The Effectiveness of Non-Surgical Weight Management Interventions for Obesity in the UK: A Review and Meta-Regression Analysis

Jason Randall, Matt Slater, Antony Stewart, Geoff Pugh, Kevin Lewis, Cathy Levy, Paola Alessandri-Gray

Business School—Research & Enterprise, Faculty of Business, Education and Law, Staffordshire University, Staffordshire, UK.
Centre of Sport, Health and Exercise Research, Faculty of Health Sciences, Staffordshire University, Staffordshire, UK.
Public Health Department, Shropshire County Council, Shrewsbury, UK.

DOI: 10.4236/ojmp.2014.33025                

Abstract

Background: Obesity is regarded as one of the most serious challenges public health faces in the 21st century for adults and children alike. Accordingly weight management interventions remain a public health priority aiming to reduce the burden of obesity and co-morbidities. Therefore this review aims to assess the effectiveness of non-surgical weight management interventions for obesity in the UK. Method: Thirty one databases were searched that identified 20 articles for inclusion. Articles were screened and quality scored using the “Effective Public Health Practice Project Quality Assessment Tool”. Meta-regression analysis (MRA) was undertaken on seven studies that allowed for effect size calculations. Results: In adult populations, lifestyle interventions that targeted both diet and physical activity, delivered in the private sector were most effective in reducing weight and/or BMI, and were more cost-effective. In children the most successful interventions mirrored adult interventions, but were family-orientated. MRA supported these findings. Most frequent intervention duration was 12 weeks. Discussion: The results provide evidence to support policy makers for the effective delivery of weight management interventions. Findings suggest that weight management interventions in the UK are effective in reducing weight and/or BMI for both children and adults. Interventions delivered in the private sector (e.g. Weight Watchers), targeting diet and physical activity levels, demonstrated the highest levels of effectiveness. However, compared to these models, NHS programmes are less well defined in the research literature and may not have been optimised. For children, effectiveness is improved by family-level programmes incorporating children and their parents.

