Behavioural Interventions for Obese Adults with Additional Risk Factors for Morbidity: Systematic Review of Effects on Behaviour, Weight and Disease Risk Factors

Dombrowski, Stephan U.; Avenell, Alison; Sniehott, Falko F.

doi:10.1159/000323076

Cited by 156Obesity, Physical Activity, DietObesity and Health PracticesBehavioral Health and Interventions

Behavioural Interventions for Obese Adults with Additional Risk Factors for Morbidity: Systematic Review of Effects on Behaviour, Weight and Disease Risk Factors

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Dombrowski, Stephan U., Avenell, Alison, Sniehott, Falko F.·2010·Obesity Facts

DOI 10.1159/000323076PMC PMC6515855

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Abstract

BACKGROUND: Reducing obesity through effective behaviour change interventions is of key importance to prevent disabling and life-threatening conditions, particularly in individuals already at risk for morbidity. PURPOSE: To assess the effects of behavioural interventions for obese adults with additional risk factors for morbidity on behaviour, weight and disease risk factors. METHODS: Systematic review of randomised controlled trials (RCTs). Three electronic databases and three journals were searched for behavioural interventions (aimed at changing dietary intake and/or physical activity (PA)) for adults (mean BMI ≥30 kg/m(2); mean age ≥40 years) with risk factors for morbidity, reporting follow-up data ≥12 weeks. RESULTS: 44 RCTs met the inclusion criteria. Behavioural outcomes, weight loss, and cardiovascular disease risk factors showed consistent modest improvements over time, especially for interventions targeting both diet and PA. CONCLUSION: Behavioural interventions in at-risk populations showed positive effect tendencies on behaviour, weight, and disease risk factors. However, there is still ample room for improvement, and future research should focus on identifying the most effective means of inducing dietary and PA behaviour change in this vulnerable population.

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Behavioral interventions that target improvements in diet and physical activity are an effective way to help people lose weight and decrease chronic disease risk factors.
“Behavioral interventions that target improvements in diet and physical activity are an effective way to help people lose weight and decrease chronic disease risk factors [6].”
From Tweets, Apps, and Pods: Results of the 6-Month Mobile Pounds Off Digitally (Mobile POD) Randomized Weight-Loss Intervention Among Adults (2011) · cites this paper as [6]

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Self-citation
Global Overview of the Epidemiology of Atherosclerotic Cardiovascular Disease
Barquera, S., Pedroza-Tobías, A., Medina, C., Hernández-Barrera, L., Bibbins-Domingo, K. B., Lozano, R., & Moran, A. E. (2015) · Archives of Medical Research · doi:10.1016/j.arcmed.2015.06.006 · Cited by 715 · see citing works
Effective behaviour change techniques for physical activity and healthy eating in overweight and obese adults; systematic review and meta-regression analyses
Samdal, G. B., Eide, G. E., Barth, T., Williams, G., & Meland, E. (2017) · International Journal of Behavioral Nutrition and Physical Activity · doi:10.1186/s12966-017-0494-y · Cited by 788 · see citing works
Probability of an obese person attaining normal body weight: Cohort study using electronic health records
Fildes, A., Charlton, J., Rudisill, C., Littlejohns, P., Prevost, A. T., & Gulliford, M. C. (2015) · American Journal of Public Health · doi:10.2105/ajph.2015.302773 · Cited by 394 · see citing works
“9 27 490 53 613 7 (4–12) 7 200 (26) 5 070 (18) 2 525 (9) 12 695 (46)”
BAP guidelines on the management of weight gain, metabolic disturbances and cardiovascular risk associated with psychosis and antipsychotic drug treatment
Cooper, S. J., Reynolds, G. P., order):, W. E. C.-A. (. A., Barnes, T., England, E., Haddad, P., Heald, A., Holt, R., Lingford-Hughes, A., Osborn, D., et al. (2016) · Journal of Psychopharmacology · doi:10.1177/0269881116645254 · Cited by 292 · see citing works
Tweets, Apps, and Pods: Results of the 6-Month Mobile Pounds Off Digitally (Mobile POD) Randomized Weight-Loss Intervention Among Adults
Turner-McGrievy, G., & Tate, D. (2011) · Journal of Medical Internet Research · doi:10.2196/jmir.1841 · Cited by 263 · see citing works
“Behavioral interventions that target improvements in diet and physical activity are an effective way to help people lose weight and decrease chronic disease risk factors [6].”
