Interventions in the Treatment and Prevention of Obesity

A narrative systematic review 1 including 99 studies was abstracted in DARE. 13 studies were on children and adolescents. Family therapy programmes were effective in preventing the progression of obesity in already obese children. Behavioural, diet and exercise programmes have all been shown to be effective in the treatment of adult obesity. Pharmacological interventions produce weight loss for up to 9 months whereafter a proportion of participants regain weight. The weight loss achieved by surgical interventions is greater and more sustained than that obtained by other methods. Maintenance strategies have been shown to be effective at reducing the amount of weight regain following weight loss after treatment.

Another systematic review 2 including 84 studies was abstracted in DARE.

• Drug interventions: The long-term weight change with orlistat and sibutramine in conjunction with diet was significantly greater than with placebo and diet (WMD -3.01 kg, 95% CI -3.48 to -2.54 with orlistat at 24 months, WMD -4.12 kg, 95% CI -4.97 to -3.26 with sibutramine at 18 months). Blood lipid levels decreased with both drugs, but only orlistat was associated with a fall in blood-pressure. Metformin and SSRIs were not associated with significant weight loss over 12 months. Metformin was associated with decreased mortality at 10 years in diabetic participants. There was insufficient evidence on the effects of acarbose.

• Dietary interventions: A low-fat or 600 kcal/day diet was associated with a significant weight change, compared with control, at 12 months (WMD -5.31 kg, 95% CI -5.86 to -4.77) and also at 24 and 36 months. It was also associated with the prevention of type 2 diabetes and improved control of hypertension. The protein-sparing modified fast was not shown to have a greater effect on weight than a low-fat or 600 kcal/day diet. There was insufficient evidence to assess the putative benefits of low-calorie or very low-calorie diets.
• Exercise and behaviour therapy: The addition of an exercise programme to diet was associated with additional weight change at 12 months (WMD -1.95 kg, 95% CI -3.22 to -0.68), along with improvements in blood lipids. The addition of behaviour therapy to diet was also associated with additional weight change (WMD -7.67 kg, 95% CI -11.97 to -3.36). It was unclear whether the addition of both exercise and behaviour therapy further enhanced weight loss.
• Mode of delivery: Family therapy was associated with more weight change than individual treatment at 12 months (WMD -2.96 kg, 95% CI -5.31 to -0.60). There was insufficient evidence to assess group versus individual therapy.

References

• O'Meara S, Glenny AM. What are the best ways of tackling obesity? Nurs Times 1997 May 28-Jun 3;93(22):50-1. [PubMed]
• Avenell A, Broom J, Brown TJ, et al. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technology Assessment 2004;8(21). [DARE]