Treatment of obesity
The prevalence of obesity is increasing around the world, and has effects on short- and long-term functioning, health, and well-being. Obesity is therefore an international public health priority.
This special collection brings together a selection of Cochrane Reviews for treating obesity or reducing weight, and includes Cochrane Reviews assessing general strategies, exercise and physical activity, diet, psychological interventions, drugs and supplements, surgery, and health-systems interventions.
The Cochrane Reviews in this collection have been prepared by the authors and editors from the Cochrane Airways Group; Cochrane Effective Practice and Organisation of Care Group; Cochrane Heart Group; Cochrane Hepato-Biliary Group; Cochrane Hypertension Group; Cochrane Menstrual Disorders and Subfertility Group; Cochrane Metabolic and Endocrine Disorders Group; and Cochrane Schizophrenia Group.
General strategies
Interventions for treating obesity in children
Child and adolescent obesity is increasingly prevalent, and can be associated with significant short- and long-term health consequences. This review assesses the efficacy of lifestyle, drug and surgical interventions for treating obesity in childhood.
Interventions to reduce weight gain in schizophrenia
Weight gain is common for people with schizophrenia, and this has serious implications for health and well-being. This review evaluates the effects of both pharmacological (excluding medication switching) and non-pharmacological strategies for reducing or preventing weight gain in people with schizophrenia.
Lifestyle modification for obstructive sleep apnoea
Obstructive sleep apnoeas are due to transient closure of the upper airway during sleep and merge into hypopnoeas in which the airway narrows, but some airflow continues. They are due to the forces compressing the airway overcoming those which stabilise its patency. The most common association is obesity, in which fatty tissue is deposited around the airway. Exercise has been recommended as a method of losing weight, but other techniques which achieve this are also thought to improve symptoms due to sleep apnoeas. Sleep hygiene may alter the sleep structure and the control of the upper airway during sleep, and thus promote its patency. This review assesses whether weight loss, sleep hygiene and exercise are effective in the treatment of obstructive sleep apnoeas.
Lifestyle changes in women with polycystic ovary syndrome
Polycystic ovary syndrome affects 4% to 18% of reproductive-aged women and is associated with reproductive, metabolic and psychological dysfunction. Obesity worsens the presentation of polycystic ovary syndrome, and weight management (weight loss, maintenance or prevention of excess weight gain) is proposed as an initial treatment strategy, best achieved through lifestyle changes incorporating diet, exercise and behavioural interventions. This review assesses the effectiveness of lifestyle treatment in improving reproductive, anthropometric (weight and body composition), metabolic and quality of life factors in polycystic ovary syndrome.
Long-term non-pharmacological weight loss interventions for adults with prediabetes
Most people with prediabetes (impaired glucose tolerance or impaired fasting glucose) are overweight, and obesity worsens the metabolic and physiologic abnormalities associated with this condition. Prediabetes is an important risk factor for the development of type 2 diabetes. This review assesses the effectiveness of dietary, physical activity, and behavioural weight loss, and weight control interventions for adults with prediabetes.
Long-term non-pharmacological weight loss interventions for adults with type 2 diabetes mellitus
Most people with type 2 diabetes are overweight, and obesity worsens the metabolic and physiologic abnormalities associated with diabetes. This review assesses the effectiveness of lifestyle and behavioural weight loss and weight control interventions for adults with type 2 diabetes.
Weight reduction for non-alcoholic fatty liver disease
Non-alcoholic fatty liver disease is becoming a widespread liver disease. The present recommendations for treatment are not evidence-based. Some of them are various weight reduction measures with diet, exercise, drug, or surgical therapy. This review assesses the benefits and harms of intended weight reduction for patients with non-alcoholic fatty liver disease.
Weight reduction for primary prevention of stroke in adults with overweight or obesity
Obesity is seen as a worldwide chronic disease with high prevalence that has been associated with increased morbidity from many conditions, including stroke, which is the third leading cause of death in developed countries and a leading cause of severe long-term disability. The causal association between overweight or obesity and stroke is unclear, and there is no definite study clarifying the role of obesity treatment in the prevention of a first stroke (primary prevention). Given the prevalence of stroke and the enormous health and economic cost of the disease, it is important to establish the possible impact of weight reduction per se on stroke incidence. This review assesses the effects of weight reduction in people with overweight or obesity on stroke incidence.
