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Randomized Controlled Trials to Treat Obesity in Military Populations: A Systematic Review and Meta-Analysis

Published online by Cambridge University Press:  27 August 2024

D. Gravina ,
J. L. Keeler ,
M. N. Akkese ,
S. Bektas ,
P. Fina ,
C. Tweed ,
G. D. Willmund ,
L. Dell’Osso ,
J. Treasure  and
H. Himmerich
D. Gravina*
Affiliation:
1Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Centre for Research in Eating and Weight Disorders, London, United Kingdom 2University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy
J. L. Keeler
Affiliation:
1Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Centre for Research in Eating and Weight Disorders, London, United Kingdom 3Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom
M. N. Akkese
Affiliation:
1Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Centre for Research in Eating and Weight Disorders, London, United Kingdom
S. Bektas
Affiliation:
1Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Centre for Research in Eating and Weight Disorders, London, United Kingdom 4Hacettepe University, Department of Psychology, Ankara, Türkiye
P. Fina
Affiliation:
5Sigmund Freud University Vienna, Faculty of Psychology, Vienna, Austria
C. Tweed
Affiliation:
3Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom 6Royal Navy Reserve, London, United Kingdom
G. D. Willmund
Affiliation:
7Military Hospital Berlin, Bundeswehr Center for Military Mental Health, Berlin, Germany
L. Dell’Osso
Affiliation:
2University of Pisa, Department of Clinical and Experimental Medicine, Pisa, Italy
J. Treasure
Affiliation:
1Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Centre for Research in Eating and Weight Disorders, London, United Kingdom 3Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom
H. Himmerich
Affiliation:
1Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Centre for Research in Eating and Weight Disorders, London, United Kingdom 3Bethlem Royal Hospital, South London and Maudsley NHS Foundation Trust, London, United Kingdom
*
*Corresponding author.

Abstract

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Introduction

In recent years, overweight and obesity have reached an alarmingly high incidence and prevalence worldwide; they have also been steadily increasing in military populations. Military personnel as an occupational group are often exposed to stressful and harmful environments that represent a risk factor for disordered eating with major repercussions on both physical and mental health.

Objectives

This study aims to explore the effectiveness of weight loss interventions and to assess the significance of current obesity treatments for military populations.

Methods

Three online databases (PubMed, PsycInfo, and Web of Science) were screened to identify randomized controlled trials (RCTs) aiming to treat obesity in active-duty military personnel and veterans. Random-effects meta-analyses were conducted for body weight (BW) and body mass index (BMI) values, both longitudinally comparing treatment group from pre-to-post intervention, and cross-sectionally comparing the treatment group to controls at the end of the intervention.

Results

A total of 21 studies were included: 16 cross-sectional (BW: n=15; BMI: n=12) and 16 longitudinal (BW: n=15; BMI: n=12) were meta-analyzed, and 5 studies were narratively synthesized. A significant small overall BW and BMI reduction from baseline to post-intervention was observed (BW: g = -0.10; p = 0.015; BMI: g = -0.32; p < 0.001), together with a decreased BMI (g = -0.16; p = 0.001) and nominally lower BW (g = -0.08; p = 0.178) in the intervention group compared to controls at post-intervention time-point. When conducting additional meta-analyses dividing by sample type, a significant decrease in both BMI (g= -0.35; p< 0.001) and BW (g= -0.12; p= 0.041) from pre-to-post intervention was observed in active-duty military personnel but not for veterans.Recommendations for clinical practice have been outlined from the findings of this study and summarized in Figure 1.

Image:

Conclusions

Despite limitations, such as the heterogeneity across the included interventions and the follow-up duration, our findings highlight how current weight loss interventions are effective in term of BW and BMI reductions in military populations, and how a comprehensive approach with multiple therapeutic goals should be taken during the intervention.

Disclosure of Interest

None Declared

Type
Abstract
Information
European Psychiatry , Volume 67 , Special Issue S1: Abstracts of the 32nd European Congress of Psychiatry , April 2024 , pp. S307 - S308
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2024. Published by Cambridge University Press on behalf of European Psychiatric Association
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