Abstract
Keywords
Global Health Observatory. Obesity. http://www.who.int/gho/ncd/risk_factors/obesity_text/en/. Accessed 28 May 20, 2013.
- Klein S.
- Burke L.E.
- Bray G.A.
- et al.
Methods
Search Strategy and Inclusion Criteria
Data Collection
Statistical Analysis
Results

Characteristics of Included Studies
Study | Country | Comparison | Population | Content | Delivery | Percentage followed up at 12 mo | |||
---|---|---|---|---|---|---|---|---|---|
Diet | Physical activity | Diet component | Physical activity component | Combined BWMP | |||||
Bertz and colleagues, 2012 22 | Sweden | BWMP vs D BWMP vs PA | N=68 Female: 100% Mean baseline BMI (SD): D=30.0 (2.6); PA=30.4 (3.1); D+PA= 29.2 (2.2); Control=30.2 (3.4) Additional inclusion criteria: Women 8-12 wk postpartum | Calorie restriction (deficit of 500 kcal/d) | Brisk walking (moderate intensity), supervised twice, and recommended 4 d/wk, with length of each session incremental to 45 min |
|
| Women in D+PA group got an additional 2 h of contact, 2 sessions (2.5 h at baseline and 2 h at 6 wk) | Total: 92% BWMP: 100%, D: 76%, PA: 83% |
Foster-Schubert and colleagues, 2012 20 | United States | BWMP vs D BWMP vs PA | N=439 Female: 100% Mean baseline BMI (SD): D+PA=31.0 (4.3); D=31.0 (3.9); PA=30.7 (3.7); Control=30.7 (3.9) Additional inclusion criteria: Postmenopausal women | Reduced-calorie and low-fat (1,200-2,000 kcal/d based on baseline weight) | Recommended and supervised moderate to high intensity PA, 45 min 5 d/wk |
|
| Participants received both components; therefore, had a total of 194 contacts | Total: 91% BWMP: 92%, D: 89%, PA: 91% |
Rejeski and colleagues, 2011 21 | United States | BWMP vs PA | N=288 Female: 67% Mean baseline BMI (SD): D+PA: 33.1 (4.1); PA: 32.8 (3.9); Control: 32.6 (3.5) Additional inclusion criteria: Older adults with evidence of cardiovascular disease or metabolic syndrome and self-reported mobility limitation | Reduced-calorie diet (1,200-1,500 kcal/d if baseline weight <113.4 kg, 1,500-1,800 kcal/d if ≥113.4 kg) | Recommended and supervised, moderate intensity PA, at least 5 d/wk, 30-45 min per session |
|
| No differences in length or number of contacts between PA only BWMP and D+PA BWMP | Total: 86% BWMP: 96% PA: 86% |
Skender and colleagues, 1996 23 | United States | BWMP vs D BWMP vs PA | N=127 Female: 49% Mean baseline BMI: Not reported Additional inclusion criteria: Not applicable | “Controlled energy intake” diet, calories not reported, 30% fat, 50% carbohydrate, 20% protein, using Help Your Heart Eating Plan | Recommended and supervised brisk walking (“vigorous” but not “strenuous”), gradual to 45 min or more 3 to 5 times/wk |
|
| Participants received both components therefore had a total of 226 contacts | Total: 67% BWMP: 64% D: 69% PA: 70% |
Villareal and colleagues, 2011 27 | United States | BWMP vs D BWMP vs PA | N=107 Female: 63% Mean baseline BMI (SD): D+PA: 37.2 (5.4); D: 37.2 (4.5); PA only: 36.9 (5.4); Control: 37.3 (4.7) Additional inclusion criteria: Aged 65 y or older; mild to moderate frailty | Calorie restriction of 500-750 kcal/d (determined by resting energy expenditure×1.7) | Supervised activity sessions (3/wk) of 90 min, including moderate- to high- intensity PA (gradual increase to 70%-80% of peak heart rate) |
|
| Participants received both components therefore had a total of 208 contacts | Total: 87% BWMP: 89% D: 88% PA: 85% |
Vissers and colleagues, 2010 19 | Belgium |
| N=79 Female: Not reported Mean baseline BMI (SD): D+vibration: 33.19 (4.7); D+fitness: 33.1 (3.4); D only: 32.9 (3.1); Control: 30.8 (3.4) Additional inclusion criteria: Not applicable | Hypocaloric diet calculated on an individual level using: (resting metabolic rate×1.3)–600 kcal/d |
|
|
3-6 mo: 1 supervised session and 2 home/wk 6-12 mo: advised to maintain an active lifestyle
3-6 mo: Dynamic exercises 6-12 mo: Advised to maintain an active lifestyle | BWMP Fitness Participants received the additional 36 physical activity contacts taking their total sessions to 48 BWMP vibration Participants received additional contacts but number unclear | Total: 77% BWMP (fitness): 95% BWMP (vibration): 72% D: 60% |
Wadden and colleagues, 1988 24 | United States | BWMP vs D (A second BWMP was not included as its diet component was not comparable to the D only arm) | N=59 Female: 86% Mean baseline BMI: Not reported Additional inclusion criteria: Not applicable | Energy-restricted diet, including very-low-energy component. Month 1 1,000-1,200 kcal/d, Months 2 and 3 400-500 kcal/d, Month 4 “refeeding,” Months 5 and 6 1,000-1,200 kcal/d | Recommended moderate PA (walking and using stairs), frequency not reported |
|
| No differences in length or number of contacts between the D BWMP and D+PA BWMP | Total: 81% BWMP: 74% Diet: 83% |
Wadden and colleagues, 1997 25 | United States |
| N=120 Women: 100% Mean baseline BMI (SD): D+aerobic PA: 37.2 (5.1) D+strength PA: 36.5 (6) D+combined PA: 35.3 (4.4) D only: 36.4 (5.5) Additional inclusion criteria: Women only | Calorie-restricted liquid replacement diet − Wk 2-17: Prescribed diet of 925 kcal/d − Wk 18-22: Decreased liquid diet and increased consumption of conventional foods (Wk 18: 1,053 kcal/d; Wk 19: 1,150 kcal/d; Wk 20: 1,250 kcal/d) − Wk 22 on: Self-selected diet of 1,500 kcal/d with 12%-15% energy from protein; 55%-60% from carbohydrate, and 25%-30% from fat |
|
|
| Additional 5-10 min discussion on adherence to PA program | Total: 83% BWMP (aerobic): 90% BWMP (strength): 77% BWMP (Combined): 79% Diet: 83% |
Risk of Bias
Study | Random sequence generation | Allocation concealment | Attrition | Selective reporting | Notes |
---|---|---|---|---|---|
Wadden 1988 24 | Unclear | Unclear | Low | Low | |
Skender 1996 23 | Low | Unclear | Low | Low | |
Wadden 1997 25 | Unclear | Unclear | Low | Low | |
Vissers 2010 19 | Unclear | Unclear | High | Low | The difference in follow-up between the fitness behavioral weight management programs (95%) and the diet-only program (60%) exceeds 20% |
Rejeski 2011 21 | Unclear | Unclear | Low | High | Authors measured, but did not report, weight at 12 mo |
Villareal 2011 27 | Low | Unclear | Low | Low | |
Bertz 2012 22 | Low | Unclear | Low | Low | |
Foster-Schubert 2012 20 | Low | Low | Low | Low |
Weight Change: Combined BWMPs vs Diet-Only Interventions


