Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors: A systematic review and meta-analysis

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Abstract

Background
Obesity is a cardiovascular disease risk factor. Conventional weight-loss (CWL) programmes focus on weight-loss, however ‘health, not weight-loss, focused’ (HNWL) programmes concentrate on improved health and well-being, irrespective of weight-loss. What are the differences in CVD risk outcomes between these programmes?

Aim
To conduct a systematic review and meta-analysis to compare the effects of HNWL with CWL programmes on cardiovascular disease risk factors.
Methods
We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, clinical trial registers, commercial websites and reference lists for randomised controlled trials comparing the two programmes. (Initially searched up to August 2015 and searched updated to 5 April 2019). We used the Mantel-Haneszel fixed-effect model to pool results. Sub-group and sensitivity analyses that accounted for variations in length of follow-up, enhanced programmes and risk of bias dealt with heterogeneity.

Results
Eight randomised controlled trials of 20,242 potential studies were included. Improvements in total cholesterol-HDL ratio (mean difference: -0.21mmol/L, 95% confidence interval [-3.91, 3.50]) and weight loss (-0.28kg [-2.00, 1.44]) favoured HNWL compared to CWL programmes in the long term (53-104 week follow-up), whereas improvements in systolic (-1.14 mmHg, [-5.84, 3.56]) and diastolic (-0.15 mmHg, [-3.64, 3.34]) blood pressure favoured CWL programmes. These differences did not reach statistical significance.

Statistically significant improvements in body satisfaction (-4.30 [-8.32, -0.28]) and restrained eating behaviour (-4.30 [-6.77, -1.83]) favoured HNWL over CWL programmes.

Conclusions
We found no long-term significant differences in improved CVD risk factors, however body satisfaction and restrained eating behaviour improved more with HNWL compared to CWL programmes. Yet firm conclusions cannot be drawn from small studies with high losses to follow-up and data sometimes arising from a single small study.
Original languageEnglish
Article number200
Number of pages18
JournalSystematic Reviews
Volume8
Issue number1
DOIs
Publication statusPublished - 10 Aug 2019

Fingerprint

Weight Reduction Programs
Meta-Analysis
Weight Loss
Health
Feeding Behavior
Cardiovascular Diseases
Randomized Controlled Trials
MEDLINE
HDL Cholesterol
Obesity
Clinical Trials
Confidence Intervals
Blood Pressure

Bibliographical note

© The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Keywords

  • Cardiovascular disease
  • Disordered eating behaviour
  • Intuitive eating
  • Meta-analysis
  • Non-diet
  • Obesity
  • Systematic review
  • Weight loss
  • Well-being

ASJC Scopus subject areas

  • Medicine (miscellaneous)

Cite this

@article{49824b028e5c45a3952b5bf9192c28d8,
title = "Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors: A systematic review and meta-analysis",
abstract = "Background Obesity is a cardiovascular disease risk factor. Conventional weight-loss (CWL) programmes focus on weight-loss, however ‘health, not weight-loss, focused’ (HNWL) programmes concentrate on improved health and well-being, irrespective of weight-loss. What are the differences in CVD risk outcomes between these programmes?Aim To conduct a systematic review and meta-analysis to compare the effects of HNWL with CWL programmes on cardiovascular disease risk factors.Methods We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, clinical trial registers, commercial websites and reference lists for randomised controlled trials comparing the two programmes. (Initially searched up to August 2015 and searched updated to 5 April 2019). We used the Mantel-Haneszel fixed-effect model to pool results. Sub-group and sensitivity analyses that accounted for variations in length of follow-up, enhanced programmes and risk of bias dealt with heterogeneity. Results Eight randomised controlled trials of 20,242 potential studies were included. Improvements in total cholesterol-HDL ratio (mean difference: -0.21mmol/L, 95{\%} confidence interval [-3.91, 3.50]) and weight loss (-0.28kg [-2.00, 1.44]) favoured HNWL compared to CWL programmes in the long term (53-104 week follow-up), whereas improvements in systolic (-1.14 mmHg, [-5.84, 3.56]) and diastolic (-0.15 mmHg, [-3.64, 3.34]) blood pressure favoured CWL programmes. These differences did not reach statistical significance.Statistically significant improvements in body satisfaction (-4.30 [-8.32, -0.28]) and restrained eating behaviour (-4.30 [-6.77, -1.83]) favoured HNWL over CWL programmes.Conclusions We found no long-term significant differences in improved CVD risk factors, however body satisfaction and restrained eating behaviour improved more with HNWL compared to CWL programmes. Yet firm conclusions cannot be drawn from small studies with high losses to follow-up and data sometimes arising from a single small study.",
keywords = "Cardiovascular disease, Disordered eating behaviour, Intuitive eating, Meta-analysis, Non-diet, Obesity, Systematic review, Weight loss, Well-being",
author = "Nazanin Khasteganan and Deborah Lycett and Gill Furze and Andy Turner",
note = "{\circledC} The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.",
year = "2019",
month = "8",
day = "10",
doi = "10.1186/s13643-019-1083-8",
language = "English",
volume = "8",
journal = "Systematic Reviews",
issn = "2046-4053",
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T1 - Health, not weight loss, focused programmes versus conventional weight loss programmes for cardiovascular risk factors

