title: Behavioural interventions for obese adults with additional risk factors for morbidity: systematic review of effects on behaviour, weight and disease risk factors.
abstract: BACKGROUND
  Reducing obesity through effective behaviour change interventions is of key importance to prevent disabling and life-threatening conditions, particularly in individuals already at risk for morbidity.
  
  
  OBJECTIVE
  To assess the effects of behavioural interventions for obese adults with additional risk factors for morbidity on behaviour, weight and disease risk factors.
  
  
  METHODS
  Systematic review of randomised controlled trials (RCTs). Three electronic databases and three journals were searched for behavioural interventions (aimed at changing dietary intake and/or physical activity (PA)) for adults (mean BMI ≥30 kg/m(2); mean age ≥40 years) with risk factors for morbidity, reporting follow-up data ≥12 weeks.
  
  
  RESULTS
  44 RCTs met the inclusion criteria. Behavioural outcomes, weight loss, and cardiovascular disease risk factors showed consistent modest improvements over time, especially for interventions targeting both diet and PA.
  
  
  CONCLUSIONS
  Behavioural interventions in at-risk populations showed positive effect tendencies on behaviour, weight, and disease risk factors. However, there is still ample room for improvement, and future research should focus on identifying the most effective means of inducing dietary and PA behaviour change in this vulnerable population.
authors.affiliation: Health Services Research Unit, University of Aberdeen, Aberdeen, UK. s.u.dombrowski@abdn.ac.uk
authors.forename: Stephan U
authors.initials: SU
authors.lastname: Dombrowski
authors.forename: Alison
authors.initials: A
authors.lastname: Avenell
authors.forename: Falko F
authors.initials: FF
authors.lastname: Sniehott
mesh_terms: D000328:Adult; D000368:Aged; D001521:Behavior Therapy; D001835:Body Weight; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000517:prevention & control* / Q000523:psychology; D019317:Evidence-Based Medicine; D005247:Feeding Behavior; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome