title: Effectiveness of behavioural weight loss interventions delivered in a primary care setting: a systematic review and meta-analysis.
abstract: BACKGROUND
  Overweight and obesity have negative health effects. Primary care clinicians are best placed to intervene in weight management. Previous reviews of weight loss interventions have included studies from specialist settings. The aim of this review was to estimate the effect of behavioural interventions delivered in primary care on body weight in overweight and obese adults.
  
  
  METHODS
  The review included randomized controlled trials (RCTs) of behavioural interventions in obese or overweight adult participants in a primary care setting, with weight loss as the primary outcome, and a minimum of 12 months of follow-up. A systematic search strategy was implemented in Medline, Embase, Web of Science and the Cochrane Central Registry of Controlled Trials. Risk of bias was assessed using the Cochrane Risk of Bias tool and behavioural science components of interventions were evaluated. Data relating to weight loss in kilograms were extracted, and the results combined using meta-analysis.
  
  
  RESULTS
  Fifteen RCTs, with 4539 participants randomized, were selected for inclusion. The studies were heterogeneous with respect to inclusion criteria and type of intervention. Few studies reported interventions informed by behavioural science theory. Pooled results from meta-analysis indicated a mean weight loss of -1.36 kg (-2.10 to -0.63, P < 0.0001) at 12 months, and -1.23 kg (-2.28 to -0.18, P = 0.002) at 24 months.
  
  
  CONCLUSIONS
  Behavioural weight loss interventions in primary care yield very small reductions in body weight, which are unlikely to be clinically significant. More effective management strategies are needed for the treatment of overweight and obesity.
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK. helen.booth@kcl.ac.uk.
authors.forename: Helen P
authors.initials: HP
authors.lastname: Booth
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: Toby A
authors.initials: TA
authors.lastname: Prevost
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: Alison J
authors.initials: AJ
authors.lastname: Wright
authors.affiliation: Department of Primary Care and Public Health Sciences, King's College London, London, UK.
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001521:Behavior Therapy / Q000379:methods*; D016206:Databases, Bibliographic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods*; D016032:Randomized Controlled Trials as Topic; D061217:Weight Reduction Programs / Q000379:methods*; D055815:Young Adult
keywords: General practice; obesity; overweight; primary health care.