Obesity is a leading risk factor for premature morbidity and mortality, and an increasing public health challenge. This review aimed to systematically identify and appraise national and international clinical guidelines for the management of obesity in adults. We systematically searched MEDLINE, CINAHL, Embase, and PsycINFO from 01/01/2019 to 06/01/2025. We conducted supplementary searches on websites of clinical guideline-producing organizations and other relevant institutional and evidence-based clinical resources. We included national and international guidelines on the management of obesity in adults aged ≥ 18 years that included recommendations on prespecified primary topics of interest, clearly stated the systematic approach and evidence base underpinning recommendations, and included a rating of the quality of evidence. The Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and appraisal using the mEaningful VOice in the design and deLiVery of care (EVOLVE) framework were employed by two reviewers independently. Data were extracted by one reviewer, checked by another, and narratively synthesized. We identified 10 eligible clinical guidelines. The mean overall AGREE II score was 4.9/7 (SD: 1.22). Patients were involved in highlighting preferences, panel membership, reviewing drafts, and consensus meetings in most guidelines, and formulating/prioritizing questions, priority setting, and dissemination in a minority. The 2025 National Institute of Health and Care Excellence guideline on "Overweight and Obesity Management" displayed the most extensive scope and highest overall AGREE II score (7/7). This review will inform adaptation, as part of an ADAPTE process, for a prioritized National Clinical Guideline on the management of obesity in adults in Ireland.
Recent studies suggest that health literacy (HL) may play an important role in management of individuals living with severe obesity (BMI ≥ 40 kg/m2), but to date, there has been no attempt to synthesize characteristics and outcomes of these studies. To explore the prevalence of low HL in people with severe obesity, and how HL may impact on health outcomes and management of severe obesity, six databases and two independent journals were searched. Seventeen studies were included in this review, mostly undertaken in high income countries, among females and candidates of bariatric surgery. Low HL ranged from 3.7% to 57.9% in cohorts studied, possibly explained by the heterogeneity of HL tools (i.e., seven different validated tools). Eight studies found higher HL to lead to better treatment outcomes (e.g., weight loss, attending appointments). Thematic synthesis of qualitative studies identified a lack of access to health information and support from healthcare providers (domains of HL) as barriers in improving health in patients with severe obesity. There is notable gap in interventional studies on improving HL in people with severe obesity. Overall, HL seems to be an important predictor of health outcomes in management of severe obesity. Further research is needed to assess the impact of HL on a broader range of health outcomes in nonsurgical patients with severe obesity.
As the field of metabolic surgery (MS), also known as bariatric surgery, continues to grow and change, especially in light of emerging anti-obesity medications, the need to identify seminal studies within this domain becomes increasingly crucial. This study aims to provide a comprehensive 10-year update on the most frequently cited articles in MS. Utilizing the SCOPUS database, we identified the top 100 most cited articles in MS as of July 2023. Beyond assessing the most frequently cited works, this study also examines articles with the most citations per year and explores the citation trends. The average number of citations per article increased from 383.5 in 2014 to 889.5. Forty-four papers from the original top 50 list in 2014 were included in the current list. The year 2004 had the most number in the top 100 (n = 10). While Roux-en-Y gastric bypass (RYGB) had the highest representation (48%), sleeve gastrectomy (SG) has rapidly risen in interest. As the landscape of MS expands, the reassessment of top-cited scientific articles becomes imperative for obesity physicians and scientists, metabolic surgeons, fellows, and residents. Many of the articles listed in 2014 persisted in the 10-year update, reflecting the significant growth observed in the MS field during the early 2000s. The increased citation count likely indicates the expanding influence of MS research. Despite RYGB maintaining its status as the most studied procedure, a noticeable uptick in interest in sleeve gastrectomy post-2009 is evident as demonstrated by its increased representation within highly cited publications.