Background
Interventions that cause weight loss and the impact on cardiovascular risk factors: a systematic review and meta-analysis
Zomer, E., Gurusamy, K., Leach, R., Trimmer, C., Lobstein, T., Morris, S., James, W. P. T., & Finer, N. (2016) · Obesity Reviews · doi:10.1111/obr.12433 · Cited by 236 · see citing works
Aging, nutritional status and health
Leslie, W., & Hankey, C. (2015) · Healthcare · doi:10.3390/healthcare3030648 · Cited by 211 · see citing works
“A systematic review [49] which examined the effectiveness of weight management approaches in older adults found the effect of lifestyle advice and guidance in the older obese or overweight adult on body weight was maintained at around ~2 kg at both one and two years follow-up.”
Background
Cognitive behavioral therapy to aid weight loss in obese patients: current perspectives
Castelnuovo, G., Pietrabissa, G., Manzoni, G. M., Cattivelli, R., Rossi, A., Novelli, M., Varallo, G., & Molinari, E. (2017) · Psychology Research and Behavior Management · doi:10.2147/prbm.s113278 · Cited by 187 · see citing works
“2,28,42,43 44–46”
Associations of economic and gender inequality with global obesity prevalence: Understanding the female excess
Wells, J. C. K., Marphatia, A. A., Cole, T. J., & McCoy, D. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.03.029 · Cited by 186 · see citing works
Tackling obesity in knee osteoarthritis
Wluka, A. E., Lombard, C. B., & Cicuttini, F. (2012) · Nature Reviews Rheumatology · doi:10.1038/nrrheum.2012.224 · Cited by 175 · see citing works
Weight Loss and Black Women: A Systematic Review of the Behavioral Weight Loss Intervention Literature
Fitzgibbon, M. L., Tussing-Humphreys, L., Porter, J. S., Martin, I. K., Odoms-Young, A., & Sharp, L. K. (2011) · Obesity Reviews · doi:10.1111/j.1467-789x.2011.00945.x · Cited by 160 · see citing works
A meta‐analysis of overall effects of weight loss interventions delivered via mobile phones and effect size differences according to delivery mode, personal contact, and intervention intensity and duration
Schippers, M., Adam, P. C. G., Smolenski, D. J., Wong, H. T. H., & de Wit, J. B. F. (2017) · Obesity Reviews · doi:10.1111/obr.12492 · Cited by 150 · see citing works
“Also, only a small percentage of participants in non-surgical weight-loss interventions achieve long-term maintenance of weight loss (14); most people attempting to lose weight in tested interventions experienced peak weight loss at 6 months, followed by weight being regained (15,16).”
Importance of Weight Loss Maintenance and Risk Prediction in the Prevention of Type 2 Diabetes: Analysis of European Diabetes Prevention Study RCT
Penn, L., White, M. J., Lindström, J., den Boer, A. T., Blaak, E. E., Eriksson, J. G., Feskens, E. J. M., Ilanne‐Parikka, P., Keinanen-Kiukaanniemi, S. M., Walker, M., et al. (2013) · PLoS ONE · doi:10.1371/journal.pone.0057143 · Cited by 140 · see citing works
“The most efficient duration and intensity of lifestyle interventions to maintain weight loss [36] or to prevent T2D in individuals at high-risk remain uncertain.”
