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    Views 2,334
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    Original Investigation
    July 13, 2020

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

    Author Affiliations
    • 1Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
    • 2Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada
    • 3Diabetes Research Envisioned and Accomplished in Manitoba, Children’s Hospital Research Institute of Manitoba, Winnipeg, Canada
    • 4George & Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
    • 5I. H. Asper Clinical Research Institute, St. Boniface Hospital Research Centre, Winnipeg, Manitoba, Canada
    • 6Centre for Reviews and Dissemination, University of York, York, United Kingdom
    • 7School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
    • 8Department of Haematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Canada
    • 9Department of Internal Medicine, University of Manitoba, Winnipeg, Canada
    JAMA Netw Open. 2020;3(7):e2010364. doi:10.1001/jamanetworkopen.2020.10364
    Key Points español 中文 (chinese)

    Question  What are the short- and long-term associations of professional- and layperson-led behavioral interventions with weight loss for children and adolescents with overweight and obesity?

    Findings  In this network meta-analysis of 78 unique clinical trials including 5780 participants, professional-led, but not layperson-led, interventions were associated with short-term reductions in absolute and relative weight compared with standard care. These reductions were not sustained long term.

    Meaning  Professional-led behavioral weight loss interventions were associated with weight reduction among children and adolescents with overweight and obesity; there was a lack of direct evidence for the association of layperson-led approaches.


    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.