Sarcopenic obesity has been associated with various health conditions and mortality. Our objective was to systematically review and estimate the association between sarcopenic obesity and respiratory function outcomes. We searched EMBASE, MEDLINE, and Google Scholar for observational studies involving adults (≥ 18 years), defined sarcopenic obesity, and assessed respiratory outcomes in those with and without sarcopenic obesity. A random-effects meta-analysis was conducted for the outcomes of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and the ratio of forced expiratory volume in 1 s to forced vital capacity (FEV1/FVC). Seven papers representing 173,677 participants were included. The risk of bias assessment using the JBI Critical Appraisal Checklist revealed that all studies had a low risk of bias. The meta-analysis included data from five studies, revealing a significant association between sarcopenic obesity and lower FVC (in L) (-0.77; 95% CI, -1.27, -0.26) and FEV1 (in L) (-0.84; 95% CI, -1.26, -0.42), both with high heterogeneity (I2 = 94%). Sarcopenic obesity was significantly associated with respiratory function outcome (FEV1) when obesity was assessed using fat mass % (-1.14; 95% CI, -1.21, -1.06), but not when using the body mass index (BMI). In conclusion, sarcopenic obesity was significantly associated with poorer respiratory function outcomes. Assessment of respiratory function may be desirable in those with sarcopenic obesity, especially in high-risk populations such as older adults.
Despite all efforts, obesity remains a major health concern worldwide, with continuously increasing rates, affecting approx. 14% of the total world population, being as high as 43% in some countries. As obesity is related to numerous comorbidities, including type 2 diabetes, cardiovascular diseases, and some types of cancer, the consequences for the individual and society at large are drastic. Therefore, it is crucial to understand and predict who is at risk of developing obesity in order to implement early prevention strategies. Many individual risk factors have been emphasized. However, as obesity is a rather multifactorial complication, single markers/biomarkers have thus far not allowed for an efficient prediction of obesity. In addition to less modifiable parameters, such as environment and socio-demographics, studies have revealed that obesity is related to several interacting aspects, including host factors such as genetics/epigenetics or gut microbiota, and more readily modifiable factors, including nutrition and physical activity, as well as sleep patterns and psychological well-being. It is likely that combining markers from across different domains, that is, multimodal markers, allows for better predictability for the risk of developing obesity. However, it must be considered that not all markers are fully predictive; many are rather reactive or even both. In this review and position paper, we emphasize the state-of-the-art regarding (bio)markers that have successfully been employed for predicting obesity risk. An emphasis will rest on novel, emerging biomarkers, and the need for a more integrative, multimodal assessment of obesity risk for a combined assessment aimed at improving risk prediction.
The paper aims to assess the effects of GLP-1 RAs, structured exercise, and their combination on body composition and cardiometabolic outcomes in adults with overweight or obesity. PubMed, Web of Science, Scopus, and EBSCO were searched through April 2026 for English-language RCTs using terms related to obesity, GLP-1 RAs, exercise, and glucolipid metabolism outcomes. We included RCTs of adults (18-65 years, BMI ≥ 25 kg/m2) without major comorbidities, except for type 2 diabetes, testing GLP-1 RAs, structured exercise, or both. Of 2508 screened articles, nine studies comprising 1009 participants met eligibility criteria. Participants included 589F/420M, with a weighted mean age of 43.8 ± 12.2 years and weighted mean BMI of 32.6 ± 3.0 kg/m2. Risk of bias was assessed using RoB 2. A frequentist random-effects model calculated SMDs. Primary outcomes were changes in body weight, waist-to-hip ratio, and fat mass. Secondary outcomes included fasting glucose, HOMA-IR, triglycerides, LDL-C, and HDL-C. Meta-regression assessed weight loss as a predictor of metabolic outcomes. The combination of GLP-1 receptor agonists and exercise was associated with the greatest effects on weight (SMD -1.04; 95% CI -1.24 to -0.83), fat mass (SMD -1.01; 95% CI -1.27 to -0.75), and waist-to-hip ratio (SMD -0.55; 95% CI -0.91 to -0.18) compared with placebo. For fasting glucose, the SMD was -0.49 (95% CI -1.52 to 0.55); for HOMA-IR, -0.59 (95% CI -0.89 to -0.29). For lipid outcomes, no statistically significant differences were observed for triglycerides or LDL-C, whereas HDL-C increased compared with placebo (SMD 0.32; 95% CI 0.04 to 0.61). Confidence in the evidence was high for body weight and fat mass, moderate for waist-to-height ratio and most lipid outcomes, and very low for fasting glucose. Combined GLP-1 RA and structured exercise interventions improved weight, insulin sensitivity, and selected lipid parameters more than monotherapies or placebo.
