Psychological interventions for overweight or obesity.
BACKGROUND
Overweight and obesity are global health problems which are increasing throughout the industrialised world. If left unchecked, they will continue to contribute to the ever increasing noncommunicable disease burden.


OBJECTIVE
To assess the effects of psychological interventions for overweight or obesity as a means of achieving sustained weight loss.


METHODS
Studies were obtained from searches of multiple electronic bibliographic databases. The date of the latest search was June 2003.


METHODS
Trials were included if the fulfilled the following criteria: 1) they were randomised controlled clinical trials of a psychological intervention versus a comparison intervention, 2) one of the outcome measures of the study was weight change measured by any method, 3) participants were followed for at least three months, 4) the study participants were adults (18 years or older) who were overweight or obese (BMI > 25 kg/m(2)) at baseline.


METHODS
Two people independently applied the inclusion criteria to the studies identified and assessed study quality. Disagreement was resolved by discussion or by intervention of a third party. Meta-analyses were performed using a fixed effect model.


RESULTS
A total of 36 studies met the inclusion criteria and were included in the review. Overall, 3495 participants were evaluated. The majority of studies assessed behavioural and cognitive-behavioural weight reduction strategies. Cognitive therapy, psychotherapy, relaxation therapy and hypnotherapy were assessed in a small number of studies. Behaviour therapy was found to result in significantly greater weight reductions than placebo when assessed as a stand-alone weight loss strategy (WMD -2.5 kg; 95% CI -1.7 to -3.3). When behaviour therapy was combined with a diet / exercise approach and compared with diet / exercise alone, the combined intervention resulted in a greater weight reduction. Studies were heterogeneous however the majority of studies favoured combining behaviour therapy with dietary and exercise interventions to improve weight loss. Increasing the intensity of the behavioural intervention significantly increased the weight reduction (WMD -2.3 kg; 95% CI -1.4 to - 3.3). Cognitive-behaviour therapy, when combined with a diet / exercise intervention, was found to increase weight loss compared with diet / exercise alone (WMD -4.9 kg; 95% CI -7.3 to - 2.4). No data on mortality, morbidity or quality of life were found.


CONCLUSIONS
People who are overweight or obese benefit from psychological interventions, particularly behavioural and cognitive-behavioural strategies, to enhance weight reduction. They are predominantly useful when combined with dietary and exercise strategies. The bulk of the evidence supports the use of behavioural and cognitive-behavioural strategies. Other psychological interventions are less rigorously evaluated for their efficacy as weight loss treatments.
Shaw
K
K
Public and Environmental Health Unit, Department of Health and Human Services, Public Health Unit, 3 / 90 Davey Street, Hobart, Tasmania, Australia, 7000. kelly.shaw@dhhs.tas.gov.au
O'Rourke
P
P
Del Mar
C
C
Kenardy
J
J
D000328:Adult; D001835:Body Weight; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006801:Humans; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic