Are individual or group interventions more effective for long-term weight loss in adults with obesity? A systematic review

Feasibility and Efficacy of a Plant-Based Nutrition Intervention for Type 2 Diabetes in a Primary Care Setting

Objective: To determine the feasibility and efficacy of a plant-based nutrition intervention for type 2 diabetes in a primary care setting. Methods: Adults (n = 76) with type 2 diabetes were enrolled in a self-paid, online nutrition intervention program between August 2023 and September 2024. All participants were advised to attend weekly group classes and follow a plant-based diet for 12 weeks. Body weight, medication usage, HbA1c, and cholesterol levels were assessed at baseline and at 12 weeks. Results: Among the 58 participants who completed the program (mean age 63.4 years; 69% female), the mean body weight (-3.7 kg; 95% CI, -4.4 to -2.9; P < .0001) and HbA1c (-0.6%; 95% CI, -0.8 to -0.3; P = .0001) decreased at 12 weeks. Participants not following a plant-based diet at baseline experienced greater reductions in mean body weight and HbA1c. Total and low-density lipoprotein cholesterol levels decreased amongst participants not taking lipid-lowering medications, and 22% of participants reduced the dosages of diabetes medications. Conclusion: In a primary care setting, a novel 12-week plant-based nutrition intervention for type 2 diabetes was accessible, economically viable, and led to reductions in diabetes medications, body weight, HbA1c, and total and LDL cholesterol levels.

Integration of a lifestyle modification intervention for women with overweight and obesity in a gynecologic oncology practice

OBJECTIVE(S)

We aimed to assess the feasibility and effectiveness of a remotely delivered, group-based lifestyle modification intervention (LMI) for women with gynecologic cancer and overweight or obesity in a real-world clinic.

METHODS

A six-month LMI was implemented in an outpatient gynecologic oncologic clinic for women with a body mass index (BMI) >25 kg/m2. Participants were given a weight loss goal of ≥5 % initial body weight. Retrospective data were collected from patients enrolled in the intervention from September 2019 through February 2023. Feasibility of the LMI was assessed by the rate of enrollment and retention in the intervention. De-identified zip code data were collected to assess geographic proximity of participants to the clinic. Repeated measure analysis of variance (ANOVA) was performed to evaluate change in weight across the intervention.

RESULTS

164 patients were referred to the LMI with 82 patients being enrolled during the study timeframe. The sample consisted primarily of white (68.3 %) women between the ages of 30 to 73 years old (median age of 57) with an initial median BMI of 41.41 kg/m2. 74 % of enrolled patients completed the entire LMI. The LMI resulted in a mean loss of 4.19 kgs (p < .001), with 40.30 % of patients losing ≥5 % initial body weight.

CONCLUSIONS

Remotely delivered, group based LMI for gynecologic cancer patients with overweight or obesity is feasible in clinical practice and can transcend rural-urban inequalities. Patients in the LMI achieved statistically and clinically significant weight loss, comparable to that observed in more rigorous clinical trial.

The latest evidence and guidance in lifestyle and surgical interventions to achieve weight loss in people with overweight or obesity

BACKGROUND

The prevalence of obesity and related co-morbidities has reached epidemic proportions. Effective evidence-based treatment approaches are therefore important. Lifestyle intervention remains the mainstay of the treatment strategy to manage obesity. Increased evidence has also emerged regarding the efficacy of metabolic bariatric surgery (MBS) to induce significant and sustained weight loss while also reducing the progression of obesity-related co-morbidities for people living with obesity.

AIMS & METHODS

This article aims to bring together current evidence, guidance and best practice for the prevention and management of people living with overweight or obesity by means of lifestyle and behavioural intervention, as well as by MBS.

RESULT

Lifestyle intervention encompasses dietary strategies, physical activity and behavioural intervention. Discussion on MBS will focus on current indications, comparison between different MBS procedures, novel endoscopic techniques, potential complications and pre-operative management.

PLAIN LANGUAGE SUMMARY

The number of people living with excess weight and complications associated with being overweight is alarmingly quite high. Effective treatment approaches that are supported by clinical studies are therefore important. Lifestyle changes remain very important to manage excess weight. Increased evidence has also shown the benefits of weight loss surgery to produce significant weight loss which could be sustained, while also reducing the risk of developing medical conditions associated with excess weight. This article aims to bring together current evidence, guidance and best practice for the prevention and management of people living with excess weight by means of lifestyle and behavioural changes, as well as by weight loss surgery. Lifestyle intervention encompasses dietary strategies, physical activity and behavioural intervention. Discussion on weight loss surgery will focus on current criteria for suitability, comparison between different weight loss surgery procedures, new techniques, possible complications and appropriate management prior to weight loss surgery.