Although an attractive approach for treating obesity-related pathologies, the development of peripherally restricted cannabinoid 1 receptor inhibitors has thus far failed to deliver drugs with clinically validated efficacy and safety margins over central nervous system (CNS)-related side effects. Challenges and frequently occurring misleading assumptions with this strategy are discussed. However, the recently reported peripherally restricted hepatotropic cannabinoid 1 receptor inverse agonist TM38837 is noteworthy due to the substantial weight loss efficacy in DIO rodents coupled with minimal CNS exposure, which suggests that such a chemotype may have clinical utility. Furthermore, hepatic cannabinoid 1 receptor upregulation is implicated as a major driver of the obese phenotype in rodents, which opposes current theories based upon experiments with genetically modified mice. Accordingly, a novel hypothesis is proposed, which implicates cannabinoid 1 receptor upregulation as a mediator of cell cycle progression, which drives lipid synthesis during the mitosis phase. The upregulation is initiated by increasing redox state and amplified by a feed-forward effect whereby cannabinoid 1 receptor activation induces cannabinoid 1 receptor upregulation by increasing expression of pro-oxidant enzymes. This mechanism is activated prematurely in the cell cycle by lifestyle factors, which are known to cause oxidative stress in hepatocytes and are associated with the development of obesity. The consequence of such aberrant cannabinoid 1 receptor upregulation is sustained lipogenesis, leading to reduced cellular ATP levels, which drive increased food intake and contribute to other pathologies.
This systematic review and meta-analysis aimed to evaluate the effects of probiotic and symbiotic supplementation on lipid parameters in individuals with overweight and obesity to elucidate the aspects involved in this topic. The PubMed, EMBASE, LILACS, Scopus, Web of Science, Cochrane Library, and Science Direct electronic databases were systematically searched for RCTs up to April 2023. The risk of bias was evaluated using the updated version of the Cochrane tool for assessing bias risk in randomized trials (RoB 2). The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. The review was registered in PROSPERO under the number: CRD42023442133. Of the 1363 articles identified in the search, 28 were included in the systematic review and meta-analysis. Data analysis showed a significant effect of probiotics and symbiotics in reducing total cholesterol (MD = -0.09 mmol/L; 95% CI: -0.16, -0.03), LDL (MD = -0.06 mmol/L; 95% CI: -0.12, -0.01), and triglycerides (MD = -0.05 mmol/L; 95% CI: -0.10, -0.01) levels, but no significant effect on HDL (MD = 0.01 mmol/L; 95% CI: -0.01, 0.03) levels compared to the control group. In subgroup analyses, symbiotics showed a greater reduction in total cholesterol, LDL, and triglycerides. This meta-analysis suggests that probiotic and symbiotic supplementation can reduce total cholesterol, LDL, and triglyceride levels in individuals with overweight or obesity, with a greater effect observed for symbiotic supplementation.
Emerging literature links life dissatisfaction with maladaptive coping mechanisms, including compulsive eating, particularly in environments with limited health-promoting resources. This study explores how life satisfaction interacts with psychological and sociostructural factors to influence obesity risk, with a focus on the role of weight perception across the lifespan. A thorough search was conducted, and data were uploaded in Covidence, a validated website-based screening and data extraction tool. After an extensive review process, 83 studies remained for extraction. A qualitative approach was then used to synthesize the articles, primarily effects of age. Our analysis also considered effects of gender, geographical/racio-ethnic, and cultural differences. Across the lifespan, life satisfaction was more strongly predicted by weight perception rather than BMI or objective weight status. This effect was particularly pronounced in females, who showed greater vulnerability to negative weight perception compared to their male counterparts. The findings emphasize the psychological burden of perceived body image and its role in driving dissatisfaction, irrespective of clinical weight categories. The findings highlight the influence of gender, geography, and cultural factors in the interplay between life satisfaction and obesity. This research supports a biopsychosocial framework of obesity, highlighting effects of weight perception on life satisfaction and health behaviors. Interventions aimed at psychosocial well-being and reframing weight perception, especially among young females, may serve as protective factors against maladaptive eating behaviors and long-term obesity. Future obesity interventions should consider life meaning, personality traits, and perceived body image to better target at-risk populations.
Behavioral weight management interventions have been shown to be effective for weight loss. However, a common challenge is difficulty in engaging with the public, participants, or service-users across the research continuum. User-provider relationships are key in weight management and may be integral to continuing engagement. This overview aimed to understand the nature of relationships within behavioral weight management interventions delivered in research studies and healthcare settings, how these may influence retention as well as potential relationship barriers and facilitators. Six databases were searched; 20 reviews (27 reports) were included. Most reviews investigated weight management delivered face-to-face by healthcare professionals across different settings. The Theoretical Domains Framework guided the synthesis of qualitative and quantitative data regarding user-provider relationships. GRADE CER-Qual was used to assess the confidence of findings. Thirty-eight findings were categorized to domains in the framework in addition to two cross-cutting themes. High confidence evidence demonstrated that the domains of knowledge, skills, social/professional role or identity, environmental context and resources, and behavioral regulation provided challenges as well as enabling relationships in weight management. The central domain underpinning the influence of relationships on retention was social influences, with weight stigma a pervasive theme recurring across domains. Application of a theoretical lens to consider cognitive, affective, social, and environmental influences helped better understand user-provider relationships as a potential mechanism through which retention-related behaviors in weight management can be driven or deterred. This overview suggests that improving user-provider relationships should be considered a useful retention strategy in weight management programs.
Obesity is a major public health challenge worldwide, driving chronic disease and health care costs. Primary health care (PHC) is a key setting for prevention, early identification, and management of obesity, yet implementation of evidence-based interventions remains limited. Identifying the barriers and enablers that influence adoption of obesity care in PHC is critical to strengthen delivery. This scoping review will systematically map and synthesize barriers and enablers to implementing obesity interventions in PHC, considering behavioral, nutritional, pharmacological, digital, and organizational approaches, across both adult and pediatric populations. The review will follow the Joanna Briggs Institute (JBI) methodology and be reported according to PRISMA-ScR guidelines. Searches will be conducted in PubMed, Cochrane Library, Scopus, Web of Science, and ScienceDirect, complemented by gray literature from OpenGrey, ResearchGate, Google Scholar, and organizational websites. Eligible sources will include peer-reviewed and gray literature published between 2019 and 2025 in English, French, German, Italian, Portuguese, Spanish, or Turkish. Two reviewers will independently screen, extract, and analyze data, with discrepancies resolved by consensus. Data will be synthesized descriptively and thematically, supported by NVivo, and results presented in tables, thematic maps, and conceptual diagrams. Expected Results Anticipated barriers include time constraints, limited provider training, stigma, scarce resources, and inadequate reimbursement models. Enablers are expected to include supportive health policies, training, patient engagement strategies, and team-based care models. This review will synthesize implementation factors affecting obesity care in PHC, informing scalable strategies and policy to improve obesity management worldwide.