T2 - A systematic review and meta-analysis

AU - Khasteganan, Nazanin

AU - Lycett, Deborah

AU - Furze, Gill

AU - Turner, Andy

N1 - © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

PY - 2019/8/10

Y1 - 2019/8/10

N2 - Background Obesity is a cardiovascular disease risk factor. Conventional weight-loss (CWL) programmes focus on weight-loss, however ‘health, not weight-loss, focused’ (HNWL) programmes concentrate on improved health and well-being, irrespective of weight-loss. What are the differences in CVD risk outcomes between these programmes?Aim To conduct a systematic review and meta-analysis to compare the effects of HNWL with CWL programmes on cardiovascular disease risk factors.Methods We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, clinical trial registers, commercial websites and reference lists for randomised controlled trials comparing the two programmes. (Initially searched up to August 2015 and searched updated to 5 April 2019). We used the Mantel-Haneszel fixed-effect model to pool results. Sub-group and sensitivity analyses that accounted for variations in length of follow-up, enhanced programmes and risk of bias dealt with heterogeneity. Results Eight randomised controlled trials of 20,242 potential studies were included. Improvements in total cholesterol-HDL ratio (mean difference: -0.21mmol/L, 95% confidence interval [-3.91, 3.50]) and weight loss (-0.28kg [-2.00, 1.44]) favoured HNWL compared to CWL programmes in the long term (53-104 week follow-up), whereas improvements in systolic (-1.14 mmHg, [-5.84, 3.56]) and diastolic (-0.15 mmHg, [-3.64, 3.34]) blood pressure favoured CWL programmes. These differences did not reach statistical significance.Statistically significant improvements in body satisfaction (-4.30 [-8.32, -0.28]) and restrained eating behaviour (-4.30 [-6.77, -1.83]) favoured HNWL over CWL programmes.Conclusions We found no long-term significant differences in improved CVD risk factors, however body satisfaction and restrained eating behaviour improved more with HNWL compared to CWL programmes. Yet firm conclusions cannot be drawn from small studies with high losses to follow-up and data sometimes arising from a single small study.

AB - Background Obesity is a cardiovascular disease risk factor. Conventional weight-loss (CWL) programmes focus on weight-loss, however ‘health, not weight-loss, focused’ (HNWL) programmes concentrate on improved health and well-being, irrespective of weight-loss. What are the differences in CVD risk outcomes between these programmes?Aim To conduct a systematic review and meta-analysis to compare the effects of HNWL with CWL programmes on cardiovascular disease risk factors.Methods We searched CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, ASSIA, clinical trial registers, commercial websites and reference lists for randomised controlled trials comparing the two programmes. (Initially searched up to August 2015 and searched updated to 5 April 2019). We used the Mantel-Haneszel fixed-effect model to pool results. Sub-group and sensitivity analyses that accounted for variations in length of follow-up, enhanced programmes and risk of bias dealt with heterogeneity. Results Eight randomised controlled trials of 20,242 potential studies were included. Improvements in total cholesterol-HDL ratio (mean difference: -0.21mmol/L, 95% confidence interval [-3.91, 3.50]) and weight loss (-0.28kg [-2.00, 1.44]) favoured HNWL compared to CWL programmes in the long term (53-104 week follow-up), whereas improvements in systolic (-1.14 mmHg, [-5.84, 3.56]) and diastolic (-0.15 mmHg, [-3.64, 3.34]) blood pressure favoured CWL programmes. These differences did not reach statistical significance.Statistically significant improvements in body satisfaction (-4.30 [-8.32, -0.28]) and restrained eating behaviour (-4.30 [-6.77, -1.83]) favoured HNWL over CWL programmes.Conclusions We found no long-term significant differences in improved CVD risk factors, however body satisfaction and restrained eating behaviour improved more with HNWL compared to CWL programmes. Yet firm conclusions cannot be drawn from small studies with high losses to follow-up and data sometimes arising from a single small study.

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KW - Disordered eating behaviour

KW - Intuitive eating

KW - Meta-analysis

KW - Non-diet

KW - Obesity

KW - Systematic review

KW - Weight loss

KW - Well-being

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