Effective weight management practice: a review of the lifestyle intervention evidence

Objectives: Despite the existence of guidelines for obesity management, uncertainty remains as to what interventions comprise effective practice. This uncertainty could act as a barrier to busy health care professionals, who may lack the time and expertize to fully appraise the huge amount of literature that is published each year on obesity management. Therefore, the objectives of this review were to synthesize the available evidence, determine most effective and most promising practices for obesity management in adults, using an established methodology, and present this information according to its quality. Evidence acquisition: This synthesis review was conducted from January 2009. A detailed search of relevant databases was conducted to September 2010. Most effective and promising practices were defined using the Canadian Best Practice Initiative Methodology Background Paper, with systematic reviews (with/without meta analysis) as the most rigorous methodology for developing recommendations that were deemed most effective (level 1), and non-systematic reviews for developing recommendations deemed as most promising (level 2). Literature was reviewed and classified across these two levels of rigor, and supplemented with primary studies to further refine recommendations. Results: Evidence from systematic reviews and meta-analyses was classified into three intervention themes or areas of context, in which more specific most effective and/or promising practice recommendations could be nested. These intervention themes were (1) targeted multi-component interventions for weight management, (2) dietary manipulation strategies and (3) delivery of weight management interventions, including health professional roles and method of delivery. Specific recommendations accompanied each theme. Conclusions: This review highlights the value of multi-component interventions that are delivered over the longer term, and reinforces the role of health care professionals. The findings will help to inform evidence-based practice for health care practitioners involved in obesity management and prevention. International Journal of Obesity (2012) 36, 178-185; doi:10.1038/ijo.2011.80; published online 12 April 2011