Exercise and physical activity
Exercise for overweight or obesity
Clinical trials have shown that exercise in adults with overweight or obesity can reduce bodyweight. This review assesses exercise as a means of achieving weight loss in people with overweight or obesity, using randomised controlled clinical trials.
Diet
Low glycaemic index or low glycaemic load diets for overweight and obesity
Obesity is increasingly prevalent, yet the nutritional management remains contentious. It has been suggested that low glycaemic index or load diets may stimulate greater weight loss than higher glycaemic index or load diets or other weight reduction diets. This review assesses the effects of low glycaemic index or load diets for weight loss in overweight or obese people.
Long-term effects of weight-reducing diets in hypertensive patients
All major guidelines for antihypertensive therapy recommend weight loss. Thus dietary interventions that aim to reduce body weight might be a useful intervention to reduce blood pressure and adverse cardiovascular events associated with hypertension. This review assesses the long-term effects of weight-reducing diets in hypertensive patients.
Psychological interventions
Psychological interventions for overweight or obesity
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. This review assesses the effects of psychological interventions for overweight or obesity as a means of achieving sustained weight loss.
Drugs and supplements
Chitosan for overweight or obesity
Chitosan, a deacetylated chitin, is a dietary supplement reported to decrease body weight. It is widely available over the counter worldwide, and although evaluated in a number of trials, its efficacy remains in dispute. This review assesses the effects of chitosan as a treatment for overweight and obesity.
Rimonabant for overweight or obesity
Worldwide, the prevalence of obesity and overweight in industrialised countries and in a substantial number of developing countries is increasing at an alarming rate. Rimonabant is a selective cannabinoid-1 receptor antagonist that has been investigated for its efficacy in reducing body weight and associated risk factors in obese people. Given the prevalence of overweight and obesity, it is important to establish the efficacy and safety of rimonabant. This review assesses the effects of rimonabant in overweight and obese people.
Long-term pharmacotherapy for obesity and overweight
Obesity is a highly and increasingly prevalent chronic condition for which drugs are commonly prescribed to improve health. This review assesses the long-term effects of approved anti-obesity medications in clinical trials of at least one-year duration.
Pharmacotherapy for weight loss in adults with type 2 diabetes mellitus
Obesity is closely related to type 2 diabetes, and long-term weight reduction is an important part of the care delivered to obese persons with diabetes. This review assesses the efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes.
Long-term effects of weight-reducing drugs in hypertensive patients
All major guidelines for antihypertensive therapy recommend weight loss; anti-obesity drugs might be a helpful option. This review assesses the long-term effects of pharmacologically induced reduction in body weight with orlistat, sibutramine or rimonabant on all-cause mortality, cardiovascular morbidity, adverse events, changes in systolic and/or diastolic blood pressure, and body weight reduction.
Weight gain is common for people with schizophrenia, and this has serious implications for a patient's health and well-being. Switching strategies have been recommended as a management option. This review evaluates the effects of antipsychotic medication-switching as a strategy for reducing or preventing weight gain and metabolic problems in people with schizophrenia.
Surgery
Bariatric (weight loss) surgery for obesity is considered when other treatments have failed. The effects of the available bariatric procedures compared with medical management and with each other are uncertain. This review assesses the effects of bariatric surgery for obesity.
Intragastric balloon for obesity
Intragastric balloon treatment for obesity has been developed as a temporary aid. Its primary objective is the treatment of obese people, who have had unsatisfactory results in their clinical treatment for obesity, in spite of being cared for by a multidisciplinary team, and super-obese patients with a higher surgical risk. However, the effects of different intragastric balloon procedures compared with conventional treatments and with each other are uncertain. This review assesses the effects of intragastric balloon in people with obesity.
Health-systems interventions
The prevalence of obesity is increasing globally and will, if left unchecked, have major implications for both population health and costs to health services. This review assesses the effectiveness of strategies to change the behaviour of health professionals and the organisation of care to promote weight reduction in overweight and obese people.
Image credit: Medicalrf.com /Science Photo Library, F002/1629
Date published: 7 December 2011
Contact: Cochrane Editorial Unit (editorial-unit@cochrane.org)