The effectiveness and usability of online, group-based interventions for people with severe obesity: a systematic review and meta-analysis

Long wait times, limited resources, and a lack of local options mean that many people with severe obesity cannot access treatment. Face-to-face group-based interventions have been found effective and can treat multiple people simultaneously, but are limited by service capacity. Digital group interventions could reduce wait times, but research on their effectiveness is limited. This systematic review aimed to examine the literature about online group-based interventions for adults with severe obesity (BMI ≥ 35 kg/m2). The review followed the PRISMA and PICOS frameworks. MEDLINE, Embase, CINAHL, Web of Science, and Cochrane Central Register of Controlled Trials were searched. Two authors independently screened articles. Data extraction, analysis, and quality assessment (using RoB2 and MMAT) was shared between two authors. A meta-analysis was conducted on eligible studies; other results were descriptively analysed. 20 papers reporting on 15 studies were included. Most studies reported some evidence of weight loss, but evidence of weight-related behaviour change was mixed. A meta-analysis on four studies indicated that online, group-based interventions had a statistically significant impact on weight loss (p = 0.001; 95% CI -0.69 to -0.17) with a small-to-moderate effect size, compared to waitlist or standard care conditions. Online interventions were considered more convenient but lack of familiarity with the group or counsellor, accessibility issues, and time constraints hindered engagement. Technical support, incentives, and interactive forums to improve group cohesion could mitigate these barriers. The findings suggested that online, group-based interventions are feasible and potentially beneficial, but barriers such as internet accessibility, digital literacy, and unfamiliarity with group members need to be mitigated. Key recommendations to improve experience and impact include providing instructions and run-throughs, building group cohesion, and providing session and additional content throughout the intervention. Future studies should focus on the influence of specific intervention characteristics and investigate the effect of these interventions compared to face-to-face interventions. Registration: National Institute for Health Research, PROSPERO CRD42021227101; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021227101 .

Coach-Assisted eHealth With Group or Individual Support for Employees With Obesity: Randomized Controlled Trial on Weight, Body Composition, and Health Metrics

BACKGROUND

Acceptance and commitment therapy provides a psychobehavioral framework feasible for digital and hybrid weight loss interventions. In face-to-face studies, group-based interventions yield more favorable outcomes than individual interventions, but the effect of the intervention form has not been studied in combination with eHealth.

OBJECTIVE

This study investigated whether a minimal, 3-session group or individual enhancement could provide additional benefits compared to an eHealth-only intervention when assessing weight, body composition, and laboratory metrics in a sample of occupational health patients with obesity.

METHODS

This study was a randomized controlled trial with a 12-month intervention, followed by a 12-month follow-up period without additional support (March 2021 to March 2023). Recruited from occupational health care for Finnish municipal employees, 111 working-age adults with a BMI of 30-40 kg/m2 were randomized to 1 of the 3 treatment arms: eHealth, eHealth+group, or eHealth+individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on acceptance and commitment therapy, and additionally, the eHealth+group and eHealth+individual arms received 3 remotely facilitated group or individual meetings with their designated coach. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0-, 6-, 12-, and 24-month time points. Applying estimated means to decrease bias caused by dropouts, generalized estimating equations were used to study the differences between the 3 groups over time.

RESULTS

There were no between-group differences in primary measurements of weight change or categorical weight change. Secondary outcomes also did not show changes attributable to the intervention arm. Across the entire sample, the total weight loss was 1.5% during the intervention, with 18% (20/111) of the participants attaining a ≥5% weight loss. Sustained at follow-up, waist circumference decreased, and high-density lipoprotein cholesterol increased slightly. The participants completed, on average, 58.6% of the eHealth program.

CONCLUSIONS

There were no differences in weight or other somatic health variables between the eHealth arm and intervention combining eHealth with minimal group or individual enhancement. Despite a modest overall weight loss, the intervention shows promise in improving body composition and metabolic health. Moving forward, further research is needed to determine if there is a threshold where face-to-face meetings provide additional benefits in hybrid interventions. Moreover, there is a need to explore for whom and under what conditions eHealth and hybrid models may be most effective.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04785586; https://clinicaltrials.gov/study/NCT04785586.

General practitioner-centered rural obesity management: Design, protocol and baseline data of the German HAPpEN pragmatic trial

Objective

HAPpEN aims to implement and evaluate a holistic general practitioner-centered, interdisciplinary obesity management strategy in rural Germany, focusing on feasibility, health outcomes, and economic benefits.

