Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
JAMA. 2018 Sep 18;320(11):1172-1191. doi: 10.1001/jama.2018.7777.
Overweight and obesity have been associated with adverse health effects.
To systematically review evidence on benefits and harms of behavioral and pharmacotherapy weight loss and weight loss maintenance interventions in adults to inform the US Preventive Services Task Force.
MEDLINE, PubMed Publisher-Supplied Records, PsycINFO, and the Cochrane Central Register of Controlled Trials for studies published through June 6, 2017; ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry Platform for ongoing trials through August 2017; and ongoing surveillance in targeted publications through March 23, 2018. Studies from previous reviews were reevaluated for inclusion.
Randomized clinical trials (RCTs) focusing on weight loss or weight loss maintenance in adults.
Data were abstracted by one reviewer and confirmed by another. Random-effects meta-analyses were conducted for weight loss outcomes in behavior-based interventions.
Health outcomes, weight loss or weight loss maintenance, reduction in obesity-related conditions, and adverse events.
A total of 122 RCTs (N = 62 533) and 2 observational studies (N = 209 993) were identified. Compared with controls, participants in behavior-based interventions had greater mean weight loss at 12 to 18 months (-2.39 kg [95% CI, -2.86 to -1.93]; 67 studies [n = 22065]) and less weight regain (-1.59 kg [95% CI, -2.38 to -0.79]; 8 studies [n = 1408]). Studies of medication-based weight loss and maintenance interventions also reported greater weight loss or less weight regain in intervention compared with placebo groups at 12 to 18 months (range, -0.6 to -5.8 kg; no meta-analysis). Participants with prediabetes in weight loss interventions had a lower risk of developing diabetes compared with controls (relative risk, 0.67 [95% CI, 0.51 to 0.89]). There was no evidence of other benefits, but most health outcomes such as mortality, cardiovascular disease, and cancer were infrequently reported. Small improvements in quality of life in some medication trials were noted but were of unclear clinical significance. There was no evidence of harm such as cardiovascular disease from behavior-based interventions; higher rates of adverse events were associated with higher dropout rates in medication groups than in placebo groups.
Behavior-based weight loss interventions with or without weight loss medications were associated with more weight loss and a lower risk of developing diabetes than control conditions. Weight loss medications, but not behavior-based interventions, were associated with higher rates of harms. Long-term weight and health outcomes data, as well as data on important subgroups, were limited.
超重和肥胖与不良健康后果有关。
系统评价行为和药物减肥及减肥维持干预对成年人的益处和危害的证据，为美国预防服务工作组提供信息。
MEDLINE、PubMed 出版商提供的记录、PsycINFO 和 Cochrane 中央对照试验注册中心，检索截至 2017 年 6 月 6 日发表的研究；ClinicalTrials.gov 和世界卫生组织国际临床试验注册平台，检索截至 2017 年 8 月正在进行的试验；以及 2018 年 3 月 23 日前通过目标出版物进行的持续监测。对之前综述中的研究进行了重新评估以确定是否纳入。
以成年人减肥或减肥维持为重点的随机临床试验（RCT）。
由一名审查员进行数据提取，另一名审查员进行确认。对基于行为的干预措施中的体重减轻结果进行了随机效应荟萃分析。
健康结局、体重减轻或体重维持、肥胖相关疾病的减少以及不良事件。
共确定了 122 项 RCT（N=62533）和 2 项观察性研究（N=209993）。与对照组相比，行为干预组在 12 至 18 个月时的平均体重减轻更大（-2.39kg[95%CI，-2.86 至-1.93]；67 项研究[n=22065]），体重反弹更少（-1.59kg[95%CI，-2.38 至-0.79]；8 项研究[n=1408]）。药物减肥和维持干预的研究也报告了在 12 至 18 个月时，与安慰剂组相比，干预组的体重减轻或体重反弹减少（范围，-0.6 至-5.8kg；未进行荟萃分析）。与对照组相比，减肥干预中患有前驱糖尿病的参与者发生糖尿病的风险较低（相对风险，0.67[95%CI，0.51 至 0.89]）。没有证据表明有其他益处，但大多数健康结局，如死亡率、心血管疾病和癌症，很少报告。一些药物试验中注意到生活质量的小的改善，但临床意义尚不清楚。没有证据表明行为干预会导致心血管疾病等危害；与安慰剂组相比，药物组的不良反应发生率更高，导致更高的脱落率。长期体重和健康结局数据，以及重要亚组的数据有限。