Overweight and obesity rates are rising globally, including among young adults, posing significant health risks. However, prevention programs in low- and middle-income countries (LMICs) are limited, and little is known about their applicability in these settings. This systematic review aimed to assess the effectiveness and feasibility of overweight and obesity prevention and management interventions among young adults in LMICs. Databases, including Medline, Scopus, and Web of Science, were systematically searched to identify trials published between 2014 and February 2026. Studies were included if they targeted young adults in LMICs and reported outcomes such as body mass index (BMI) and/or waist circumference. Publications reporting feasibility outcomes were manually searched. A random-effects meta-analysis estimated the mean difference in outcomes by gender and intervention duration. A narrative synthesis complemented the random-effects meta-analysis. The Cochrane risk-of-bias tool and Grades of Recommendations, Assessment, Development and Evaluation (GRADE) framework evaluated the evidence quality. Sixteen intervention studies met inclusion criteria, but none reported on feasibility. Nine studies were included in the meta-analysis on effectiveness. Pooled estimates show that mean BMI (kg/m2) (-1.13; 95% CI: -2.10, -0.17) and waist circumference (cm) (-1.66; 95% CI: -2.35, -0.96) were significantly lower in the intervention group compared to the controls. Greater effects were observed in longer durations of interventions (≥ 6 months). The quality of evidence was moderate. Obesity control interventions may benefit young adults in LMICs, but evidence is limited and moderate in quality. Future studies should evaluate feasibility using established implementation frameworks.
To compare the ratings of quality and risk of bias of systematic reviews/meta-analyses (SRs/MAs) in bariatric research published in 2016 and 2017 using the AMSTAR 2 and ROBIS tools. The methodology is described in detail in our first publication (Obes Rev. 2020; https://doi.org/10.1111/obr.12994). A systematic survey by searching three electronic databases was conducted to identify SRs/MAs assessing any outcome in patients with morbid obesity undergoing or scheduled for bariatric surgery published in 2016 and 2017. Pairs of reviewers independently screened titles and abstracts, assessed full texts, extracted data, and evaluated the quality and risk of bias using the AMSTAR 2 and ROBIS tools. Discrepancies were resolved by a third reviewer. Agreement between reviewers and between the instruments was assessed using Fleiss' kappa and Gwet's statistics. Matching between AMSTAR 2 items (critical and noncritical) and ROBIS signaling questions was also examined. Of the 78 included SRs/MAs, 77 (98.7%) were assessed as critically low methodological quality by AMSTAR 2, while ROBIS classified five reviews (6.4%) as low risk of bias, 61 (78.2%) as high, and 12 (15.4%) as unclear. Both tools demonstrated moderate inter-rater reliability for individual items and overall judgments. The methodological quality of SRs/MAs in bariatric research was predominantly critically low. Calibration exercises are strongly recommended before applying either tool. AMSTAR 2 and ROBIS each address a distinct research question, and tool choice should be guided by the specific study objective. PROSPERO Registration: CRD42017080394.
Obesity and poor mental well-being in childhood and adolescence are growing public health concerns with potential implications for a broad range of life outcomes. Understanding the longitudinal and potentially bidirectional relationship between weight status and mental well-being is crucial for developing effective interventions to support children and adolescents. This systematic review synthesizes evidence on the bidirectional relationship between weight status and indicators of mental well-being over time. Peer-reviewed studies published up to January 10, 2025 were identified through searches in PubMed, PsycINFO, Scopus, and Web of Science. Eligible studies included longitudinal designs assessing weight status and mental well-being in populations up to age 18 years. The Joanna Briggs Instrument assessed the risk of bias, and the findings were narratively summarized. The review included 33 longitudinal studies conducted between 1994 and 2022. We found that higher childhood weight was associated with subsequent low mental well-being, and an indication that poor mental well-being was associated with subsequent higher weight. However, there was a scarcity of longitudinal studies exploring the influence of mental well-being on subsequent weight status. Large heterogeneity in design and methods was found across the included studies. Findings indicated a bidirectional association between weight status and mental well-being, with stronger evidence supporting the impact of weight status on mental well-being than vice versa. Future research should prioritize longitudinal designs to better understand the influence of mental well-being on later weight development and explore underlying mechanisms.
