Layperson-Led vs Professional-Led Behavioral Interventions for Weight Loss in Pediatric Obesity: A Systematic Review and Meta-analysis

Jonathan McGavock, Bhupendrasinh F Chauhan, Rasheda Rabbani, Sofia Dias, Nika Klaprat, Sara Boissoneault, Justin Lys, Aleksandra K Wierzbowski, Mohammad Nazmus Sakib, Ryan Zarychanski, Ahmed M Abou-Setta, Jonathan McGavock, Bhupendrasinh F Chauhan, Rasheda Rabbani, Sofia Dias, Nika Klaprat, Sara Boissoneault, Justin Lys, Aleksandra K Wierzbowski, Mohammad Nazmus Sakib, Ryan Zarychanski, Ahmed M Abou-Setta

Abstract

Importance: The appropriate approach for weight loss among children and adolescents with overweight and obesity remains unclear.

Objective: To evaluate the difference in the treatment outcomes associated with behavioral weight loss interventions led by laypersons and professionals in comparison with unsupervised control arms among children and adolescents with overweight and obesity.

Data sources: For this systematic review and meta-analysis, the Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, the Cochrane Library, and Cumulative Index of Nursing and Allied Health Literature (CINAHL) databases were searched from January 1, 1996, to June 1, 2019.

Study selection: Included in this study were randomized clinical trials (RCTs) of behavioral interventions lasting at least 12 weeks for children and adolescents (aged 5-18 years) with overweight and obesity. Exclusion criteria included non-RCT studies, interventions lasting less than 12 weeks, adult enrollment, participants with other medical diagnoses, pharmacological treatment use, and articles not written in English. Two of 6 reviewers independently screened all citations. Of 25 586 citations, after duplicate removal, 78 RCTs (5780 participants) met eligibility criteria.

Data extraction and synthesis: A bayesian framework and Markov chain Monte Carlo simulation methods were used to combine direct and indirect associations. Random-effects and fixed-effect network meta-analysis models were used with the preferred model chosen by comparing the deviance information criteria. This study was registered with the International Prospective Register of Systematic Reviews (PROSPERO) and followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline.

Main outcomes and measures: The immediate and sustained changes in weight and body mass index (BMI) standardized mean difference (SMD) were primary outcomes planned before data collection began, whereas waist circumference and percent body fat were secondary outcomes. The hypothesis being tested was formulated before the data collection.

Results: Of 25 586 citations retrieved, we included 78 RCTs (5780 participants), with a follow-up of 12 to 104 weeks. Compared with the control condition, random-effects models revealed that professional-led weight loss interventions were associated with reductions in weight (mean difference [MD], -1.60 kg [95% CI, -2.30 to -0.99 kg]; 68 trials; P < .001) and BMI (SMD, -0.30 [95% CI, -0.39 to -0.20]; 59 trials; P < .001) that were not sustained long term (weight MD, -1.02 kg [95% CI, -2.20 to 0.34 kg]; 21 trials; P = .06; BMI SMD, -0.12 [95% CI, -0.46 to 0.21]; 20 trials; P < .001). There was no association between layperson-led interventions and weight loss in the short-term (MD, -1.40 kg [95% CI, -3.00 to 0.26 kg]; 5 trials; P = .05) or long-term (MD, -0.98 kg [95% CI, -3.60 to 1.80 kg]; 1 trial; P = .23) compared with standard care. No difference was found in head-to-head trials (professional vs layperson MD, -0.25 kg [95% CI -1.90 to 1.30 kg]; 5 trials; P = .38).

Conclusions and relevance: This systematic review and meta-analysis found that professional-led weight loss interventions were associated with short-term but not sustained weight reduction among children and adolescents with overweight or obesity, and the evidence for layperson-led approaches was insufficient to draw firm conclusions.

Conflict of interest statement

Conflict of Interest Disclosures: Drs McGavock and Zarychanski reported receiving a salary and operating support from the Canadian Institutes of Health Research outside the submitted work. No other disclosures were reported.

Figures

Figure 1.. Network of Trials That Examined…
Figure 1.. Network of Trials That Examined Layperson- and Professional-Led Approaches to Weight Loss Among Children and Adolescents With Overweight and Obesity
Illustration of a network meta-analysis that combines direct evidence for the immediate postintervention change (A, B) and long-term change (C, D) in weight (A, C) and BMI (B, D) obtained from randomized clinical trials comparing 3 nodes: professional-led, layperson-led, and standard weight loss interventions. The size of the nodes is proportional to the number of participants randomized to that intervention type. The thickness of lines and the numbers represent the number of studies that contributed data for the comparison. Standard treatment considered as reference treatment for all network meta-analysis. BMI indicates body mass index.
Figure 2.. Short- and Long-term Efficacy of…
Figure 2.. Short- and Long-term Efficacy of Layperson- and Professional-Led Weight Loss Interventions in Children and Adolescents With Overweight and Obesity
A, Differences for weight outcomes are shown. B, Differences for body mass index are shown (standard mean difference). Results of the 3 possible comparisons within the network for the 2 primary outcome measures, body weight and body mass index, are displayed. From top to bottom in each panel, we compare professional-led interventions to standard of care, layperson-led interventions to standard of care, and head-to-head comparisons of professional- and layperson-led interventions. Blue circles represent immediate changes in outcomes; orange circles represent long-term (sustained) changes in outcomes. Horizontal lines reflect no difference between the intervention arm and the comparison arm. Whiskers indicate 95% CIs.
Figure 3.. Ranked Intervention Types for Short-…
Figure 3.. Ranked Intervention Types for Short- and Long-term Weight Loss Among Children and Adolescents With Overweight and Obesity
Surface under the cumulative ranking curve–based treatment rankings for immediate postintervention change (A, B) and long-term change (C, D) in weight (A, C) and BMI (B, D) obtained from randomized clinical trials. Data represent the probability of being ranked as the best (1), next best (2), and least effective (3) intervention. BMI indicates body mass index.

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