Background
Obesity, income and gender: The changing global relationship
Ameye, H., & Swinnen, J. (2019) · Global Food Security · doi:10.1016/j.gfs.2019.09.003 · Cited by 137 · see citing works
Health Behavior Change for Obesity Management
Teixeira, P. J., & Marques, M. M. (2017) · Obesity Facts · doi:10.1159/000484933 · Cited by 97 · see citing works
Defining Adherence to Mobile Dietary Self-Monitoring and Assessing Tracking Over Time: Tracking at Least Two Eating Occasions per Day Is Best Marker of Adherence within Two Different Mobile Health Randomized Weight Loss Interventions
Turner‐McGrievy, G. M., Dunn, C. G., Wilcox, S., Boutté, A. K., Hutto, B., Hoover, A. W., & Muth, E. R. (2019) · Journal of the Academy of Nutrition and Dietetics · doi:10.1016/j.jand.2019.03.012 · Cited by 86 · see citing works
Effect of vitamin D supplementation alone or with calcium on adiposity measures: a systematic review and meta-analysis of randomized controlled trials
Chandler, P. D., Wang, L., Zhang, X., Sesso, H. D., Moorthy, M. V., Obi, O., Lewis, J. R., Prince, R. L., Danik, J. S., Manson, J. E., et al. (2015) · Nutrition Reviews · doi:10.1093/nutrit/nuv012 · Cited by 84 · see citing works
Does self‐monitoring diet and physical activity behaviors using digital technology support adults with obesity or overweight to lose weight? A systematic literature review with meta‐analysis
Berry, R., Kassavou, A., & Sutton, S. R. (2021) · Obesity Reviews · doi:10.1111/obr.13306 · Cited by 87 · see citing works
“Evidence suggests that behavioral interventions aiming to improve physical activity and/or eating behavior have modest effects at supporting adults with obesity lose weight.(8) Although promising, these behavioral interventions require many resources, are timeconsuming, and are not easy to disseminate and implement, o…”
Background
What is habit and how can it be used to change real‐world behaviour? Narrowing the theory‐reality gap
Gardner, B., Rebar, A. L., de Wit, S., & Lally, P. J. (2024) · Social and Personality Psychology Compass · doi:10.1111/spc3.12975 · Cited by 87 · see citing works
Social networks for improving healthy weight loss behaviors for overweight and obese adults: A randomized clinical trial of the social pounds off digitally (Social POD) mobile app
Hales, S. B., Turner‐McGrievy, G. M., Wilcox, S., Fahim, A., Davis, R. E., Huhns, M. N., & Valafar, H. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.07.003 · Cited by 73 · see citing works
Obesity and outpatient rehabilitation using mobile technologies: the potential mHealth approach
Castelnuovo, G., Manzoni, G. M., Pietrabissa, G., Corti, S. P., Giusti, E. M., Molinari, E., & Simpson, S. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.00559 · Cited by 71 · see citing works
Weight outcomes audit in 1.3 million adults during their first 3 months’ attendance in a commercial weight management programme
Stubbs, R. J., Morris, L., Pallister, C., Horgan, G. W., & Lavin, J. H. (2015) · BMC Public Health · doi:10.1186/s12889-015-2225-0 · Cited by 66 · see citing works
“What is known is that certain behaviour change techniques are associated with better weight outcomes [29, 30, 74].”
Background
Small-Changes Obesity Treatment Among Veterans
Damschroder, L. J., Lutes, L. D., Kirsh, S., Kim, H. M., Gillon, L., Holleman, R. G., Goodrich, D. E., Lowery, J. C., & Richardson, C. R. (2014) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2014.06.016 · Cited by 65 · see citing works
A systematic review with meta‐analyses of text message‐delivered behaviour change interventions for weight loss and weight loss maintenance
Skinner, R., Gonet, V., Currie, S., Hoddinott, P., & Dombrowski, S. U. (2020) · Obesity Reviews · doi:10.1111/obr.12999 · Cited by 63 · see citing works
Self-citation
Long-term body mass index changes in overweight and obese adults and the risk of heart failure, cardiovascular disease and mortality: a cohort study of over 260,000 adults in the UK
Iyen, B., Weng, S. F., Vinogradova, Y., Akyea, R. K., Qureshi, N., & Kai, J. (2021) · BMC Public Health · doi:10.1186/s12889-021-10606-1 · Cited by 64 · see citing works
“3 kg weight gain at 24 months [6], and many severely obese individuals remain severely obese for at least 5 years [7].”
Background
The Impact of Shame, Self-Criticism and Social Rank on Eating Behaviours in Overweight and Obese Women Participating in a Weight Management Programme
Duarte, C., Matos, M., Stubbs, R. J., Gale, C., Morris, L., Pinto‐Gouveia, J., & Gilbert, P. (2017) · PLoS ONE · doi:10.1371/journal.pone.0167571 · Cited by 61 · see citing works
Cardiovascular diseases in mega-countries: the challenges of the nutrition, physical activity and epidemiologic transitions, and the double burden of disease
Barquera, S., Pedroza-Tobías, A., & Medina, C. (2016) · Current Opinion in Lipidology · doi:10.1097/mol.0000000000000320 · Cited by 59 · see citing works
Chronic care management of globesity: promoting healthier lifestyles in traditional and mHealth based settings
Castelnuovo, G., Pietrabissa, G., Manzoni, G. M., Corti, S. P., Ceccarini, M., Borrello, M., Giusti, E. M., Novelli, M., Cattivelli, R., Middleton, N. A., et al. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01557 · Cited by 61 · see citing works
“Borrello M, Giusti EM, Novelli M, Cattivelli R, Middleton NA, Simpson”
Background
Effectiveness of interventions aimed at improving dietary behaviours among people at higher risk of or with chronic non-communicable diseases: an overview of systematic reviews
Browne, S., Minozzi, S., Bellisario, C., Sweeney, M. R., & Susta, D. (2018) · European Journal of Clinical Nutrition · doi:10.1038/s41430-018-0327-3 · Cited by 55 · see citing works
“Overweight and obese populations One review reported improvements in dietary behaviours in most studies examined (33 of 44 studies), which tended to be greatest at around 6 months [27].”
BackgroundInfluential
Evaluating the Maintenance of Lifestyle Changes in a Randomized Controlled Trial of the ‘Get Healthy, Stay Healthy’ Program
Fjeldsoe, B., Goode, A. D., Phongsavan, P., Bauman, A., Maher, G., Winkler, E., & Eakin, E. G. (2016) · JMIR mHealth and uHealth · doi:10.2196/mhealth.5280 · Cited by 39 · see citing works
“Maintaining improvements in weight and related behaviors following the end of interventions is challenging [3-9].”
Influential
General practitioner opinion of weight management interventions in New Zealand
Claridge, R., Gray, L., Stubbe, M. H., Macdonald, L., Tester, R., & Dowell, A. C. (2014) · Journal of Primary Health Care · doi:10.1071/hc14212 · Cited by 54 · see citing works
N-of-1 study of weight loss maintenance assessing predictors of physical activity, adherence to weight loss plan and weight change
Kwaśnicka, D., Dombrowski, S. U., White, M. J., & Sniehotta, F. F. (2017) · Psychology and Health · doi:10.1080/08870446.2017.1293057 · Cited by 48 · see citing works
Self-citation
Effectiveness of Interventions for Changing More Than One Behavior at a Time to Manage Chronic Conditions: A Systematic Review and Meta-analysis
Silva, C. C., Presseau, J., van Allen, Z., Schenk, P. M., Moreto, M., Dinsmore, J. G., & Marques, M. M. (2024) · Annals of Behavioral Medicine · doi:10.1093/abm/kaae021 · Cited by 52 · see citing works
“Interestingly, a systematic review of randomized controlled trials in adults with obesity revealed that focusing on a single behavior yielded greater long-term effects on behavior change, whereas targeting both diet and physical activity together resulted in greater long-term weight loss [36].”
Background
The challenges of implementing behaviour changes that lead to sustained weight management
Stubbs, R. J., & Lavin, J. (2013) · Nutrition Bulletin · doi:10.1111/nbu.12002 · Cited by 48 · see citing works
Do humans still forage in an obesogenic environment? Mechanisms and implications for weight maintenance
Brunstrom, J. M., & Cheon, B. K. (2018) · Physiology & Behavior · doi:10.1016/j.physbeh.2018.02.038 · Cited by 46 · see citing works
Effectiveness of extended contact interventions for weight management delivered via text messaging: a systematic review and meta-analysis
Job, J. R., Fjeldsoe, B. S., Eakin, E. G., & Reeves, M. M. (2018) · Obesity Reviews · doi:10.1111/obr.12648 · Cited by 41 · see citing works
“Best practice supports weight management interventions, which target diet and physical activity behaviour (51).”
Background
Optimizing acceptability and feasibility of an evidence-based behavioral intervention for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: An open-pilot intervention study in secondary care
Dombrowski, S. U., Sniehotta, F. F., Johnston, M., Broom, I., Kulkarni, U., Brown, J., Murray, L., & Araújo-Soares, V. (2012) · Patient Education and Counseling · doi:10.1016/j.pec.2011.08.003 · Cited by 33 · see citing works
“The current intervention is relatively brief in comparison to other interventions in this domain [12,32].”
