Scientific Report of the 2015 Dietary Guidelines Advisory Committee

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Part D. Chapter 2: Dietary Patterns, Foods and Nutrients, and Health Outcomes - Continued

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References

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Table D2.1.AHA/ACC/TOS Guideline for the Management of Overweight and Obesity in Adults, 2013

Critical Question 4a. Among overweight and obese adults, what is the efficacy/effectiveness of a comprehensive lifestyle intervention program (i.e., comprised of diet, physical activity, and behavior therapy) in facilitating weight loss or maintenance of lost weight?

Critical Question 4b. What characteristics of delivering comprehensive lifestyle interventions (e.g., frequency and duration of treatment, individual versus group sessions, onsite versus telephone/email contact) are associated with greater weight loss or weight loss maintenance?

Intervention/Question  

Included Studies

Evidence Statement (Strength of Evidence)  

3.4.1. Description of the Diet, Physical Activity, and Behavior Therapy Components in High-Intensity, Onsite Lifestyle  Interventions

12 RCTs

ES1. The principal components of an effective high-intensity, on-site comprehensive-lifestyle intervention include: 1) prescription of a moderately-reduced calorie diet; 2) a program of increased physical activity; and 3) the use of behavioral strategies to facilitate adherence to diet and activity recommendations. (High)

3.4.2. Comprehensive Interventions Compared with Usual Care, Minimal Care, or No-Treatment Control  

15 RCTs

ES 2a (Short-Term Weight Loss). In overweight and obese individuals in whom weight loss is indicated and who wish to lose weight, comprehensive lifestyle interventions consisting of diet, physical activity, and behavior therapy (all 3 components) produce average weight losses of up to 8 kg in 6 months of frequent (i.e., initially weekly), onsite treatment provided by a trained interventionist* in group or individual sessions. Such losses (which can approximate reductions of 5% to 10% of initial weight) are greater than those produced by usual care (i.e., characterized by the limited provision of advice or educational materials). Comparable 6-month weight losses have been observed in treatment comparison studies of comprehensive lifestyle interventions, which did not include a usual care group. (High)

ES 2b (Intermediate-Term Weight Loss). Longer-term comprehensive lifestyle interventions, which additionally provide weekly to monthly on-site treatment for another 6 months, produce average weight losses of up to 8 kg at 1 year, losses which are greater than those resulting from usual care. Comparable 1-year weight losses have been observed in treatment comparison studies of comprehensive lifestyle interventions, which did not include a usual care group. (Moderate)

ES 2c (Long-Term Weight Loss). Comprehensive lifestyle interventions which, after the first year, continue to provide bimonthly or more frequent intervention contacts, are associated with gradual weight regain of 1 to 2 kg/year (on average), from the weight loss achieved at 6 to 12 months. Long-term (>1 year) weight losses, however, remain larger than those associated with usual care. Comparable findings have been observed in treatment comparison studies of comprehensive lifestyle interventions, which did not include a usual care group. (High)

3.4.3. Efficacy/Effectiveness of Electronically Delivered, Comprehensive Interventions in Achieving Weight Loss Evidence Statement

13 RCTs

ES 3. Electronically delivered, comprehensive weight loss interventions developed in academic settings, which include frequent self-monitoring of weight, food intake, and physical activity—as well as personalized feedback from a trained interventionist*—can produce weight loss of up to 5 kg at 6 to 12 months, a loss which is greater than that resulting from no or minimal intervention (i.e., primarily knowledge based) offered on the internet or in print. (Moderate)

3.4.4. Efficacy/Effectiveness of Comprehensive, Telephone-Delivered Lifestyle Interventions in Achieving Weight Loss

3 RCTs

ES 4. In comprehensive lifestyle interventions that are delivered by telephone or face-to-face counseling, and which also include the use of either commercially-prepared prepackaged meals or an interactive web based program, the telephone delivered and face-to-face delivered interventions produced similar mean net weight losses of approximately 5 kg at 6 months and 24 months, compared with a usual care control group. (Low)

3.4.5. Efficacy/Effectiveness of Comprehensive Weight Loss Programs in Patients Within a Primary Care Practice Setting Compared With Usual Care

4 RCTs

ES 5. In studies to date, low to moderate-intensity lifestyle interventions for weight loss provided to overweight or obese adults by primary care practices alone, have not been shown to be effective. (Low)