Keywords

Health, Meta-Regression, Non-Surgical, Obesity, Weight Management

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	The NHS Information Centre Lifestyle Statistics (2009) Statistics on Besity, Physical Activity and Diet London: The Health and Social care information Centre.
[2]	Health Survey for England (2012) Statistics on Obesity, Physical Activity and Diet: England 2010. The Health and Social Care Information Centre, p. 119.
[3]	Watson, P., Dugdill, L., Murphy, R., Knowles, Z. and Cable, N. (2013) Moving forward in Childhood Obesity Treatment: A Call for Translational Research. Health Education Journal, 72, 230-239. http://dx.doi.org/10.1177/0017896912438313
[4]	Lean, M.E., Han, T.S. and Seidell, J.C. (1999) Impairment of Health and Quality of Life Using New US Federal Guidelines for the Identification of Obesity. Archives of Internal Medicine, 159, 837. http://dx.doi.org/10.1001/archinte.159.8.837
[5]	Must, A., Spadano, J., Coakley, E.H., Field, A.E., Colditz, G. and Dietz, W.H. (1999) The Disease Burden Associated with Overweight and Obesity. JAMA: The Journal of the American Medical Association, 282, 1523-1529. http://dx.doi.org/10.1001/jama.282.16.1523
[6]	Roberts, C.K. and Barnard, R.J. (2005) Effects of Exercise and Diet on Chronic Disease. Journal of Applied Physiology, 98, 3-30. http://dx.doi.org/10.1152/japplphysiol.00852.2004
[7]	Calise, T.V. and Martin, S. (2010) Assessing the Capacity of State Physical Activity Programs—A Baseline Perspective. Journal of Physical Activity & Health, 7, 119.
[8]	Goldberg, J.H. and King, A.C. (2007) Physical Activity and Weight Management across the Lifespan. Annual Review of Public Health, 28, 145-170. http://dx.doi.org/10.1146/annurev.publhealth.28.021406.144105
[9]	Teixeira, P.J., Silva, M.N., Mata, J., Palmeira, A.L. and Markland, D. (2012) Motivation, Self-Determination, and Long-Term Weight Control. International Journal of Behavioral Nutrition and Physical Activity, 9, 1-13.
[10]	Fiese, B.H., Hammons, A. and Grigsby-Toussaint, D. (2012) Family Mealtimes: A Contextual Approach to Understanding Childhood Obesity. Economics & Human Biology, 10, 365-74. http://dx.doi.org/10.1016/j.ehb.2012.04.004
[11]	Thomas, B., Ciliska, D., Dobbins, M. and Micucci, S. (2004) A Process for Systematically Reviewing the Literature: Providing the Research Evidence for Public Health Nursing Interventions. Worldviews on Evidence-Based Nursing, 1, 176-184. http://dx.doi.org/10.1111/j.1524-475X.2004.04006.x
[12]	Thomas, B.H., Ciliska, D., Dobbins, M. and Micucci, S. (2004) A Process for Systematically Reviewing the Literature: Providing the Research Evidence for Public Health Nursing Interventions. Worldviews on Evidence-Based Nursing, 1, 176-184. http://dx.doi.org/10.1111/j.1524-475X.2004.04006.x
[13]	Armijo-Olivo, S., Stiles, C.R., Hagen, N.A., Biondo, P.D. and Cummings, G.G. (2012) Assessment of Study Quality for Systematic Reviews: A Comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: Methodological Research. Journal of Evaluation in Clinical Practice, 18, 12-18. http://dx.doi.org/10.1111/j.1365-2753.2010.01516.x
[14]	Gray, C.M., Anderson, A.S., Clarke, A.M., Dalziel, A., Hunt, K., Leishman, J., et al. (2009) Addressing Male Obesity: An Evaluation of a Group-Based Weight Management Intervention for Scottish Men. Journal of Men’s Health, 6, 70-81. http://dx.doi.org/10.1016/j.jomh.2008.11.002
[15]	Jolly, K., Lewis, A., Beach, J., Denley, J., Adab, P., Deeks, J.J., et al. (2011) Comparison of Range of Commercial or Primary Care Led Weight Reduction Programmes with MINIMAL intervention Control for Weight Loss in Obesity: Lighten up Randomised Controlled Trial. BMJ: British Medical Journal, 343.
[16]	Lavin, J., Avery, A., Whitehead, S., Rees, E., Parsons, J., Bagnall, T., et al. (2006) Feasibility and Benefits of Implementing a Slimming on Referral Service in Primary Care Using a Commercial Weight Management Partner. Public Health, 120, 872-881. http://dx.doi.org/10.1016/j.puhe.2006.05.008
[17]	Laws, R. (2004) A New Evidence-Based Model for Weight Management in Primary Care: The Counterweight Programme. Journal of Human Nutrition and Dietetics, 17, 191-208. http://dx.doi.org/10.1111/j.1365-277X.2004.00517.x
[18]	McConnon, á., Kirk, S.F. and Ransley, J.K. (2009) Process Evaluation of an Internet-Based Resource for Weight Control: Use and Views of an Obese Sample. Journal of Nutrition Education and Behavior, 41, 261-267. http://dx.doi.org/10.1016/j.jneb.2008.07.008
[19]	McCormick, B. and Stone, I. (2007) Economic Costs of Obesity and the Case for Government Intervention. Obesity Reviews, 8, 161-164. http://dx.doi.org/10.1111/j.1467-789X.2007.00337.x
[20]	McQuigg, M., Brown, J., Broom, J., Laws, R., Reckless, J., Noble, P., et al. (2005) Empowering Primary Care to Tackle the Obesity Epidemic: The Counterweight Programme. European Journal of Clinical Nutrition, 59, S93. http://dx.doi.org/10.1038/sj.ejcn.1602180
