Behavioural Interventions for Obese Adults with Additional Risk Factors for Morbidity: Systematic Review of Effects on Behaviour, Weight and Disease Risk Factors

Abstract

Background: Reducing obesity through effective behaviour change interventions is of key importance to prevent disabling and life-threatening conditions, particularly in individuals already at risk for morbidity. Purpose: To assess the effects of behavioural interventions for obese adults with additional risk factors for morbidity on behaviour, weight and disease risk factors. Methods: Systematic review of randomised controlled trials (RCTs). Three electronic databases and three journals were searched for behavioural interventions (aimed at changing dietary intake and/or physical activity (PA)) for adults (mean BMI ≧30 kg/m²; mean age ≧40 years) with risk factors for morbidity, reporting follow-up data ≧12 weeks. Results: 44 RCTs met the inclusion criteria. Behavioural outcomes, weight loss, and cardiovascular disease risk factors showed consistent modest improvements over time, especially for interventions targeting both diet and PA. Conclusion: Behavioural interventions in at-risk populations showed positive effect tendencies on behaviour, weight, and disease risk factors. However, there is still ample room for improvement, and future research should focus on identifying the most effective means of inducing dietary and PA behaviour change in this vulnerable population.

Probability of an Obese Person Attaining Normal Body Weight: Cohort Study Using Electronic Health Records

“…8 However, even when treatment is accessed, evidence suggests behavioral weight loss interventions focusing on caloric restriction and increased physical activity are unlikely to yield clinically significant reductions in body weight. 5,9 A recent series of reviews documented the limited progress in reversing the global obesity epidemic and called for regulatory actions from governments as well as coordinated efforts across industry and society to reduce obesity. [10][11][12][13] Dietz and colleagues warn that preventive strategies are unlikely to reduce weight in people living with severe obesity and stress the need for changes in the delivery of care for these patients.…”

Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records

“…98 However, even when treatment is accessed, evidence suggests that behavioural weight-loss interventions focusing on caloric restriction and increased physical activity are unlikely to yield clinically significant reductions in body weight. 29,99 A recent series of reviews documented the limited progress in reversing the global obesity epidemic and called for regulatory actions from governments as well as co-ordinated efforts across industry and society to reduce obesity. [100][101][102][103] Dietz et al 104 warn that preventative strategies are unlikely to reduce weight in people living with severe obesity and stress the need for changes in the delivery of care for these patients.…”

Weight Loss and Maintenance in Adult Populations: What Works?

“…11,12 Several recommendations for maintaining initial weight loss that have stood the test of time include the limiting of the number of eating occasions away from home and selecting healthy options when eating out. The forthcoming 2015 menu labeling regulations may be of some additional guidance; however, the perception that a salad is the safest option may still preclude an individual to inquire about nutritional information.…”