ResultSelf-citation
A Paleolithic-type diet results in iodine deficiency: a 2-year randomized trial in postmenopausal obese women
Manousou, S., Stål, M., Larsson, C. L., Mellberg, C., Lindahl, B., Eggertsen, R., Hulthén, L., Olsson, T., Ryberg, M., Sandberg, S., et al. (2017) · European Journal of Clinical Nutrition · doi:10.1038/ejcn.2017.134 · Cited by 36 · see citing works
The NoHoW protocol: a multicentre 2×2 factorial randomised controlled trial investigating an evidence-based digital toolkit for weight loss maintenance in European adults
Scott, S., Duarte, C., Encantado, J., Evans, E. H., Harjumaa, M., Heitmann, B. L., Horgan, G. W., Larsen, S. C., Marques, M. M., Mattila, E., et al. (2019) · BMJ Open · doi:10.1136/bmjopen-2019-029425 · Cited by 36 · see citing works
Association of magnitude of weight loss and weight variability with mortality and major cardiovascular events among individuals with type 2 diabetes mellitus: a systematic review and meta-analysis
Huang, S., Shi, K., Ren, Y., Wang, J., Yan, W., Qian, W., Yang, Z., & Li, Y. (2022) · Cardiovascular Diabetology · doi:10.1186/s12933-022-01503-x · Cited by 35 · see citing works
“Furthermore, studies have shown that following behavioural interventions, the body weight typically declines sharply during the first few months, followed by weight regain over the subsequent months to years [42].”
Background
The Risks of Cardiovascular Disease and Mortality Following Weight Change in Adults with Diabetes: Results from ADVANCE
Lee, A. K., Woodward, M., Wang, D., Ohkuma, T., Warren, B., Sharrett, A. R., Williams, B., Marre, M., Hamet, P., Harrap, S. B., et al. (2019) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/clinem/dgz045 · Cited by 33 · see citing works
Costs and outcomes of increasing access to bariatric surgery for obesity: cohort study and cost-effectiveness analysis using electronic health records
Gulliford, M. C., Charlton, J., Booth, H., Fildes, A., Khan, O. A., Reddy, M., Ashworth, M. J., Littlejohns, P., Prevost, A. T., & Rudisill, C. (2016) · Health Services and Delivery Research · doi:10.3310/hsdr04170 · Cited by 32 · see citing works
Do more specific plans help you lose weight? Examining the relationship between plan specificity, weight loss goals, and plan content in the context of a weight management programme
Dombrowski, S. U., Endevelt, R., Steinberg, D. M., & Benyamini, Y. (2016) · British Journal of Health Psychology · doi:10.1111/bjhp.12212 · Cited by 31 · see citing works
Self-citation
Occupational problems and barriers reported by individuals with obesity
Nossum, R., Johansen, A.-E., & Kjeken, I. (2017) · Scandinavian Journal of Occupational Therapy · doi:10.1080/11038128.2017.1279211 · Cited by 31 · see citing works
Primary health care-level interventions targeting health literacy and their effect on weight loss: a systematic review
Faruqi, N., Spooner, C., Joshi, C., Lloyd, J. E., Dennis, S. M., Stocks, N., Taggart, J., & Harris, M. (2015) · BMC Obesity · doi:10.1186/s40608-015-0035-7 · Cited by 30 · see citing works
“This review reinforces earlier systematic reviews’ findings which support the efficacy of combining both dietary and PA interventions together with behaviour modification [34,35].”
