[Is the individual motivational interviewing effective in overweight and obesity treatment? A systematic review]

Effectiveness of Motivational Interviewing in Managing Overweight and Obesity : A Systematic Review and Meta-analysis

BACKGROUND

Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear.

PURPOSE

To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being.

DATA SOURCES

6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021.

STUDY SELECTION

Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI.

DATA EXTRACTION

Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses.

DATA SYNTHESIS

Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (-0.88 [95% CI, -1.27 to -0.48] kg; I ² = 0%) but were not statistically significantly more effective than lower-intensity (-0.88 [CI, -2.39 to 0.62] kg; I ² = 55.8%) or similar-intensity (-1.36 [CI, -2.80 to 0.07] kg; I ² = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (-1.16 [CI, -2.49 to 0.17] kg; I ² = 88.7%) or similar-intensity (-0.18 [CI, -2.40 to 2.04] kg; I ² = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective.

LIMITATIONS

High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies.

CONCLUSION

There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs.

PRIMARY FUNDING SOURCE

National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259).

[Knowledge, beliefs, and attitudes about obesity and overweight in a sample of dietitians-nutritionists in Spain]

INTRODUCTION

overweight and obesity make up one of the greatest public health challenges worldwide. Dietitians-nutritionists promote the acquisition of healthy habits to adjust weight. There are interesting contributions by psychology to be considered.

OBJECTIVES

a) to study the link between the variables included in the study and the therapeutic intervention of dietitians in overweight and obesity; b) to collect the opinions of dietitians on the psychological aspects involved; c) to analyze the predictors of therapeutic success.

METHODS

a descriptive cross-sectional study that, through a survey to dietitians-nutritionists in Spain (n = 266), analyzes demographic, training, and occupational data, as well as knowledge, beliefs, and interventions on obesity and overweight, with emphasis on psychological aspects. Chi-squared analyses were performed for qualitative variables, and a regression analysis was performed to estimate the perception of therapeutic success.

RESULTS

specialization in overweight and obesity was linked to nutrition education interventions. The consideration of psychological aspects was associated with addressing emotional and social problems. Nutritional education, number of sessions, and average time per session predicted the perception of therapeutic success, all of these explaining 46.5 % of the variance.

CONCLUSIONS

the findings documented a highly specific training in obesity, and a limited use of clinical practice guidelines; the cause of obesity is mostly attributable to environmental factors, and teamwork is preferred by most. Psychological factors were considered very necessary in the approach to this problem, with nutritional education being most efficient. The professionals' self-perception of therapeutic success is remarkable.

Effectiveness of web-based feedback interventions for people with overweight and obesity: systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Web-based delivered interventions have become an innovative option to treat health problems, like obesity. The aim of this systematic review and network meta-analysis was to analyze the effectiveness of web-based behavioral treatments for adults with overweight and obesity. Web-based interventions and comparison interventions (traditional weight control programs) were classified according to the following feedback characteristics: frequency, personalization, and provider (human versus machine).

METHOD

From the initial 1789 studies, 15 were included in this review. A network meta-analysis was conducted to analyze the efficacy of web-based programs with traditional interventions, considering direct and indirect comparisons. The main outcome was the weight loss mean difference (kg) between baseline and post-treatment. Heterogeneity and consistency assumptions were validated to conduct the network meta-analysis.

RESULTS

Network meta-analysis showed comparisons between different treatment options. The main results were that Intensive Contact Web-based programs were more effective than wait-list (Mean Difference - 1.86 kg; 95% Confidence Interval: - 3.61, - 0.12). Moreover, Intensive Contact Web-based programs were more effective than the other web-based options and self-help traditional interventions. However, the only significant comparison was Intensive Contact Web-based programs versus Guided Self-Help Web-based programs (Mean Difference - 4.31 kg; 95% Confidence Interval: - 5,22, - 3,41). Intensive Contact Web-based programs were the most effective treatment option according the obtained results, achieving the first place in the ranking provided by the network meta-analysis with 98.5% of probabilities.

CONCLUSIONS

Intensive Contact Web-based interventions have obtained the first position in the ranking, proving the relevance of frequent, personalized, and professional feedback and their association with a better prognosis for people with overweight and obesity. These results provide relevant information to design more effective treatments for people with overweight and obesity, in a new format especially appropriate for the current situation.

The Effectiveness of an Acceptance and Commitment Therapy and Mindfulness Group Intervention for Enhancing the Psychological and Physical Well-Being of Adults with Overweight or Obesity Seeking Treatment: The Mind&Life Randomized Control Trial Study Protocol

Although several interventions that target obesity have been examined, the success of these interventions in generating and maintaining positive results has yet to be confirmed. This study protocol therefore presents a trial aimed at analyzing the effectiveness of a well-being-centered acceptance and commitment therapy (ACT)- and mindfulness-based group intervention following the valued-based healthy living (VHL) approach (Mind&Life intervention) for individuals experiencing overweight-related distress. A randomized controlled trial with two parallel groups will be conducted in 110 adults attending primary care units with overweight or obesity. Participants will be randomly allocated to one of the two study conditions. Interventions will either be the treatment as usual (TAU) or the Mind&Life intervention—an ACT- and mindfulness-based intervention—plus the TAU intervention. Quality of life, weight self-stigma, general health status, eating habits, physical activity, eating behavior, anthropometric, body composition, cardiovascular, and physiological variables, as well as process variables, will be examined at baseline, posttreatment, 6-month follow-up, and 1-year follow-up. This trial aims to offer a novel psychological approach for addressing the psychological and physical impairments suffered by people with overweight or obesity in the current environment. ClinicalTrials.gov identifier: NCT03718728.

Long-Term Evaluation of a UK Community Pharmacy-Based Weight Management Service

Obesity increases the risk of cardiovascular disease, type 2 diabetes and cancer, reducing both the quality and quantity of life. Consequently, government healthcare costs are significant. A greater than 5% reduction in weight has been shown to result in significant improvements in type II diabetes, blood pressure and cholesterol levels and therefore effective interventions are required. This paper reports the results from 17 years of delivering a private, individualised very low calorie diet (VLCD) programme in community pharmacy. In line with national guidelines, a community pharmacy-based private weight management service was set up to support individuals over the age of 18. After assessment for clinical suitability, individuals were offered either a flexible weight loss plan or a strict weight loss plan using a very low calorie diet (VLCD). The VLCD was delivered using the protocols of the proprietary programme, Lipotrim™. These individuals followed one or more dieting sequences, defined as at least one week of attendance whilst following the VLCD, without discontinuation, producing at least a start and end weight. Data were recorded weekly and audited for this report including weight and BMI on initial presentation, weight and BMI lost and % weight and BMI loss. A total of 1875 dieting sequences were recorded from 1023 dieters. In 1261 (67.3%) sequences, a medically beneficial weight loss of >5% was achieved. Overall, the cohort demonstrated mean (sd) % weight losses of 10.1% (7.7). Mean (sd) % weight losses seen in people with type 2 diabetes was 10.4% (2.7) and 10.6% (5.9) in hypertension. In total, 555 diet sequences accessed long-term weight maintenance support. In 173 (31%) of these cases, a second weight check post weight loss could not be made. The remaining 382 individuals presenting showed a mean (sd) weight gain of only 1.4kg (4.3) equating to a mean (sd) % weight gain of only 1.8% (4.6) over a mean (sd) number of days post weight-loss of 132 days (179). The results from this long-term review demonstrate that with proper provision of a nutritionally complete VLCD, through private service provision, community pharmacies can make a significant contribution to reducing the obesity epidemic at no cost to state-funded health systems.