Behavioral weight-loss interventions for patients with NAFLD: A systematic scoping review

Abstract

Background: Clinically significant weight loss—which requires sustained dietary and physical activity changes—is central to treating NAFLD. Although behavioral interventions have demonstrated effectiveness in promoting weight loss among primary prevention populations, the data are limited among patients with NAFLD who need weight loss for treatment. We undertook this scoping review to map the existing data on the characteristics, weight-loss outcomes, and determinants of success of interventions evaluated among patients with NAFLD. Methods: We searched Medline, EMBASE, Cochrane, PsycINFO, and Web of Science from inception to January 1, 2023 to identify publications reporting weight loss among adults with NAFLD in behavioral weight-loss interventions. We summarized interventions and classified them as successful if there was an average weight loss of ≥ 5% from baseline across enrolled participants or achieved by ≥ 50% of enrolled participants. Results: We included 28 studies: 10 randomized control trials, ten quasi-experimental, and 8 observational studies. Intervention delivery, duration, and counseling frequency varied; 12 were successful. Retention was highest among telephone interventions and lowest among “real-world” face-to-face interventions. Patients who were women, younger, and/or had multiple metabolic conditions were most likely to dropout. Successful interventions had biweekly counseling, specific physical activity, and calorie targets, behavioral theory grounding, and promoted goal-setting, self-monitoring, and problem-solving. Conclusion: There are limited data on behavioral weight-loss interventions in NAFLD. Research is needed to develop effective interventions generalizable to diverse patient populations and that maximize adherence, particularly among patients who are diabetic, women, and younger.

Preventive behavioral interventions for patients with steatotic liver disease

“…Successful interventions for weight loss in MASLD incorporate behavioral interventions such as teaching self-monitoring skills and promoting behavioral self-awareness, goal-setting, and problem-solving. Trials have demonstrated that taking behavioral theory into account, particularly social cognitive theory (self-monitoring and self-efficacy as key concepts) and CBT, leads to increased success in lifestyle modification interventions 15 …”

“…Trials have demonstrated that taking behavioral theory into account, particularly social cognitive theory (selfmonitoring and self-efficacy as key concepts) and CBT, leads to increased success in lifestyle modification interventions. [15]…”

Editorial: Does knowledge about liver disease enhance adherence to lifestyle recommendations?

“…Despite the foreseeable advent of pharmacologic treatment aiming at resolution of steatohepatitis and regression of fibrosis, lifestyle interventions will remain the foundation of treatment of MASLD 3 . To increase awareness about diet and eating habits, behavioural therapy has been established as an important intervention to promote these lifestyle recommendations 4 . However, despite the positive results of lifestyle interventions in the short term, they remain challenging in clinical practice in the long term due to a lack of adherence and high attrition rates 5,6 …”