Result
Feasibility, acceptability and outcomes at a 12-month follow-up of a novel community-based intervention to prevent type 2 diabetes in adults at high risk: mixed methods pilot study
Penn, L., Ryan, V., & White, M. J. (2013) · BMJ Open · doi:10.1136/bmjopen-2013-003585 · Cited by 31 · see citing works
Modelling multiple health behavior change with network analyses: results from a one-year study conducted among overweight and obese adults
Chevance, G., Golaszewski, N. M., Baretta, D., Hekler, E. B., Larsen, B. A., Patrick, K., & Godino, J. (2020) · Journal of Behavioral Medicine · doi:10.1007/s10865-020-00137-2 · Cited by 29 · see citing works
Metabolic syndrome in patients with schizophrenia: Underlying mechanisms and therapeutic approaches (Review)
Manta, A., Georganta, A., Roumpou, A., Zoumpourlis, V., Spandidos, D. A., Rizos, E. N., & Peppa, Μ. (2025) · Molecular Medicine Reports · doi:10.3892/mmr.2025.13479 · Cited by 38 · see citing works
A Randomised Trial of a Weight Loss Intervention for Overweight and Obese People Diagnosed with Coronary Heart Disease and/or Type 2 Diabetes
Gallagher, R. D., Kirkness, A., Zelestis, E., Hollams, D., Kneale, C., Armari, E., Bennett, T., Daly, J., & Tofler, G. H. (2012) · Annals of Behavioral Medicine · doi:10.1007/s12160-012-9369-2 · Cited by 28 · see citing works
The combination effects of body acupuncture and auricular acupressure compared to sham acupuncture for body weight control: study protocol for a randomized controlled trial
Zhong, L. L. D., Kun, W., Lam, T. F., et al. (2016) · Trials · doi:10.1186/s13063-016-1458-2 · Cited by 27 · see citing works
“The weight control treatments commonly used nowadays include behavioural intervention, dietary intervention and physical activity, which require a higher level of self-discipline and take up to 6 months or longer to achieve significant weight change [4]; surgery like the duodenal–jejunal bypass liner, which may cause…”
Background
Weight loss maintenance: An agenda for health psychology
Sniehotta, F. F., Simpson, S. A., & Greaves, C. J. (2014) · British Journal of Health Psychology · doi:10.1111/bjhp.12107 · Cited by 26 · see citing works
Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program
Resman, F. (2020) · Therapeutic Advances in Infectious Disease · doi:10.1177/2049936120933187 · Cited by 28 · see citing works
Obesity and Associated Lifestyle in a Large Sample of Multi-Morbid German Primary Care Attendees
Sikorski, C., Luppa, M., Weyerer, S. B., König, H., Maier, W., Schön, G., Petersen, J. J., Gensichen, J. S., Fuchs, Â., Bickel, H., et al. (2014) · PLoS ONE · doi:10.1371/journal.pone.0102587 · Cited by 26 · see citing works
“Research has shown that this kind of at-risk population benefits from behavioral interventions as well but studies on obesity and lifestyle in this population are lacking up to this date [12].”
Background
Byte by bite: Use of a mobile Bite Counter and weekly behavioral challenges to promote weight loss
Turner‐McGrievy, G. M., Boutté, A. K., Crimarco, A. E., Wilcox, S., Hutto, B., Hoover, A. W., & Muth, E. R. (2017) · Smart Health · doi:10.1016/j.smhl.2017.03.004 · Cited by 26 · see citing works
The use of crowdsourcing for dietary self-monitoring: crowdsourced ratings of food pictures are comparable to ratings by trained observers
Turner‐McGrievy, G. M., Helander, E. E., Kaipainen, K., Perez-Macias, J. M., & Korhonen, I. (2014) · Journal of the American Medical Informatics Association · doi:10.1136/amiajnl-2014-002636 · Cited by 24 · see citing works
The Impact of Self-Criticism and Self-Reassurance on Weight-Related Affect and Well-Being in Participants of a Commercial Weight Management Programme
Duarte, C., Stubbs, R. J., Pinto‐Gouveia, J., Matos, M., Gale, C., Morris, L., & Gilbert, P. (2017) · Obesity Facts · doi:10.1159/000454834 · Cited by 24 · see citing works
Multi-component weight-loss interventions for people with cardiovascular disease and/or type 2 diabetes mellitus: a systematic review
Gallagher, R. D., Armari, E., White, H., & Hollams, D. (2013) · European Journal of Cardiovascular Nursing · doi:10.1177/1474515112471002 · Cited by 24 · see citing works
Understanding the impact of rural weight loss interventions: A systematic review and meta‐analysis
Porter, G. C., Laumb, K., Michaud, T. L., Brito, F., Petreça, D. R., Schwieger, G., Bartee, T., Yeary, K. H. K., & Estabrooks, P. A. (2019) · Obesity Reviews · doi:10.1111/obr.12825 · Cited by 23 · see citing works
The NULevel trial of a scalable, technology-assisted weight loss maintenance intervention for obese adults after clinically significant weight loss: study protocol for a randomised controlled trial
Evans, E. H., Araújo‐Soares, V., Adamson, A., Batterham, A. M., Brown, H., Campbell, M., Dombrowski, S. U., Guest, A., Jackson, D., Kwaśnicka, D., et al. (2015) · Trials · doi:10.1186/s13063-015-0931-7 · Cited by 23 · see citing works
“Behavioural weight loss interventions typically produce initial, clinically significant weight loss [4, 5] and such evidence-based interventions are now widely available [6].”
