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Behavioural strategies to reduce obesity among lower socio-economic adults living in high-income countries: a Grades of Recommendation, Assessment, Development and Evaluation-assessed systematic review and meta-analysis of randomised controlled trials

Published online by Cambridge University Press:  25 August 2023

Priscilla Li Open the ORCID record for Priscilla Li [Opens in a new window] ,
Yingxiao Huang  and
Alvin Wong Open the ORCID record for Alvin Wong [Opens in a new window]
Priscilla Li*
Affiliation:
Department of Dietetics, Changi General Hospital, 529889 Singapore, Singapore King’s College London, Department of Population Health Sciences, London, UK
Yingxiao Huang
Affiliation:
Department of Dietetics, Changi General Hospital, 529889 Singapore, Singapore
Alvin Wong
Affiliation:
Department of Dietetics, Changi General Hospital, 529889 Singapore, Singapore
*
*Corresponding author: Priscilla Li, email priszyli@gmail.com
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Abstract

Adult obesity disproportionately affects lower socio-economic groups in high-income countries and perpetuates health inequalities, imposing health and socio-economic burden. This review evaluates the effectiveness of behavioural strategies in reducing weight and cardiovascular disease (CVD) risks among low-income groups based in high-income countries. We searched major databases for randomised controlled trials published between 1 November 2011 and 1 May 2023. Meta-analyses and subgroup analyses were undertaken to analyse the pooled and individual effects of behavioural strategies. Cochrane Risk of bias (RoB 2·0) tool and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria were used to assess the quality and certainty of evidence. Fourteen trials (3618 adults, aged 40·2 ± 9·7 years with BMI 33·6 ± 2·8 kg/m2) and nine unique interventions were identified. Three trials with high RoB were omitted. Meta-analysis favoured interventions, demonstrating significant reductions in body weight (MD: −1·56 kg, (95 % CI –2·09, −1·03)) and HbA1c (MD: −0·05 %, (95 % CI − 0·10, −0·001)) at intervention end. Sub-group analysis showed no differences in waist circumference, blood pressure or serum lipids. Financial incentives and interactive feedback produced greatest amounts of weight losses ≥ 2 kg (GRADE: moderate). Behavioural strategies are effective weight loss interventions among lower socio-economic groups living in high-income nations. However, the impact on CVD risk remains unclear.

Keywords

ObesityMeta-analysisClinical nutritionLow Income
Type
Systematic Review and Meta-Analysis
Information
British Journal of Nutrition , Volume 131 , Issue 3 , 14 February 2024 , pp. 544 - 552
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Nutrition Society

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