Diet or Exercise Interventions vs Combined Behavioral Weight Management Programs: A Systematic Review and Meta-Analysis of Direct Comparisons

diet analysis plus

Diet analysis plus

Journal of the Academy of Nutrition and Dietetics

Weight loss can reduce the health risks associated with being overweight or obese. However, the most effective method of weight loss remains unclear. Some programs emphasize physical activity, others diet, but existing evidence is mixed as to whether these are more effective individually or in combination. We aimed to examine the clinical effectiveness of combined behavioral weight management programs (BWMPs) targeting weight loss in comparison to single component programs, using within study comparisons. We included randomized controlled trials of combined BWMPs compared with diet-only or physical activity-only programs with at least 12 months of follow-up, conducted in overweight and obese adults (body mass index ≥25). Systematic searches of nine databases were run and two reviewers extracted data independently. Random effects meta-analyses were conducted for mean difference in weight change at 3 to 6 months and 12 to 18 months using a baseline observation carried forward approach for combined BWMPs vs diet-only BWMPs and combined BWMPs vs physical activity-only BWMPs. In total, eight studies were included, representing 1,022 participants, the majority of whom were women. Six studies met the inclusion criteria for combined BWMP vs diet-only. Pooled results showed no significant difference in weight loss from baseline or at 3 to 6 months between the BWMPs and diet-only arms (–0.62 kg; 95% CI –1.67 to 0.44). However, at 12 months, a significantly greater weight-loss was detected in the combined BWMPs (–1.72 kg; 95% CI –2.80 to –0.64). Five studies met the inclusion criteria for combined BWMP vs physical activity-only. Pooled results showed significantly greater weight loss in the combined BWMPs at 3 to 6 months (–5.33 kg; 95% CI –7.61 to –3.04) and 12 to 18 months (–6.29 kg; 95% CI –7.33 to –5.25). Weight loss is similar in the short-term for diet-only and combined BWMPs but in the longer-term weight loss is increased when diet and physical activity are combined. Programs based on physical activity alone are less effective than combined BWMPs in both the short and long term.

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D. J. Johns is an investigator scientist, Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom.

J. Hartman-Boyce is a DPhil student and a research associate, Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom.

P. Aveyard is a professor of behavioral medicine, Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom.

S. A. Jebb is a professor of diet and population health, Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, University of Oxford, Oxford, United Kingdom; at the time of the study, she was head of the Diet and Obesity Research Group, Medical Research Council Human Nutrition Research, Elsie Widdowson Laboratory, Cambridge, United Kingdom.

Supplementary materials: Figures 1 and 2 are available at www.andjrnl.org

STATEMENT OF POTENTIAL CONFLICT OF INTEREST P. Aveyard and S. Jebb are investigators on two trials funded by the National Prevention Research Initiative of the UK Medical Research Council. The treatments in these trials are provided free to the public by three commercial companies that advise a combination of diet and exercise for weight loss; these are Weight Watchers, Rosemary Conley, and Slimming World. S. Jebb was also an investigator on a trial with received funding from Weight Watchers International. No potential conflict of interest was reported by the other authors.

FUNDING/SUPPORT The work on which this article is based was funded by the UK National Institute for Health and Care Excellence (NICE) to support the development of NICE Gu >UK Medical Research Council (grant no. U105960389 Nutrition and Health). P. Aveyard is funded by The UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research Centre of Excellence. Funding from British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council and the Department of Health, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.

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