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Psychological interventions for overweight or obesity

  • Review
  • Intervention

Authors


Abstract

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 non communicable disease burden.

Objectives

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

Search methods

Studies were obtained from searches of multiple electronic bibliographic databases.

Selection criteria

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/m2) at baseline.

Data collection and analysis

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.

Main 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.

Authors' 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.

摘要

背景

應用精神治療於過重或肥胖

過重及肥胖是全球健康問題,在工業化國家逐漸增加。如果不去檢討,會持續增加造成非傳染病的負擔。

目標

評估精神治療對於過重或肥胖持續體重減輕的效果。

搜尋策略

由多個電子書目資料庫中搜尋研究。最後尋的日期為2003年六月。

選擇標準

收入的研究必須符合下列條件:1)它們是比較精神治療與其它治療的隨機對照試驗、2)其中的一項預後是體重的改變,不論是以什麼方法測量、3)參加者至少追蹤三個月、4)研究的參加者一開始是過重(BMI > 25 kg/m2)或肥胖的成人(大於18歲)。

資料收集與分析

由兩個人獨立執行納入研究條件及評估研究的品質。不同意見經由討論或加入第三者來解決。綜合分析使用固定效果模式。

主要結論

總共36個符合條件的研究被收入在這篇文獻中。全部共3495個人參加研究。大多數的研究在評估行為及認知行為的減重方式。少部分的研究在評估認知療法,精神療法,放鬆療法及催眠療法。若單獨以減重來看,行為療法比起安慰組在體重上有顯著的減少(WMD −2.5 kg; 95% CI −1.7 to −3.3)。若行為療法配合飲食/運動比上只用飲食/運動控制的話,合併療法會有較好的減重效果。研究雖然多樣化,但大部分的研究傾向行為療法配合飲食與運動控制來改善減重效果。增加行為療法的強度明顯增加減重程度(WMD −2.3 kg; 95% CI −1.4 to  3.3)。當認知行為療法配合上飲食/運動時,比起只用飲食/運動控制,發現會有較好的減重效果(WMD −4.9 kg; 95% CI −7.3 to  2.4)。沒有發現關於死亡率、致病率、或生活品的資料。

作者結論

過重或肥胖的人經由精神治療,特別是行為療法及認知行為療法,來加強減重是有幫助的。當配合飲食與運動控制會有更顯著的幫忙。大多數的證據支持使用行為療法及認知行為療法。其它的精神治療在評估減重效果上則比較不夠嚴密。

翻譯人

本摘要由臺灣大學附設醫院賴瑩純翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

行為療法及認知行為療法改善過重或肥胖的人減重程度。一些精神上的方法被用來試著幫助過重或肥胖的人減重。這篇文獻發現行為療法及認知行為療法明顯在這些人改善成功減重。認知療法不是有效的減重療法。其它精神治療,如放鬆療法或催眠療法,則沒有足夠的證據可以下結論。然而目前有些證據推測這樣的療法或許也能成功的幫助減重。沒有發現關於死亡率、致病率、或生活品的資料。

Plain language summary

Psychological interventions for overweight or obesity

Several psychological methods are used to try and help people who are overweight or obese to lose weight. This review found that cognitive behaviour therapy and behaviour therapy significantly improved the success of weight loss for these people. Cognitive therapy was not effective as a weight loss treatment. There was not enough evidence to reach a conclusion about other psychological forms of therapy, such as relaxation therapy and hypnotherapy, however the evidence that is available suggests that these therapies may also be successful in improving weight loss. No data on mortality, morbidity or quality of life were found.

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