Systematic review of the effectiveness of interventions used in the management of obesity
This paper briefly describes the principles of undertaking a systematic review of the effectiveness of obesity management interventions. Objective: To assess the effectiveness of interventions used in the prevention and treatment of obesity and the maintenance of weight loss. Background: Obesity represents a serious public health problem due to the associated risks of disease and mortality. Prevalence of the condition is increasing and the relevant Health of the Nation target is unlikely to be met. Methods and search strategy: A qualitative systematic review of the research literature, using electronic databases and contact with experts. Inclusion criteria: Randomized controlled trials evaluating the effectiveness of interventions used in managing obesity in which participants were observed for a minimum of 1 year. For studies of prevention, non-randomized controlled trials with a concurrent control group were also eligible. Results: Ninety-nine studies were included, most of which had been performed in North America. The methodological quality of many of the studies was poor. Family therapy and community education programmes were shown to be effective in preventing obesity in children and adults, respectively. Programmes based on the reduction of sedentary behaviour were effective in the treatment of obese children. For the treatment of obese adults, behavioural, diet, exercise and drug therapies can be effective when used in combination. Surgery is effective in morbidly obese patients. Weight regain is common following many types of weight loss interventions, and maintenance programmes based on continued contact may be useful. Conclusions: This review has identified some potentially effective interventions for the management of obesity. However, results should be interpreted with caution due to problems with the methodological quality of primary studies.