Obesity Evidence Review - National Institutes Of Health
ManagingOverweight andObesity in AdultsSystematic Evidence Review Fromthe Obesity Expert Panel, 2013
ContentsForeword .xiiiOverweight and Obesity Expert Panel . xvSection 1: Background and Description of the NHLBI Cardiovascular Risk Reduction Project . 1A. Background .1B. Overview of the Evidence-Based Methodology .2C. Scope of the Problem.3D. History.5E. Critical Questions on Overweight and Obesity .6i. Critical Questions on Weight-Related Health Risks and Benefits of Weight Loss . 6ii. Critical Questions on Treatments for Overweight and Obesity . 6F. Challenges of Achieving Weight Loss in Primary Care Practice . 7Section 2: Process and Methods Overview .8A. Overview of Evidence-Based Methodology .8i. System for Grading the Body of Evidence .9ii. Peer-Review Process .10B. Critical Question-Based Approach .11i. Critical Questions on Overweight and Obesity. 11Section 3: Critical Question 1 .13A. Statement of the Question.13i. By Population Subgroups .13ii. By Amount of Weight Loss .14iii. By Weight Loss Maintenance .14B. Selection of the Inclusion/Exclusion Criteria . 14C. Introduction and Rationale for Question and Inclusion/Exclusion Criteria . 16D. Methods for Critical Question 1 .16E. Evidence Statements and Summaries.18i. Weight Loss and Risk for Diabetes: Spreadsheets 1.1.–1.4b. . 18F. Weight Loss and Impact on Cholesterol/Lipid Profile—Spreadsheet 1.5a–1.5c. 22G. Weight Loss and Hypertension Risk—Spreadsheets 1.6a–f. 25H. Gaps in Evidence and Future Research Needs. 27Section 4: Critical Question 2 .28A. Statement of the Question.28i. Subgroup Analyses .28B. Selection of the Inclusion/Exclusion Criteria . 29C. Introduction and Rationale for Question and Inclusion/Exclusion Criteria . 31D. Methods for Critical Question 2 .32E. Evidence Statements and Summaries.35i. BMI Cutpoints and CVD-Related Risk . 36ii. Waist Circumference Cutpoints and CVD-Related Risk . 43F. Gaps in Evidence and Future Research Needs. 45Section 5: Critical Question 3 .48A. Statement of the Question.48B. Selection of the Inclusion/Exclusion Criteria . 48C. Introduction and Rationale for Question and Inclusion/Exclusion Criteria . 50MANAGING OVERWEIGHT AND OBESITY IN ADULTS: SYSTEMATIC EVIDENCE REVIEW FROM THE OBESITY EXPERT PANEL, 2013iii
D. Methods for Critical Question 3 .51E. Evidence Statements and Summaries.53F. Overall Dietary Intervention and Composition—Summary Table 3.1 . 53i. Creating Reduced Dietary Energy Intake . 53ii. Diets of Differing Forms and Structures (Macronutrient Content, Carbohydrate andFat Quality, Nutrient Density, Amount of Energy Deficit, Dietary Pattern) or OtherDietary Weight Loss Strategies (e.g., Meal Timing, Portion-Controlled MealReplacements) .55iii. Pattern of Weight Loss Over Time With Dietary Intervention . 56G. Low-Fat Approaches—Summary Table 3.2 . 57H. Higher Protein (25 to 30 Percent of Energy) Approaches—Summary Table 3.3. 58I. Low-Carbohydrate ( 30g/Day) Approaches—Summary Table 3.4 . 59J. Complex Versus Simple Carbohydrates—Summary Table 3.5 . 60K. Glycemic Load Dietary Approaches—Summary Table 3.6 . 60L. Dietary Pattern (Mediterranean Style and Vegetarian and Other Dietary Pattern)Approaches—Summary Table 3.7 .61M. Meal Replacements and Adding Foods to Liquid Diets—Summary Table 3.8 . 63N. Very Low-Calorie Diet Approaches—Summary Table 3.9 . 63O. Gaps in Evidence and Future Research Needs. 64Section 6: Critical Question 4 .66A. Statement of the Question.66B. Selection of the Inclusion/Exclusion Criteria . 66C. Introduction and Rationale for Question and Inclusion/Exclusion Criteria . 68i. A Dictionary of Lifestyle Intervention Terms. 69ii. Comprehensive Lifestyle Intervention .69iii. Intervention Delivery.69iv. Intervention Intensity .70v. Intervention Duration .70vi. Individual Versus Group Intervention .70vii. Trained Interventionist .70viii. Trials of Weight Loss Induction Versus Maintenance of Lost Weight . 70D. Methods for Critical Question 4 .71E. Evidence Statements and Summaries.74i. Introduction of Evidence Statements .74F. Diet, Physical Activity, and Behavior Therapy Components in High-Intensity, OnsiteLifestyle Interventions—Summary Tables 4.1a–c . 75G. Comprehensive Interventions Compared With Usual Care, Minimal Care, orNo-Treatment Control—Summary Tables 4.2a–d . 76H. Efficacy/Effectiveness of Electronically Delivered, Comprehensive Interventions inAchieving Weight Loss—Summary Tables 4.3a–n . 78I. Efficacy/Effectiveness of Comprehensive, Telephone-Delivered Lifestyle Interventionsin Achieving Weight Loss—Summary Tables 4.4a–b . 80J. Efficacy/Effectiveness of Comprehensive Weight Loss Programs in Patients Within aPrimary Care Practice Setting Compared With Usual Care—Summary Tables 4.5a–f . 80K. Efficacy/Effectiveness of Commercial-Based, Comprehensive Lifestyle Interventions inAchieving Weight Loss—Summary Table 4.6a. 81L. Efficacy/Effectiveness of Very Low-Calorie Diets Used as Part of a ComprehensiveLifestyle Intervention in Achieving Weight Loss—Summary Tables 4.7a–c . 82ivMANAGING OVERWEIGHT AND OBESITY IN ADULTS: SYSTEMATIC EVIDENCE REVIEW FROM THE OBESITY EXPERT PANEL, 2013
M. Efficacy/Effectiveness of Comprehensive Lifestyle Interventions in Maintaining LostWeight—Summary Tables 4.8a–e.83N. Characteristics of Lifestyle Intervention Delivery That May Affect Weight Loss:Intervention Intensity—Summary Tables 4.9a–f . 85O. Characteristics of Lifestyle Intervention Delivery That May Affect Weight Loss or WeightLoss Maintenance: Individual Versus Group Treatment—Summary Tables 4.1a–c . 87P. Characteristics of Lifestyle Intervention Delivery That May Affect Weight Loss or WeightLoss Maintenance: Onsite Versus Electronically Delivered Interventions—SummaryTables 4.10a–j .87Q. Gaps in Evidence and Future Research Needs. 88Section 7: Critical Question 5 .90A. Statement of the Question.90i. Efficacy .90ii. Predictors .90iii. Complications.91B. Selection of the Inclusion/Exclusion Criteria . 92C. Introduction and Rationale for Question and the Inclusion/Exclusion Criteria . 95i. Bariatric Surgical Procedures .96ii. Currently Used Procedures .97iii. Investigational Procedures .99D. Methods for Critical Question 5 .99E. Evidence Statements and Summaries. 101i. Component 1: Efficacy—Summary Table 5.1 . 101ii. Component 2: Predictors—Patient Characteristics—Summary Table 5.2 andTypes of Surgery—Summary Table 5.3. 107iii. Component 3: Complications—Summary Table 5.4 . 109iv. Summary .113F. Gaps in Evidence and Future Research Needs. 113AppendixesAppendix A: Detailed Methods Applying to All Critical Questions . A–1Appendix B: Question-Specific Methods . B–1Appendix C: Spreadsheets and Summary Tables . C–1Critical Question 1 . C–1Critical Question 2 . C–21Critical Question 3 . C–38Critical Question 4 . C–88Critical Question 5 . C–157Appendix D: Abbreviations and Acronyms . D–1Appendix E: Names of Studies . E–1References . R–1MANAGING OVERWEIGHT AND OBESITY IN ADULTS: SYSTEMATIC EVIDENCE REVIEW FROM THE OBESITY EXPERT PANEL, 2013v
List of FiguresFigure 1. Trends in Overweight, Obesity, and Extreme Obesity Among Adults Aged 20 to 74years: United States, 1960–1962 Through 2009–2010 . 4Figure 2. The 1998 Clinical Guidelines: Classification of Overweight and Obesity by BMI,Waist Circumference, and Associated Disease Risk . 5Figure 3. PRISMA Diagram Showing Selection of Articles for Critical Question 1 . 18Figure 4. PRISMA Diagram Showing Selection of Articles for Critical Question 2 . 33Figure 5. PRISMA Diagram Showing Selection of Articles for Critical Question 3 . 52Figure 6. PRISMA Diagram Showing Selection of Articles for Critical Question 4 . 73Figure 7. Vertical Banded Gastroplasty . 97Figure 8. Roux-en-Y Gastric Bypass . 97Figure 9. Laparoscopic Adjustable Gastric Banding. 98Figure 10. Biliopancreatic Diversion With or Without Duodenal Switch . 98Figure 11. Sleeve Gastrectomy . 99Figure 12. PRISMA Diagram Showing Selection of Articles for Critical Question 5 . 100Figure B–1. PRISMA Diagram Showing Selection of Articles for CQ1 . B–8Figure B–2. PRISMA Diagram Showing Selection of Articles for CQ2 . B–13Figure B–3. PRISMA Diagram Showing Selection of Articles for CQ3 . B–19Figure B–4. PRISMA Diagram Showing Selection of Articles for CQ4 . B–26Figure B–5. PRISMA Diagram Showing Selection of Articles for CQ5 . B–32List of TablesTable 1. Evidence Quality Grading System. 10Table 2. Criteria for Selection of Publications for CQ1 . 14Table 3. Criteria for Selection of Publications for CQ2 . 30Table 4. Criteria for Selection of Publications for CQ3 . 48Table 5. Criteria for Selection of Publications for CQ4 . 66Table 6. Criteria for Selection of Publications for CQ5 . 92Table A–1. Quality Assessment Tool for Controlled Intervention Studies. A–6Table A–2. Quality Assessment Tool for Systematic Reviews and Meta-Analyses . A–11Table A–3. Quality Assessment Tool for Cohort and Cross-Sectional Studies . A–14Table A–4. Quality Assessment Tool for Case-Control Studies . A–21Table A–5. Quality Assessment Tool for Before-After (Pre-Post) Studies With No ControlGroup . A–27Table A–6. Quality Assessment Tool for Case Series Studies . A–31Table A–7. Evidence Quality Grading System . A–34Table B–1. Examples of Simple Queries . B–1Table B–2. Attributes, Their Values, and Explanation . B–2Table B–3. Common Macro Queries Used in Search Strategies. B–2Table B–4. Criteria for Selection of Publications for CQ1 . B–8Table B–5. Criteria for Selection of Publications for CQ2 . B–13Table B–6. Criteria for Selection of Publications for CQ3 . B–20Table B–7. Criteria for Selection of Publications for CQ4 . B–27Table B–8. Criteria for Selection of Publications for CQ5 . B–33Table B–9. CQ1 Studies Rated Fair or Good . B–36Table B–10. CQ1 Studies Rated as Poor With Rationale. B–38Table B–11. CQ2 Studies Rated Fair or Good . B–40Table B–12. CQ2 Studies Rated as Poor With Rationale. B–41Table B–13. CQ3 Studies Rated Fair or Good . B–43viMANAGING OVERWEIGHT AND OBESITY IN ADULTS: SYSTEMATIC EVIDENCE REVIEW FROM THE OBESITY EXPERT PANEL, 2013
Table B–14.Table B–15.Table B–16.Table B–17.Table B–18.CQ3 Studies Rated Poor With Rationale . B–44CQ4 Studies Rated Fair or Good . B–50CQ4 Studies Rated Poor With Rationale . B–54CQ5 Studies Rated Fair or Good . B–63CQ5 Studies Rated Poor With Rationale . B–65List of Spreadsheet TablesSpreadsheet 1.1. Effect of Weight Loss From Lifestyle Interventions in Patients With Diabeteson Blood Glucose and HbA1c .C–1Spreadsheet 1.2. Effect of Weight Loss From Lifestyle Interventions in Persons at Risk forDeveloping Diabetes (Prediabetes) on Risk for Converting to Type 2 Diabetes .C–3Spreadsheet 1.3. Effect of Intentional Weight Loss From Lifestyle Interventions in PatientsWith or Without Diabetes on Mortality .C–5Spreadsheet 1.4a. Effect of Weight Loss From Orlistat Interventions in Patients With Diabeteson Blood Glucose and HbA1c .C–5Spreadsheet 1.4b. Effect of Weight Loss From Orlistat Interventions in Patients at Risk forDiabetes on Blood Glucose and HbA1c .C–6Spreadsheet 1.5a. Effect of Weight Loss on Serum Lipids: Lifestyle Interventions .C–7Spreadsheet 1.5b. Effect of Weight Loss on Serum Lipids: Orlistat Interventions .C–10Spreadsheet 1.5c. Effect of Weight Loss on Serum Lipids: Diabetes Subjects .C–12Spreadsheet 1.6a. Weight Loss and Hypertension Risk: Orlistat Trials, All Subjects . C–14Spreadsheet 1.6b. Weight Loss and Hypertension Risk: Orlistat Trials, Diabetes Subjects . C–16Spreadsheet 1.6c. Weight Loss and Hypertension Risk: Hypertension Subjects .C–17Spreadsheet 1.6d. Weight Loss and Hypertension Risk: Lifestyles Trials, All Subjects . C–18Spreadsheet 1.6e. Weight Loss and Hypertension Risk: Lifestyles Trials, Diabetes Subjects . C–19Spreadsheet 1.6f. Weight Loss and Hypertension Risk: Lifestyles Trials, HypertensionSubjects .C–20Spreadsheet 2.1. Study Descriptives .C–21Spreadsheet 2.2.1a. Combined Fatal and Nonfatal CHD—Results for BMI .C–25Spreadsheet 2.2.1b. Fatal CHD—Results for BMI .C–25Spreadsheet 2.2.2a. Combined Fatal and Nonfatal Stroke—Results for BMI.C–26Spreadsheet 2.2.2b. Fatal Stroke—Results for BMI.C–29Spreadsheet 2.2.3a. Combined Fatal and Nonfatal CVD—Results for BMI .C–30Spreadsheet 2.2.3b. Fatal CVD—Results for BMI .C–30Spreadsheet 2.2.4. Incident Diabetes—Results for BMI .C–31Spreadsheet 2.2.5. Overall Mortality—Results for BMI .C–32Spreadsheet 2.3.1. Combined Fatal and Nonfatal CHD—Results for Waist Circumference. C–35Spreadsheet 2.3.2. Combined Fatal and Nonfatal Stroke—Results for Waist Circumference . C–35Spreadsheet 2.3.3. Combined Fatal and Nonfatal CVD—Results for Waist Circumference . C–36Spreadsheet 2.3.4. Overall Mortality—Results for Waist Circumference.C–36Spreadsheet 2.3.5. Incident Diabetes—Results for Waist Circumference .C–37List of Summary TablesSummary Table 3.1.Summary Table 3.2.Summary Table 3.3.Summary Table 3.4.Overall Dietary Intervention and Composition .C–38Low-Fat Approaches .C–52Higher (25–30% of Energy) Protein Approaches.C–60Low Carbohydrate Approaches ( 30 g/day for at least a period). C–70MANAGING OVERWEIGHT AND OBESITY IN ADULTS: SYSTEMATIC EVIDENCE REVIEW FROM THE OBESITY EXPERT PANEL, 2013vii
Summary Table 3.5. Complex Versus Simple Carbohydrates .C–73Summary Table 3.6. Glycemic Load Dietary Approaches .C–74Summary Table 3.7. CQ3—Dietary Patterns (Mediterranean Style and Vegetarian and OtherDietary Pattern Approaches) .C–76Summary Table 3.8. Meal Replacements and Adding Foods to Liquid Diets .C–83Summary Table 3.9. Very Low-Calorie-Diet (VLCD) Approaches .C–85Summary Table 4.1. Diet, Physical Activity, and Behavior Therapy Components inHigh-Intensity,* Onsite Lifestyle Interventions .C–88Summary Table 4.1a. Weight Loss Trials Compared With Usual Care, Minimal Care, or NoCare Control Interventions: Outcome Data at 6 Months or Less as First Time PeriodReporting .C–88Summary Table 4.1b. Weight Loss Trials Compared With Usual Care, Minimal Care, or NoCare Control Interventions: Outcome Data at Greater Than 6 Months as First Time PeriodReporting .C–92Summary Table 4.1c. Weight Loss Trials Compared With Usual Care, Minimal Care, or NoCare Control Interventions: Outcome Data at Greater Than 12 Months as First Time PeriodReporting .C–94Summary Table 4.2. Evidence for the Comprehensive Interventions Compared With UsualCare, Minimal Care, or No-Treatment Control .C–95Summary Table 4.2a. Weight Loss Trials Compared With Usual Care, Minimal Care, or NoCare Control Interventions: Outcome Data at 6 Months or Less as First Time PeriodReporting .C–95Summary Table 4.2b. Weight Loss Trials Compared With Usual Care, Minimal Care, or NoCare Control Interventions: Outcome Data at Greater Than 6 Months as First Time PeriodReporting .C–99Summary Table 4.2c. Weight Loss Trials Compared With Usual Care, Minimal Care, or NoCare Control Interventions: Outcome Data at Greater Than 12 Months as First Time PeriodReporting .C–101Summary Table 4.2d. Comprehensive Interventions Compared to Other ComprehensiveIntervention That Varied the Physical Activity or Behavior Therapy Component: OutcomeData at 6 Months or Less as the First Time Period Reported .C–102Summary Table 4.3. Efficacy/Effectiveness of Electronically Delivered, ComprehensiveInterventions in Achieving Weight Loss .C–105Summary Table 4.3a. Compared With Usual Care, Minimal Control, or No Intervention(Includes Self-Directed): Electronic Text Messaging—Outcome Data at 6 Months or Lessas First Time Period Reporting .C–105Summary Table 4.3b. Compared
Spreadsheet 1.6c. Weight Loss and Hypertension Risk: Hypertension Subjects . C-17 Spreadsheet 1.6d. Weight Loss and Hypertension Risk: Lifestyles Trials, All Subjects . C-18 Spreadsheet 1.6e. Weight Loss and Hypertension Risk: Lifestyles Trials, Diabetes Subjects .C-19 Spreadsheet 1.6f.
Prevalence of obesity and severe obesity in US children, 1999‐2014. Obesity, 2016 May;24(5):1116-23. Wang et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev, 2015 Langford et al. Obesity prevention and the Health Promoting Schools framework: essential components and barriers to .
Obesity Obesity is a disease where a person’s weight is in an unhealthy range (BMI of 30.0-39.9). It is a disease that can lead to other health problems. Talk with your healthcare provider to better understand and treat obesity. Severe Obesity Someone who is more than 100 pounds over their
2. Obesity trends and co-morbid consequences. 3. Poverty, obesity and food econo-mics. 4. Genetics and Caribbean culture. 5. The cost of obesity to develop-ment. Dimensions 1- Obesity Epide-miology: Prevalence, Age and Gender Relationships The most striking features of Figure 1 are (a) the high prevalence of overweight (BMI 25) and obesity
beneficial effect of weight loss on a myriad of obesity-related co- morbidities. In an effort to translate the emerging science and practice of obesity care for clinicians, the . Practical Manual of Clinical Obesity. has been written as a practical, evidence-based companion guide to the textbook . Clinical Obesity in Adults and Children
growth in obesity in children under the age of 11, this research was commissioned into the evidence for the causes of obesity in this age group. Genes Certain genes can pre-dispose children to obesity. However, in a genetically stable population, the recent increase in obesity prevalence in children is a result
obesity [3]. The economic burden of obesity in the USA was estimated to be US 117 billion in 1998, with obesity accounting for approximately 5.7% of the US National Health expenditure [3]. The relatively rapid and dramatic increase in the prevalence of obesity has been largely attrib-uted to a changing lifestyle that promotes
of obesity is related to the increase of metabolic syndrome, a cluster of central obesity, insulin resistance, hypertension and dyslipidemia. Metabolic syndrome is a known risk factor for the cardiovascular disease and diabetes in the adolescents and adults. Adolescent obesity is a strong precursor of obesity and related morbidity in adulthood .
Obesity Medicine Association Education Syllabus Health Professional Students Course Title: Obesity Medicine Health Professional Student Rotation – Study Material Mission: To provide foundational information and training in obesity medicine for health professional students in an online format Purpose: Obesity is the most common disease encountered in medical practice.
