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Strategies to prevent weight gain among adults |
Hutfless S, Maruthur NM, Wilson RF, Gudzune KA, Brown R, Lau B, Fawole OA, Chaudhry ZW, Anderson CA, Segal JB |
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CRD summary This review found no strong evidence for promoting any particular strategy to prevent weight gain and no evidence that not adopting a prevention strategy was preferable. The low quality of the evidence and the diversity in the studies suggest that the results are unlikely to be reliable and that the authors’ cautious conclusions are appropriate. Authors' objectives To assess the effectiveness, safety and impact on quality of life of strategies to prevent weight gain in adults. Searching MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and PsycINFO were searched to June 2012 for articles in English. Search strategies were presented. Reference lists of included articles and review articles and ClinicalTrials.gov were searched. Study selection Any type of study that investigated interventions to prevent weight gain in adults (over 18) with a body mass index of more than 18.5 was eligible for inclusion. Eligible interventions included self-management, dietary changes, physical activity and use of orlistat or combinations of these. The intervention could be compared to no intervention, usual care, another intervention or a different intensity of the same intervention. Studies had to measure weight (or body mass index or weight circumference) with at least one year of follow-up. Studies where the aim was to achieve weight loss were excluded. Studies of biological (such as genetic) determinants of weight, studies of herbal, vitamin or mineral supplements and studies that included smoking cessation were excluded. There appeared to be a very diverse range of studies that examined a wide variety of different participant populations and interventions (including work-based and college-based interventions) and a range of outcomes. Two reviewers independently performed the study selection, with disagreements resolved by consensus. Assessment of study quality Study quality was assessed using the Down and Blacks criteria to assess quality of reporting and validity. Overall quality of the evidence was graded using Agency for Healthcare Research & Quality (AHRQ) criteria. Two reviewers independently assessed quality. Disagreements were resolved by consensus. Data extraction Data on weight after one, two, five years and the last follow-up time were extracted from studies. Data for other outcomes after at least one-year's follow-up were extracted. Where possible, mean differences, relative risks or risk differences for comparisons between interventions were extracted, with their corresponding 95% confidence intervals. Data extraction was performed by two reviewers. Disagreements were resolved by consensus. Methods of synthesis A narrative synthesis was presented as no meta-analysis was considered feasible. Results from individual studies were presented, categorised according to population and type of intervention and with a summary of the overall strength of the evidence. Results of the review Fifty-eight publications of 51 studies (555,783 participants) were included: 38 trials (150,081 participants) and 13 observational studies (420,986 participants). The overall quality of studies appeared to be low or insufficient; lack of blinding and low adherence rates were particularly common. Among the general population there was low quality evidence from 23 studies that low fat diets, monitoring heart rate during exercise, group lifestyle advice sessions sending text messages to mothers of young children and eating fewer meals prepared outside the home may all prevent weight gain when compared to a range of different control interventions. Seven trials provided moderate evidence that workplace-based strategies to prevent weight gain may be effective when compared to no intervention. Two trials provided low quality evidence that college-based strategies may be effective. Twelve trials provided low quality evidence that physical activity prevented weight gain in people with or at risk for cardiovascular disease or diabetes when compared to no intervention. Four studies provided moderate evidence that aerobic and resistance exercise prevented weight gain among women with cancer. In three trials of people with mental illness there was low quality evidence that no intervention was favoured in preventing weight gain. Other results were reported, including on obesity-related outcomes and adverse events. Authors' conclusions Evidence on interventions that may prevent weight gain was limited. There was no strong evidence for promoting any particular strategy to prevent weight gain and there was no evidence that not adopting a weight gain prevention strategy was preferable. CRD commentary This review examined an extremely broad research question with correspondingly broad inclusion criteria. A suitable search was conducted. The search was limited to studies in English. Effort was taken to identify unpublished studies. Action was taken to reduce reviewer error and bias at all stages of the review. Study quality was assessed and (although full details were not presented) quality generally appeared to be low. A narrative synthesis was presented and was generally appropriate given the diverse range of study populations and interventions; however, there appeared to be some areas where a meta-analysis would have been feasible and useful. The low quality and clinical diversity of the included studies suggest that the results are unlikely to be reliable. The authors’ cautious conclusions are appropriate. Implications of the review for practice and research Practice: The authors made no recommendations for medical practice. Research: The authors suggested that more research was needed in areas with low or insufficient evidence, that research may be better focused on interventions made when people were already making other lifestyle changes and that observational studies in this area should routinely measure weight. Funding Agency for Healthcare Research and Quality (AHRQ), USA. Bibliographic details Hutfless S, Maruthur NM, Wilson RF, Gudzune KA, Brown R, Lau B, Fawole OA, Chaudhry ZW, Anderson CA, Segal JB. Strategies to prevent weight gain among adults. Rockville, MD, USA: Agency for Healthcare Research and Quality. Comparative Effectiveness Review; 97. 2013 Other publications of related interest Gudzune K, Hutfless S, Maruthur N, Wilson R, Segal J. Strategies to prevent weight gain in workplace and college settings: a systematic review. Preventive Medicine 2013; 57(4): 268-277. Hutfless S, Gudzune KA, Maruthur N, Wilson RF, Bleich SN, Lau BD, Fawole OA, Anderson CA, Segal J. Strategies to prevent weight gain in adults: a systematic review. American Journal of Preventive Medicine 2013; 45(6): e41-51. Chaudhry ZW, Brown RV, Fawole OA, Wilson R, Gudzune KA, Maruthur NM, Segal J, Hutfless SM. Comparative effectiveness of strategies to prevent weight gain among women with and at risk for breast cancer: a systematic review. SpringerPlus 2013; 2: 277. Indexing Status Subject indexing assigned by CRD MeSH Adult; Health Promotion; Humans; Public Health; Weight Gain AccessionNumber 12013021199 Date bibliographic record published 29/04/2013 Date abstract record published 08/08/2013 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. |
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