managed impulses using distraction techniques. Regainers did not report making plans, used relaxed dietary monitoring, found distraction techniques to be ineffective and appeared to have difficulty navigating food within interpersonal relationships. This study is one of the longest qualitative follow‐ups of a weight loss trial to date, offering unique insights into long‐term maintenance. Future programmes should emphasize strategies focusing on self‐monitoring, planning and managing interpersonal relationships to help participants successfully maintain weight‐loss in the longer‐term.