Meal satisfaction is considered a multidimensional concept that includes sensory enjoyment, cognitive, emotional, and physiological components and relates to contentment with the meal experience as a whole. However, its relevance to eating behavior and body weight remains unclear, especially in children. The present review investigated the potential relationship between meal satisfaction-related constructs and childhood obesity, and whether this relation is shaped by individual factors and the external environment. Seventeen eligible studies from 350 records published between 2008 and 2024 were included. No study directly assessed meal satisfaction; instead, proxy measures were used. Food enjoyment emerged as the proxy most consistently associated with BMI, often clustering with higher food responsiveness, lower satiety responsiveness, and emotional overeating. Parental feeding practices, especially pressure to eat, significantly contributed to variation in children's eating behavior and were associated with lower food enjoyment. Overall, meal satisfaction could be a key aspect to consider in childhood obesity prevention programs. However, to date, the available evidence is heterogeneous and predominantly observational. Future longitudinal and intervention studies are needed, alongside child-appropriate instruments to objectively quantify food satisfaction in children. Research that helps understand the role of contextual eating factors on children's meal satisfaction and eating behavior is also warranted.
Maternal obesity represents an urgent public health challenge with serious maternal, neonatal, and health system implications. Characterizing levels of obesity during pregnancy is necessary to guide future research, policy, and practice. This review summarizes existing data on maternal obesity prevalence across Europe. Studies published between 2009 and 2023 that reported the prevalence of obesity during pregnancy were included. The primary outcome was to measure the prevalence of obesity during pregnancy. Secondary outcomes were assessing the method and timing of BMI ascertainment. In total, 99 studies were included. Over three quarters of studies (N = 76, 76.7%) collected data from Swedish, United Kingdom, or Irish populations. Height was objectively assessed in 37 studies (37.4%) and weight in 53 studies (53.5%). The median obesity prevalence was 12.5% (IQR 4.4-20.6). In a subset of studies reporting prevalence by year, obesity ranged from 2.2% (1986) to 28.3% (2007) with a significant positive association of maternal obesity over time (τ = 0.64, p < 0.001). This review highlights consistent increases in obesity during pregnancy among European populations with significant implications for patients and health systems.
This study aimed to examine the causal effect of adiposity on mental illnesses by summarizing and assessing evidence from Mendelian randomization (MR) studies. Searches were conducted on Embase, Medline, and Web of Science from database inception to September 22nd, 2025. Studies using MR study designs that estimated adiposity measures including body mass index, abdominal adiposity, peripheral adiposity, or body composition in relation to mental illnesses were included. Outcomes were the presence or severity of depression, anxiety, eating disorders, bipolar disorder, obsessive compulsive disorder, post-traumatic stress disorder, schizophrenia, and related psychotic disorders. Study quality was assessed with a scoring system reflecting MR study guidelines. Data were pooled in meta-analyses using random-effects models. Subgroup analyses were conducted by sex. Fifty-seven studies with 215 MR estimates were included in the systematic review, and 23 studies with 44 MR estimates were included in meta-analyses. Pooled estimates suggested that general adiposity was causally associated with depression (OR: 1.09, 95% CI, 1.02-1.15, p < 0.001; I2 = 94%), but the effect size was modest and there was high heterogeneity. Subgroup differences by sex in the causal relationship were not observed (p = 0.318). There was suggestive evidence for causal associations of adiposity with schizophrenia and OCD; however, these analyses were characterized by high imprecision and heterogeneity. The evidence for other mental illnesses remains unclear. General adiposity appears to be causally associated with depression, suggesting psychological benefits of weight management. Evidence for causal associations between adiposity and other mental illnesses remains suggestive or uncertain.
