Abstract
Background
Weight loss interventions focus on dietary and physical activity changes to induce
weight loss. Both through weight loss and independent of it, diet quality is important
for reducing chronic disease risk. However, whether and how diet quality changes over
the course of a behavioral intervention is unclear.
Objective
To systematically review the evidence from randomized controlled trials on the effect
of behavioral interventions on diet quality as defined by the Healthy Eating Index
(HEI) among adults with overweight and obesity.
Methods
PubMed, Ebscohost CINAHL, Embase, OVID APA PsycInfo, Scopus, and Web of Science were
searched through May 2021. Inclusion criteria comprised randomized controlled trial
design, a primary or secondary aim of weight loss, a sample of US adults with overweight
or obesity, measurement using the HEI-2005, 2010, or 2015, and assessment of the time
by treatment effect. Interventions must have included behavioral components and lasted
at least 3 months. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool.
The systematic review protocol was published on Open Science Framework.
Results
Of 3,707 citations retrieved, 18 studies met inclusion criteria. A wide array of behavioral
interventions were assessed, including in-person and mobile health interventions as
well as those prescribing intake of specific foods. Risk of bias in the included studies
primarily arose from the measurement of the outcome variable. Sample sizes ranged
from 34 to 413 participants. Nine studies used multiple dietary recalls, with few
using the recommended method of Healthy Eating Index calculation. Changes in diet
quality ranged from no improvement to a 20-point improvement. More often, improvement
was in the 4- to 7-point range.
Conclusions
The evidence for the efficacy of behavioral weight loss interventions for improving
diet quality among adults with overweight and obesity is limited. Modest improvements
in HEI scores were observed in the reviewed studies.
Keywords
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Biography
J. C. is a PhD student, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA.
Biography
H.-W. Liang is a PhD student, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA.
Biography
T. C. is an associate professor, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, PA.
Biography
M. L. K. is a librarian, Health Sciences Library System, University of Pittsburgh, PA.
Biography
L. E. B. is a professor, Department of Health and Community Systems, School of Nursing, University of Pittsburgh, PA.
Article Info
Publication History
Published online: August 10, 2022
Accepted:
August 3,
2022
Received:
January 7,
2022
Publication stage
In Press Corrected ProofFootnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors.
FUNDING/SUPPORT Research reported in this publication was supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Number F31HL156278 . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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© 2022 by the Academy of Nutrition and Dietetics.
