Applied Physiology & Nutrition Research Group; School of Physical Education and Sport; Laboratory of Assessment and Conditioning in Rheumatology; School of Medicine, FMUSP, University of Sao Paulo, Sao Paulo, SP, BR.
School of Physical Education, Faculty IELUSC, Joinville-SC, BR.
Adv Nutr. 2021 Jul 30;12(4):1449-1460. doi: 10.1093/advances/nmaa159.
Health coaching has emerged as a potential supporting tool for health professionals to overcome behavioral barriers, but its efficacy in weight management remains unclear. We conducted a systematic review and meta-analysis to synthesize and evaluate the quality of evidence supporting the use of self-reported health coaching for weight loss. Seven electronic databases (PubMed, Web of Science, Scopus, Cochrane, Psyinfo, Virtual Health Library, and Scielo) were independently searched from inception to May 2020. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation recommendations. Any study that investigated a self-reported health coaching intervention with the goal of inducing weight loss in individuals of any age, health, or training status was considered for inclusion. Quantitative data were analyzed using multilevel hierarchical metaregression models conducted within a Bayesian framework. A total of 653 studies were screened and 38 were selected for inclusion. The quality of evidence supporting outcomes based on the entire evidence base was very low and studies were deemed to have high risk of bias. Meta-analysis of controlled studies provided evidence of an effect favoring coaching compared with usual care but was trivial in magnitude [effect size (ES)0.5: -0.09; 95% credible interval (CrI): -0.17, -0.02]. The multilevel extension of Egger's regression-intercept test indicated the existence of publication bias, whereas a sensitivity analysis based only on those studies deemed to be of high quality provided no evidence of an effect of coaching on weight loss (ES0.5: -0.04; 95% CrI: -0.12, 0.09). Considered collectively, the results of this investigation indicate that the available evidence is not of sufficient quality to support the use of self-reported health coaching as a health care intervention for weight loss. This trial was registered at Prospective Register of Systematic Reviews (PROSPERO) as CRD42020159023.
健康指导已成为医疗专业人员克服行为障碍的一种潜在支持工具，但它在体重管理方面的效果尚不清楚。我们进行了系统评价和荟萃分析，以综合和评估支持使用自我报告的健康指导来减肥的证据质量。从成立到 2020 年 5 月，我们独立地在七个电子数据库（PubMed、Web of Science、Scopus、Cochrane、Psyinfo、Virtual Health Library 和 Scielo）中进行了搜索。本综述按照系统评价和荟萃分析的首选报告项目以及使用推荐评估、制定和评估建议评估证据质量进行。任何研究都考虑了调查自我报告的健康指导干预，目标是诱导任何年龄、健康或训练状态的个体减肥。使用多层次分层荟萃回归模型在贝叶斯框架内分析定量数据。共筛选了 653 项研究，其中 38 项被纳入。基于整个证据基础的结果的证据质量非常低，研究被认为存在高偏倚风险。对照研究的荟萃分析提供了支持与常规护理相比，指导更有利的证据，但效果很小[效应量（ES）0.5：-0.09；95%可信区间（CrI）：-0.17，-0.02]。Egger 回归截距检验的多层次扩展表明存在发表偏倚，而仅基于那些被认为质量较高的研究进行的敏感性分析没有提供指导对体重减轻有影响的证据（ES0.5：-0.04；95%CrI：-0.12，0.09）。综合考虑，本研究结果表明，现有证据的质量不足以支持将自我报告的健康指导作为减肥的医疗保健干预措施。该试验在系统评价前瞻性登记（PROSPERO）中注册为 CRD42020159023。
