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Systematic review of long-term weight loss studies in obese adults: clinical significance and applicability to clinical practice
Abstract
Background Obesity is a common health problem that requires a long-term care approach. We systematically reviewed long-term (> or =2 y) studies investigating dietary/lifestyle, pharmacologic, and surgical weight loss methods to assess (1) weight loss efficacy, defined by absolute weight loss and the proportion of subjects with > or =5% weight loss, (2) effects of weight loss on cardiovascular risk factors, and (3) applicability of findings from studies to everyday clinical practice.Methods The MEDLINE, HealthSTAR, and the Cochrane Controlled Trials databases were searched for studies investigating the long-term efficacy of weight loss methods in overweight and obese adults. Data were extracted for (i) weight loss after 1 y (pharmacologic studies only), 2 y, 3 y, and 4 y, (ii) proportion of subjects with > or =5% weight loss at the end of follow-up, and (iii) changes (end-of follow-up minus baseline values) in blood lipids, fasting blood glucose, and systolic and diastolic blood pressure.Results Dietary/lifestyle therapy provides <5 kg weight loss after 2-4 y, pharmacologic therapy provides 5-10 kg weight loss after 1-2 y, and surgical therapy provides 25-75 kg weight loss after 2-4 y. Weight loss of > or =5% baseline weight is not consistently associated with improvements in cardiovascular risk factors and these benefits appear to be intervention specific and occur mainly in people with concomitant cardiovascular risk factors. Weight loss studies have methodologic limitations that restrict the applicability of findings to unselected obese people assessed in everyday clinical practice. These limitations include an inadequate study duration, large proportions of subjects lost to follow-up, a lack of an appropriate usual care group, and a lack of reporting of outcomes in high-risk subgroups.Conclusions Dietary/lifestyle and pharmacologic weight loss interventions provide modest weight loss, and may improve markers of cardiovascular risk factors although these benefits occur mainly in patients with cardiovascular risks. Studies investigating weight loss have methodologic limitations that restrict the applicability of findings to obese patients assessed in clinical practice.
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“Finally, our findings pertain to an initial weight loss intervention phase and do not provide information related to the more difficult stage of weight loss maintenance [50].”
From A qualitative evaluation of a group phone-based weight loss intervention for rural breast cancer survivors: Themes and mechanisms of success (2016) · cites this paper as [50]
In the citing paper
“Aerobic exercise can reduce weight and BP, but when exercise is the only intervention, weight losses are small, with an estimated change of 1.6 kg in moderate-intensity programs continued for 6 to 12 months.124,139,140”
From Obesity‐Related Hypertension: Pathogenesis, Cardiovascular Risk, and Treatment: A Position Paper of The Obesity Society and the American Society of Hypertension (2013) · cites this paper as [140]
In the citing paper
“An average attrition rate of 21% is typical in lifestyle interventions for weight loss [27], in a recent review of long term weight loss studies in obese adults losses to follow-up typically between 30–60% were reported [32].”
From The Internet for weight control in an obese sample: results of a randomised controlled trial (2007) · cites this paper as [32]
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“In order to promote weight loss andweight lossmaintenance, aerobic exercise (particularly walking) is highly promoted in conjunction with a low fat, low calorie diet (Catenacci et al., 2008; Douketis et al., 2005;Wing, 1999).”
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Metadata
- Authors
- Douketis, J. D., Macie, C., Thabane, L., & Williamson, D. F.
- Affiliations
- McMaster University (CA)
- Centers for Disease Control and Prevention (US)
- Corresponding author
- Douketis, J D
- Venue
- International Journal of Obesity
- Published
- 2005-07-05
- Volume
- 29
- Issue
- 10
- Pages
- 1153-1167
- ISSN
- 0307-0565 (ISSN-L)
- 1476-5497
- OpenAlex
- W2050986291
- Cited by
- 665
- References
- 121
- Citations by year
- 2026: 16 · 2025: 20 · 2024: 20 · 2023: 20 · 2022: 21 · 2021: 34 · 2020: 30 · 2019: 27 · 2018: 36 · 2017: 35 · 2016: 42 · 2015: 41 · 2014: 55 · 2013: 44 · 2012: 39
- FWCI
- 4.60
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- International Journal of Obesity (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Health Sciences › Medicine › Pharmacology (medical) › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- obesity, long-term weight loss, weight loss efficacy, bariatric surgery, cardiovascular risk factors, serum lipids, blood glucose, blood pressure, overweight adults
- MeSH terms
- Adolescent, Adult, Aged, Cardiovascular Diseases, Diet, Reducing, Female, Humans, Life Style, Male, Middle Aged, Obesity, Weight Loss, Randomized Controlled Trials as Topic, Anti-Obesity Agents
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