The effectiveness of obesity prevention or obesity reduction policies is co-determined by policy content, the implementation process, and contextual factors. This systematic review provides insight into implementation strategies used in whole-of-community obesity prevention policies aimed at changes in two types of outcomes: (1) a reduction in obesity/overweight prevalence, body mass index-related outcomes, and other weight-related outcomes, or (2) a change in nutrition behaviors, physical activity, and sedentary behaviors or screen time. We specifically examined implementation strategies using the Expert Recommendations for Implementing Change (ERIC) framework, focusing on policies implemented in low socioeconomic status communities. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, eight databases were searched. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. The efficacy of implementation strategies was considered supported if at least 66% of the studies that applied respective strategies reported significant improvements for a given outcome type across at least three studies. A total of 29 original studies were included. Fifteen implementation strategies from the ERIC framework were consistently associated with favorable outcomes. These strategies included altering incentive structures, assessing community readiness, and using data warehousing techniques. Six additional non-ERIC strategies (e.g., cultural adaptation and grassroots mobilization) received support across different outcome domains. Most studies (72%) had a low risk of bias. Findings may help prioritize implementation strategies that may drive the success of whole-of-community obesity policies targeting disadvantaged populations. The results suggest a need to expand existing implementation taxonomies to include community-driven strategies.
Achieving and maintaining weight loss are challenging and require sustained lifestyle changes. This study examined which behavior change techniques (BCTs) support long-term weight outcomes among adults with overweight or obesity. We synthesized evidence from randomized controlled trials of behavioral interventions versus control or alternative interventions, focusing on nonclinical adults (BMI > 25) with ≥ 6-month follow-up, published between 2010 and 2025, that reported weight outcomes. Sixty-five studies (approximately 10,000 participants) evaluating 87 behavioral interventions targeting physical activity, diet, or both were included. BCTs were coded using the BCT Taxonomy v1. Meta-analysis estimated pooled effects on total weight loss (baseline to follow-up) and weight maintenance (posttreatment to follow-up). Behavioral interventions produced a mean effect size for total weight loss of Hedges' g = -0.19 (95% CI = -0.30 to -0.13), equating to an average additional weight loss of approximately 3.25 kg compared to controls. No significant effect was found for weight maintenance after initial loss, indicating no statistically significant difference in weight change between intervention and control groups during follow-up. Meta-regression examined the number of BCTs, intervention type, and follow-up duration, but none significantly moderated effects. Subgroup analyses identified the following effective BCTs: goal setting, feedback on behavior and outcome(s) of behavior, self-monitoring of behavior and outcome(s) of behavior, instruction on how to perform the behavior, demonstration of the behavior, conserving mental resources and incentives. These BCTs appear to support relative long-term weight outcomes and warrant further investigation.
This work aimed to investigate the efficacy and safety of Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in adults with acquired hypothalamic obesity (HO). Systematic review and meta-analysis. Publications reporting relevant outcomes in patients with HO before and after RYGB or SG were identified through a systematic literature search. Two meta-analyses were performed: one based on individual patient data (IPD) and one on case-control studies. Thirteen publications including 36 unique patients with HO were included in the IPD meta-analysis. Percent total weight loss was 16.5% (95% CI, 11.6%-21.4%; p = 5.7 × 10-8) after a median follow-up of 31.5 months (IQR 24.0, 60.0). Weight loss after RYGB was slightly but not significantly larger compared with SG (17.4% vs. 15.2%). Type and rate of adverse events were reported to be as expected, and no major concerns were raised regarding hormone replacement therapy (HRT). Four publications including 49 patients with HO and 223 patients with common obesity were included in the case-control meta-analysis that showed a 12.5%-point lower weight loss in cases compared with controls with no major differences in the safety profile of the surgical procedures. Bariatric surgery in patients with acquired HO induces a clinically meaningful weight loss sustained for at least 2.5 years and appears to be safe. No significant differences were observed between RYGB and SG, but weight loss is substantially lower in patients with HO compared with patients with common obesity. However, the limited evidence calls for close surveillance if bariatric surgery is more widely adopted in this group of patients.