A structured review of randomized controlled trials of weight loss showed little improvement in health-related quality of life.
OBJECTIVE
To estimate the effect of weight-loss interventions on health-related quality of life (HrQoL) in randomized controlled trials (RCTs); to conduct a meta-analysis of weight-loss treatment on depressive symptoms; and, to examine methodological and presentation issues that compromise study validity.


METHODS
We conducted a structured review of 34 RCTs with weight-loss interventions that reported the relationship between HrQoL and treatment at two or more time points. We also evaluated study quality.


RESULTS
Trials lasted 6 weeks to 208 weeks and evaluated behavioral, surgical, or pharmacologic interventions. Nine of 34 trials showed HrQoL improvements in generic measures. Obesity-specific measures were more likely to show improvement in response to treatment than non-obesity-specific measures. Meta-analysis showed no treatment effect on depressive symptoms. Most trials tracked loss to follow-up and conducted intent-to-treat analysis, but only four trials concealed recruitment staff to randomization and 14 blinded the investigation team to randomization.


CONCLUSIONS
HrQoL outcomes, including depression, were not consistently improved in RCTs of weight loss. The overall quality of these clinical trials was poor. Better-designed RCTs using standardized HrQoL measures are needed to determine the extent to which weight loss improves HrQoL.
Maciejewski
Matthew L
ML
Northwest Center for Outcomes Research in Older Adults, Veterans Affairs Puget Sound Health Care System, University of Washington, Seattle, USA. mlmaciej@u.washington.edu
Patrick
Donald L
DL
Williamson
David F
DF
D000328:Adult; D003863:Depression / Q000209:etiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology / Q000534:rehabilitation*; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012107:Research Design; D016896:Treatment Outcome; D015431:Weight Loss