3.4.6. Efficacy/Effectiveness of Commercial-Based, Comprehensive Lifestyle Interventions in Achieving Weight Loss

4 RCTs

ES 6. Commercial-based, comprehensive weight loss interventions that are delivered in person have been shown to induce an average weight loss of 4.8 kg to 6.6 kg at 6 months in 2 trials when conventional foods are consumed and 6.6 kg to 10.1 kg at 12 months in 2 trials with provision of prepared food, losses that are greater than those produced by minimal-treatment control interventions. (Low)

3.4.7. Efficacy/Effectiveness of Very Low-Calorie Diets, as Used as Part of a Comprehensive Lifestyle Intervention, in Achieving Weight Loss

4 RCTs

ES 7a. Comprehensive, high intensity on-site lifestyle interventions that include a medically supervised very low-calorie diet (often defined as <800 kcal/day), as provided by complete meal replacement products, produce total weight loss of approximately 14.2 kg to 21 kg over 11 to 14 weeks, which is larger than that produced by no intervention or a usual care control group (i.e., advice and education only). (High)

ES 7b. Following the cessation of a high intensity lifestyle intervention with a medically supervised very-low calorie diet of 11 to 14 weeks, weight regain of 3.1 kg to 3.7 kg has been observed during the ensuing 21 to 38 weeks of non-intervention follow-up. (High)

ES 7c. The prescription of various types (resistance or aerobic training) and doses of moderate intensity exercise training (e.g., brisk walking 135 to 250 minutes/week), delivered in conjunction with weight loss maintenance therapy does not reduce the amount of weight regained after the cessation of the very-low calorie diet, as compared with weight loss maintenance therapy alone. (Low)

3.4.8. Efficacy/Effectiveness of Comprehensive Lifestyle Interventions in Maintaining Lost Weight

14 RCTs

ES 8a. After initial weight loss, some weight regain can be expected, on average, with greater regain observed over longer periods of time. Continued provision of a comprehensive weight loss maintenance program (onsite or by telephone), for periods of up to 2.5 years following initial weight loss, reduces weight regain, as compared to the provision of minimal intervention (e.g., usual care). The optimal duration of weight loss maintenance programs has not been determined. (Moderate)

ES 8b. 35% to 60% of overweight/obese adults who participate in a high intensity long-term comprehensive lifestyle intervention maintain a loss of ≥5% of initial body weight at ≥2 year’s follow-up (post-randomization). (Moderate)

3.4.9. Characteristics of Lifestyle Intervention Delivery That May Affect Weight Loss: Intervention

10 RCTs

ES 9a (Moderate-Intensity Interventions). Moderate intensity, on-site comprehensive lifestyle interventions, which provide an average of 1 to 2 treatment sessions per month typically produce mean weight losses of 2 kg to 4 kg in 6 to 12 months, losses which generally are greater than those produced by usual care (i.e., minimal intervention control group). (High)

ES 9b (Low-intensity Interventions). Low intensity, on-site comprehensive lifestyle interventions, which provide fewer than monthly treatment sessions do not consistently produce weight loss when compared to usual care. (Moderate)

ES 9c (Effect of intervention intensity). When weight loss with each intervention intensity (i.e., low, moderate, and high) is compared to usual care, high-intensity lifestyle interventions (≥14 sessions in 6 months) typically produce greater net-of-control weight losses than low-to-moderate intensity interventions. (Moderate)

3.4.10. Characteristics of Lifestyle Intervention Delivery That May Affect Weight Loss or Weight

15 RCTs

ES 10. There do not appear to be substantial differences in the size of the weight losses produced by individual- and group-based sessions in high-intensity, comprehensive lifestyle intervention delivered on site by a trained interventionist*. (Low)

3.4.11. Characteristics of Lifestyle Intervention Delivery That May Affect Weight Loss or Weight Loss Maintenance: Onsite Versus Electronically Delivered Interventions

ES 11. Weight losses observed in comprehensive lifestyle interventions, which are delivered onsite by a trained interventionist* in initially weekly and then biweekly group or individual sessions, are generally greater than weight losses observed in comprehensive interventions that are delivered by Internet or email and which include feedback from a trained interventionist. (Low)

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