Methods

HAPpEN is a 12-month, pragmatic single-arm, multicenter trial, informed by a formative survey, and initiated in April 2023 with 98 obese participants (body mass index, BMI ≥ 30 kg/m2) in Kulmbach, Germany. The program integrates nutritional counseling, physical activity, and behavior change techniques, including smartphone-based self-monitoring. Monthly consultations help set personalized goals using a multi-stage grading scale. Primary outcomes include BMI, body weight, waist circumference, heart rate, blood pressure and parameters, while secondary outcomes assess quality of life, wellbeing, health literacy, social interaction, and digital therapy support.

Results

The baseline cohort (mean age: 46.9 ± 11.8 years, 74.1 % female) exhibited high obesity rates (mean BMI: 40.1 ± 6.1 kg/m2), with 48.5 % classified as grade III obese. Common comorbidities were hypertension (51.8 %), dyslipidemia (30.5 %) and diabetes (21.8 %). Chronic joint paint, mainly in the knees and hips, affected up to 82.4 %. A familial aggregation of obesity, diabetes, and cardiovascular diseases was noted, alongside behavioral challenges such as lack of physical activity (81.8 %) and unhealthy eating habits (56.8 %).

Conclusion

HAPpEN addresses obesity's multifactorial nature through general practitioner-led, community-based, and digital strategies to promote sustainable lifestyle changes in rural areas. The trial aims to inform primary care obesity management guidelines, focusing on improving health literacy, patient engagement, and long-term clinical benefits. German Clinical Trials Register: DRKS00033916.

The Group-basEd Telehealth behavioral WEight Loss Program Among Breast Cancer Survivors: A Pilot and Feasibility Study

Objective

Obesity is related to the recurrence of breast cancer. In-person groups or individual telephone counseling currently comprise the behavioral weight loss (BWL) programs tested for cancer survivors. Group support via telehealth may be convenient and provide support from fellow survivors, but feasibility, acceptability, and efficacy testing are needed.

Methods

A single-arm, 6-month BWL program was conducted for female breast cancer survivors with an ECOG performance 0 or 1, BMI > 25 kg/m2, and > 6 months from completion of adjuvant chemotherapy and/or radiation treatment. Participants attended 22 video group sessions over 6 months, completing acceptability ratings, weight measurements, Patient Health Questionnaire (PHQ-9), City of Hope Breast Cancer Quality of Life Scale (QOL), and International Physical Activity Questionnaire. Changes in survey scores and weight (last-observation carried forward) and differences in outcomes by patients' race were computed with paired t-tests, ANCOVAs and Chi-square tests.

Results

Twenty-one (5 Black, 15 White, 1 Asian American; Mean (SD) = 60.7 (11.6) years; BMI 33.1 (5.9) kg/m2) survivors enrolled with 90% retention and 81.3% of sessions attended. Acceptability ratings were high (all > 4 on a five-point scale). Mean (SD) weight loss was 5.9% (5.2%), with 60% losing ≥ 5% of baseline weight; White participants lost 7.5% and Black participants lost 1.9% (p = 0.04). Significant improvements were observed in mood (PHQ-9; p = 0.01) and physical wellbeing QOL (p = 0.01). Physical activity did not change.

Conclusion

This telehealth group BWL program was feasible and acceptable for breast cancer survivors, yielding a clinically significant weight loss. Future studies should test this intervention in larger, more diverse samples.

Trail Registration

ClinicalTrials.gov identifier: NCT04855552, posted April 22, 2021.

Physical Activity and Excess Body Weight and Adiposity for Adults. American College of Sports Medicine Consensus Statement

ABSTRACT

Excessive body weight and adiposity contribute to many adverse health concerns. The American College of Sports Medicine (ACSM) recognizes that the condition of excess body weight and adiposity is complex, with numerous factors warranting consideration. The ACSM published a position stand on this topic in 2001 with an update in 2009, and a consensus paper on the role of physical activity in the prevention of weight gain in 2019. This current consensus paper serves as an additional update to those prior ACSM position and consensus papers. The ACSM supports the inclusion of physical activity in medical treatments (pharmacotherapy, metabolic and bariatric surgery) of excess weight and adiposity, as deemed to be medically appropriate, and provides perspectives on physical activity within these therapies. For weight loss and prevention of weight gain, the effects may be most prevalent when physical activity is progressed in an appropriate manner to at least 150 min·wk-1 of moderate-intensity physical activity, and these benefits occur in a dose-response manner. High-intensity interval training does not appear to be superior to moderate-to-vigorous physical activity for body weight regulation, and light-intensity physical activity may also be an alternative approach provided it is of sufficient energy expenditure. Evidence does not support that any one single mode of physical activity is superior to other modes for the prevention of weight gain or weight loss, and to elicit holistic health benefits beyond the effects on body weight and adiposity, multimodal physical activity should be recommended. The interaction between energy expenditure and energy intake is complex, and the effects of exercise on the control of appetite are variable between individuals. Physical activity interventions should be inclusive and tailored for sex, self-identified gender, race, ethnicity, socioeconomic status, age, and developmental level. Intervention approaches can also include different forms, channels, and methods to support physical activity.