Weight Change: Combined BWMPs vs Physical Activity–Only BWMPs


Diet and Physical Activity Measures
Discussion
Strengths and Limitations
Conclusions
Acknowledgements
Supplementary Materials
- Figure 1
- Figure 2
References
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Biography
Article info
Publication history
Footnotes
Supplementary materials: Figures 1 and 2 are available at www.andjrnl.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST P. Aveyard and S. Jebb are investigators on two trials funded by the National Prevention Research Initiative of the UK Medical Research Council. The treatments in these trials are provided free to the public by three commercial companies that advise a combination of diet and exercise for weight loss; these are Weight Watchers, Rosemary Conley, and Slimming World. S. Jebb was also an investigator on a trial with received funding from Weight Watchers International. No potential conflict of interest was reported by the other authors.
FUNDING/SUPPORT The work on which this article is based was funded by the UK National Institute for Health and Care Excellence (NICE) to support the development of NICE Guidance on Managing Overweight and Obese Adults–Lifestyle Weight Management Services. The opinions expressed are those of the authors and do not represent either NICE's position on these matters or constitute NICE guidance. Funding was also provided by the UK Medical Research Council (grant no. U105960389 Nutrition and Health). P. Aveyard is funded by The UK Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research Centre of Excellence. Funding from British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council and the Department of Health, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.
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