[21]	Packianathan, I.C., Sheikh, M., Feben, S. and Finer, N. (2002) The Eating Disorder Inventory in a UK National Health Service Obesity Clinic and Its Response to Modest Weight Loss. Eating Behaviors, 3, 275-284. http://dx.doi.org/10.1016/S1471-0153(02)00063-6
[22]	Quinn, A., Doody, C. and O’Shea, D. (2008) The Effect of a Physical Activity Education Programme on Physical Activity, Fitness, Quality of Life and Attitudes to Exercise in Obese Females. Journal of Science and Medicine in Sport, 11, 469-472. http://dx.doi.org/10.1016/j.jsams.2007.07.011
[23]	Ross, H., Laws, R., Reckless, J. and Lean, M. (2008) Evaluation of the Counterweight Programme for Obesity Management in Primary Care: A Starting Point for Continuous Improvement. The British Journal of General Practice, 58, 548-554. http://dx.doi.org/10.3399/bjgp08X319710
[24]	Sniehotta, F.F., Dombrowski, S.U., Avenell, A., Johnston, M., McDonald, S., Murchie, P., Ramsay, C.R., Robertson, K. and Araujo-Soares, V. (2011) Randomised Controlled Feasibility Trial of an Evidence-Informed Behavioural Intervention for Obese Adults with Additional Risk Factors. PloS ONE, 6, Article ID: e23040. http://dx.doi.org/10.1371/journal.pone.0023040
[25]	Carroll, S., Marshall, P., Borkoles, E., Ingle, L., Barker, D. and Tan, L.B. (2007) Efficacy of Lifestyle Intervention on Peak Exercise Cardiac Power Output and Reserve in Premenopausal Obese Females: A Randomised Pilot Study. International Journal of Cardiology, 119, 147-155. http://dx.doi.org/10.1016/j.ijcard.2006.07.099
[26]	Paxman, J.R., Hall, A.C., Harden, C.J., O’Keeffe, J. and Simper, T.N. (2011) Weight Loss Is Coupled with Improvements to Affective State in Obese Participants Engaged in Behavior Change Therapy Based on Incremental, Self-Selected “Small Changes”. Nutrition Research, 31, 327-337. http://dx.doi.org/10.1016/j.nutres.2011.03.015
[27]	Croker, H., Viner, R.M., Nicholls, D., Haroun, D., Chadwick, P., Edwards, C., Wells, J.C.K. and Wardle, J. (2011) Family-Based Behavioural Treatment of Childhood Obesity in a UK National Health Service Setting: Randomized Controlled Trial. International Journal of Obesity, 36, 16-26. http://dx.doi.org/10.1038/ijo.2011.182
[28]	Edwards, C., Nicholls, D., Croker, H., Van Zyl, S., Viner, R. and Wardle, J. (2005) Family-Based Behavioural Treatment of Obesity: Acceptability and Effectiveness in the UK. European Journal of Clinical Nutrition, 60, 587-592. http://dx.doi.org/10.1038/sj.ejcn.1602353
[29]	Sabin, M.A., Ford, A., Hunt, L., Jamal, R., Crowne, E.C. and Shield, J.P. (2007) Which Factors Are Associated with a Successful Outcome in a Weight Management Programme for Obese Children? Journal of Evaluation in Clinical Practice, 13, 364-368. http://dx.doi.org/10.1111/j.1365-2753.2006.00706.x
[30]	Baker, J. and Saunders, K. (2012) Fitter, Healthier, Happier Families: A Partnership to Treat Childhood Obesity in the West Midlands. Public Health, 126, 332-334. http://dx.doi.org/10.1016/j.puhe.2012.01.013
[31]	Sacher, P.M., Kolotourou, M., Chadwick, P.M., Cole, T.J., Lawson, M.S., Lucas, A. and Singhal, A. (2010) Randomized Controlled Trial of the MEND Program: A Family-Based Community Intervention for Childhood Obesity. Obesity, 18, S62-S68. http://dx.doi.org/10.1038/oby.2009.433
[32]	Watson, P.M., Dugdill, L., Pickering, K., Bostock, S., Hargreaves, J., Staniford, L. and Cable, N.T. (2011) A Whole Family Approach to Childhood Obesity Management (GOALS): Relationship between Adult and Child BMI Change. Annals of Human Biology, 38, 445-452. http://dx.doi.org/10.3109/03014460.2011.590531
[33]	McConnon, á., Kirk, S.F., Cockroft, J.E., Harvey, E.L., Greenwood, D.C., Thomas, J.D., Ransley, J.K. and Bojke, L. (2007) The Internet for Weight Control in an Obese Sample: Results of a Randomised Controlled Trial. BMC Health Services Research, 7, 206. http://dx.doi.org/10.1186/1472-6963-7-206
[34]	Ahern, A.L., Olson, A.D., Aston, L.M. and Jebb, S.A. (2011) Weight Watchers on Prescription: An Observational Study of Weight Change among Adults Referred to Weight Watchers by the NHS. BMC Public Health, 11, 434. http://dx.doi.org/10.1186/1471-2458-11-434
[35]	Tuah, N., Amiel, C., Qureshi, S., Car, J., Kaur, B. and Majeed, A. (2011) Transtheoretical Model for Dietary and Physical Exercise Modification in Weight Loss Management for Overweight and Obese Adults. Cochrane Database System Review, 10, 1-73. http://dx.doi.org/10.1002/14651858.CD008066.pub2
[36]	Hutchison, A.J., Breckon, J.D. and Johnston, L.H. (2009) Physical Activity Behavior Change Interventions Based on the Transtheoretical Model: A Systematic Review. Health Education & Behavior, 36, 829-845. http://dx.doi.org/10.1177/1090198108318491