Weight management in rural health clinics: Results from the randomized midwest diet and exercise trial

Introduction

Rural living adults have higher rates of obesity compared with their urban counterparts and less access to weight management programs. Previous research studies have demonstrated clinically relevant weight loss in rural living adults who complete weight management programs delivered by university affiliated interventionists. However, this approach limits the potential reach, adoption, implementation, and maintenance of weight management programs for rural residents. Weight management delivered through rural health clinics by non-physician clinic associated staff, for example, nurses, registered dieticians, allied health professionals, etc. has the potential to improve access to weight management for rural living adults. This trial compared the effectiveness of a 6-month multicomponent weight management intervention for rural living adults delivered using group phone calls (GP), individual phone calls (IP) or an enhanced usual care control (EUC) by rural clinic associated staff trained by our research team.

Methods

Rural living adults with overweight/obesity (n = 187, age ∼ 50 years 82% female, body mass index ∼35 kg/m2) were randomized (2:2:1) to 1 of 3 intervention arms: GP, which included weekly ∼ 45 min sessions with 7-14 participants (n = 71), IP, which included weekly ∼ 15 min individual sessions (n = 80), or EUC, which included one-45 min in-person session at baseline.

Results

Weight loss at 6 months was clinically relevant, that is, ≥5% in the GP (-11.4 kg, 11.7%) and the IP arms (-9.1 kg, 9.2%) but not in the EUC arm (-2.6%, -2.5% kg). Specifically, 6 month weight loss was significantly greater in the IP versus EUC arms (-6.5 kg. p ≤ 0.025) but did not differ between the GP and IP arms (-2.4 kg, p > 0.025). The per participant cost per kg. weight loss for implementing the intervention was $93 and $60 for the IP and GP arms, respectively.

Conclusions

Weight management delivered by interventionists associated with rural health clinics using both group and IP calls results in clinically relevant 6 months weight loss in rural dwelling adults with overweight/obesity with the group format offering the most cost-effective strategy. Clinical trial registration: ClinicalTrials.gov (NCT02932748).

Concept of an Intervention for Sustainable Weight Loss in Postmenopausal Women with Overweight-Secondary Analysis of a Randomized Dietary Intervention Study

INTRODUCTION

The approach of an individual diet has great potential for sustainable weight reduction. Social support, participation and empowerment are also key factors for high motivation and compliance. So, the impact of an individual diet in combination with group sessions on weight loss in postmenopausal women with overweight was investigated.

METHODS

In this reanalysis of a controlled intervention study, postmenopausal women (n = 54; BMI 30.9 ± 3.4 kg/m²; 59 ± 7 years) were recruited receiving an energy restricted diet for 12 weeks, followed by a six-month follow-up phase. The women received 51 individual meal plans based on their habits and were trained in four group sessions.

RESULTS

Forty-six women completed the intervention phase, and 29 completed the follow-up. Average weight loss was -5.8 ± 3.0 kg (p < 0.001) after 12 weeks and was still significant at follow-up (-4.9 ± 5.4 kg, p < 0.001). Also, decreases in fat-free mass (-1.1 ± 1.2 kg, p < 0.001) and resting energy expenditure (-1096 ± 439 kJ/24 h, p < 0.001) were observed.

CONCLUSIONS

The individual nutrition approach with a focus on nutritype in combination with group sessions was effective for long-lasting weight loss in postmenopausal women. An important factor is close individual and group support.

Sabotage, Collusion, and Being a Feeder: Towards a New Model of Negative Social Support and Its Impact on Weight Management

PURPOSE OF REVIEW

Whilst research indicates the positive impact of social support across a number of health domains, including weight management, not all social support is beneficial.

RECENT FINDINGS

This paper reviews the evidence for both positive and negative social support in the context of behavioural interventions and surgery for obesity. It then presents a new model of negative social support focusing on sabotage ('active and intentional undermining of another person's weight goals'), feeding behaviour ('explicit over feeding of someone when they are not hungry or wishing not to eat'), and collusion ('passive and benign negative social support to avoid conflict') which can be conceptualised within the context of relationships as systems and the mechanisms of homeostasis. There is increasing evidence for the negative impact of social support. This new model could form the basis of further research and the development of interventions for family, friends, and partners to maximise weight loss outcomes.