TY - JOUR
T1 - Association between characteristics of behavioural weight loss programmes and weight change after programme end
T2 - Systematic review and meta-analysis
AU - Hartmann-Boyce, Jamie
AU - Theodoulou, Annika
AU - Oke, Jason L.
AU - Butler, Ailsa R.
AU - Scarborough, Peter
AU - Bastounis, Anastasios
AU - Dunnigan, Anna
AU - Byadya, Rimu
AU - Richard Hobbs, F. D.
AU - Sniehotta, Falko F.
AU - Jebb, Susan A.
AU - Aveyard, Paul
N1 - Funding Information:
Funding: This research was funded by the British Heart Foundation (BHF), PG/17/68/33247, and National Institute for Health Research (NIHR) Oxford Biomedical Research Centre (BRC) Obesity, Diet, and Lifestyle Theme. JH-B, PA, SAJ, and FDRH are part funded by NIHR Oxford BRC. JH-B is also part funded by an NIHR Cochrane Programme Grant. PA and SAJ are NIHR senior investigators and are also funded by NIHR Oxford and Thames Valley Applied Research Collaboration. FDRH also acknowledges part support from the NIHR School for Primary Care Research (SPCR), the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Oxford, and the NIHR Oxford BRC. The views expressed are those of the authors and not necessarily those of the BHF, NHS, NIHR, or the Department of Health and Social Care. The funders were not involved in study design, conduct, reporting, or decision to submit for publication. Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from the British Heart Foundation and National Institute for Health Research Oxford Biomedical Research Centre Obesity, Diet, and Lifestyle Theme for the submitted work. PA and SAJ were
Funding Information:
We thank the people with overweight and obesity who shaped this work at the outset, and Anna Whiting and Philippa Seeber for serving as patient and public involvement advisors on this work. Nia Roberts, subject librarian, designed and executed searches. Alison Avenell, Brian Taylor, and colleagues at Aberdeen provided invaluable support and advice throughout. Initial work on database construction was funded by National Institute for Health Research (NIHR) HTA grant 15/09/04 - (REBALANCE) REview of Behaviour And Lifestyle interventions for severe obesity: AN evidenCE synthesis. We thank Sarah King, Mary Logan, and Yolanda Warren for their help with study screening. We thank Alex Robinson and Louis Robinson for their help with data entry. We thank Helen Parretti, Stephan Dombrowski, Alison Avenell, and Nerys Astbury for sharing data extraction forms from previous reviews. We are grateful to the many authors who answered our queries and provided additional data for our analyses. Contributors: JH-B, PA, SAJ, FFS, FDRH, PS, and JLO conceived and designed the review. JH-B, RB, AT, ARB, AB, and AD conducted the screening. JH-B, AT, ARB, AB, and AD conducted the data extraction and assessed studies for risk of bias. JLO conducted the main statistical analyses. JH-B prepared the first draft of the review, with further input from AT, PA, and SAJ, and all authors contributed to the interpretation and final write up. All authors had direct access to the data, or access was provided as requested. JH-B is the guarantor. SAJ and PA are joint senior authors. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
Publisher Copyright:
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
PY - 2021/8/17
Y1 - 2021/8/17
N2 - AbstractObjective To determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme. Design Systematic review and meta-analysis. Data sources Trial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Randomised trials of behavioural weight loss programmes in adults with overweight or obesity, reporting outcomes at ≥12 months, including at the end of the programme and after the end of the programme. Review methods Studies were screened by two independent reviewers with discrepancies resolved by discussion. 5% of the studies identified in the searches met the inclusion criteria. One reviewer extracted the data and a second reviewer checked the data. Risk of bias was assessed with Cochrane's risk of bias tool (version 1). The rate of change in weight was calculated (kg/month; converted to kg/year for interpretability) after the end of the programme in the intervention versus control groups by a mixed model with a random intercept. Associations between the rate of change in weight and prespecified variables were tested. Results Data were analysed from 249 trials (n=59 081) with a mean length of follow-up of two years (longest 30 years). 56% of studies (n=140) had an unclear risk of bias, 21% (n=52) a low risk, and 23% (n=57) a high risk of bias. Regain in weight was faster in the intervention versus the no intervention control groups (0.12-0.32 kg/year) but the difference between groups was maintained for at least five years. Each kilogram of weight lost at the end of the programme was associated with faster regain in weight at a rate of 0.13-0.19 kg/year. Financial incentives for weight loss were associated with faster regain in weight at a rate of 1-1.5 kg/year. Compared with programmes with no meal replacements, interventions involving partial meal replacements were associated with faster regain in weight but not after adjustment for weight loss during the programme. Access to the programme outside of the study was associated with slower regain in weight. Programmes where the intensity of the interaction reduced gradually were also associated with slower regain in weight in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in regain in weight. Conclusion Faster regain in weight after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with reduced weight for at least five years after the end of the programme, after which data were limited. Continued availability of the programme to participants outside of the study predicted a slower regain in weight, and provision of financial incentives predicted faster regain in weight; no other clear associations were found.
AB - AbstractObjective To determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme. Design Systematic review and meta-analysis. Data sources Trial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Randomised trials of behavioural weight loss programmes in adults with overweight or obesity, reporting outcomes at ≥12 months, including at the end of the programme and after the end of the programme. Review methods Studies were screened by two independent reviewers with discrepancies resolved by discussion. 5% of the studies identified in the searches met the inclusion criteria. One reviewer extracted the data and a second reviewer checked the data. Risk of bias was assessed with Cochrane's risk of bias tool (version 1). The rate of change in weight was calculated (kg/month; converted to kg/year for interpretability) after the end of the programme in the intervention versus control groups by a mixed model with a random intercept. Associations between the rate of change in weight and prespecified variables were tested. Results Data were analysed from 249 trials (n=59 081) with a mean length of follow-up of two years (longest 30 years). 56% of studies (n=140) had an unclear risk of bias, 21% (n=52) a low risk, and 23% (n=57) a high risk of bias. Regain in weight was faster in the intervention versus the no intervention control groups (0.12-0.32 kg/year) but the difference between groups was maintained for at least five years. Each kilogram of weight lost at the end of the programme was associated with faster regain in weight at a rate of 0.13-0.19 kg/year. Financial incentives for weight loss were associated with faster regain in weight at a rate of 1-1.5 kg/year. Compared with programmes with no meal replacements, interventions involving partial meal replacements were associated with faster regain in weight but not after adjustment for weight loss during the programme. Access to the programme outside of the study was associated with slower regain in weight. Programmes where the intensity of the interaction reduced gradually were also associated with slower regain in weight in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in regain in weight. Conclusion Faster regain in weight after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with reduced weight for at least five years after the end of the programme, after which data were limited. Continued availability of the programme to participants outside of the study predicted a slower regain in weight, and provision of financial incentives predicted faster regain in weight; no other clear associations were found.
UR - https://www.scopus.com/pages/publications/85113392142
U2 - 10.1136/bmj.n1840
DO - 10.1136/bmj.n1840
M3 - Review article
C2 - 34404631
AN - SCOPUS:85113392142
SN - 0959-535X
VL - 374
JO - BMJ
JF - BMJ
M1 - n1840
ER -
