Behavioral Therapies Effective in Weight Loss

Jim Kling

October 03, 2011

October 3, 2011 — Behavior-based weight loss interventions are safe and effective, according to a systematic review published in the October 4 issue of the Annals of Internal Medicine.

A 2007-2008 study showed that 32% of US men and 36% of US women were obese. The US Preventive Services Task Force recommends that physicians screen all adults for obesity and institute intensive counseling and behavioral interventions for obese adults.

The researchers, led by Erin S. LeBlanc, MD, MPH, from the Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon, reviewed studies of primary care-relevant weight loss interventions for overweight and obese adults. The studies were pulled from MEDLINE, the Cochrane Central Register of Controlled Trials, and PsycINFO (January 2005 - September 2010) and from systematic reviews for studies conducted before 2005.

Consideration was given to 6498 abstracts and 648 articles. Studies were eligible if they included control groups that received minimal interventions. Design-specific criteria were used to classify studies as good, fair, or poor. Good- and fair-quality studies were included in the analysis.

The researchers found that behaviorally based treatments resulted in 3 kg (6.6 pounds; 95% confidence interval [CI], -4.0 to -2.0 kg) greater weight loss compared with control groups after 12 to 18 months; this is based on data from 21 studies combined by meta-analysis. Higher numbers of treatment sessions were associated with higher weight loss totals. Some evidence suggested that weight loss was maintained for 1 year or longer, but this was limited.

Programs that combined orlistat with behavioral intervention and could be included in a meta-analysis achieved 3.0 kg (95% CI, -3.9 to -2.0 kg) more weight loss compared with placebo after 12 months.

There were insufficient data to assess the effects of weight loss on health outcomes such as death or cardiovascular disease, but the researchers did note a reduction in the incidence of diabetes in patients with prediabetes who were trying to achieve weight loss.

The researchers found minimal evidence of harm from behavioral-based therapies.

Limitations of the review include the fact that behavioral treatments were heterogeneous and were not described in detail. Other studies could not be included because of poor reporting of variance data.

This research was supported by the Agency for Healthcare Research and Quality. The authors have disclosed no relevant financial relationships.

Ann Intern Med. 2011;7:434-447. Abstract

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