BackgroundSelf-citation
Do Personalized Nutrition Interventions Improve Dietary Intake and Risk Factors in Adults With Elevated Cardiovascular Disease Risk Factors? A Systematic Review and Meta-analysis of Randomized Controlled Trials
Cross, V., Stanford, J., Gómez‐Martín, M., Collins, C. E., Robertson, S., & Clarke, E. D. (2024) · Nutrition Reviews · doi:10.1093/nutrit/nuae149 · Cited by 23 · see citing works
“…long term, as well as its long-term impacts on cardiometabolic and anthropometric outcomes, as seen in the systematic review by Dombrowski et al. 53 Longer intervention periods would also provide interventionists with greater opportunities to review and reinforce dietary advice to promote…”
Trading pounds for points: Engagement and weight loss in a mobile health intervention
Hales, S. B., Turner‐McGrievy, G. M., Wilcox, S., Davis, R. E., Fahim, A., Huhns, M. N., & Valafar, H. (2017) · Digital Health · doi:10.1177/2055207617702252 · Cited by 21 · see citing works
“Interventions developed using health behavior theories to improve diet and physical activity (PA) have been successful in promoting weight loss.(2) Mobile health (mHealth), the use of mobile technology (e.”
Background
A Role for Behavior in the Relationships Between Depression and Hostility and Cardiovascular Disease Incidence, Mortality, and All-Cause Mortality: the Prime Study
for the PRIME study group, Appleton, K. M., Woodside, J. V., Arveiler, D., Haas, B., Amouyel, P., Montaye, M., Ferrières, J., Ruidavets, J., YARNELL, J. W. G., et al. (2016) · Annals of Behavioral Medicine · doi:10.1007/s12160-016-9784-x · Cited by 20 · see citing works
Effect of adding a compassion-focused intervention on emotion, eating and weight outcomes in a commercial weight management programme
Duarte, C., Gilbert, P., Stalker, C. A., Catarino, F., Basran, J., Scott, S. E., Horgan, G., & Stubbs, R. (2019) · Journal of Health Psychology · doi:10.1177/1359105319890019 · Cited by 23 · see citing works
“Avoiding weight regain requires behavioural strategies in which relapse coping and weight loss maintenance (WLM) become learned skills of self-regulation, action planning, developing self-efficacy, autonomy and motivation (Dombrowski et al., 2010; Sniehotta”
Background
Randomised Controlled Feasibility Trial of an Evidence-Informed Behavioural Intervention for Obese Adults with Additional Risk Factors
Sniehotta, F. F., Dombrowski, S. U., Avenell, A., Johnston, M., McDonald, S., Murchie, P., Ramsay, C. R., Robertson, K., & Araújo‐Soares, V. (2011) · PLoS ONE · doi:10.1371/journal.pone.0023040 · Cited by 19 · see citing works
Self-citation
Obesity as a Growing Public Health Problem
Çakmur, H. (2017) · InTech eBooks · doi:10.5772/65718 · Cited by 19 · see citing works
Reward-related decision making and long-term weight loss maintenance
Brockmeyer, T., Simon, J. J., Becker, A., & Friederich, H.-C. (2017) · Physiology & Behavior · doi:10.1016/j.physbeh.2017.09.008 · Cited by 17 · see citing works
A Mixed-Methods Approach to the Development, Refinement, and Pilot Testing of Social Networks for Improving Healthy Behaviors
Hales, S. B., Turner‐McGrievy, G. M., Fahim, A., Freix, A., Wilcox, S., Davis, R. E., Huhns, M. N., & Valafar, H. (2016) · JMIR Human Factors · doi:10.2196/humanfactors.4512 · Cited by 17 · see citing works
“Behavioral interventions that target improvements in diet and physical activity are effective ways to help people lose weight and decrease chronic disease risk factors [6].”
Background
The H2020 “NoHoW Project”: A Position Statement on Behavioural Approaches to Longer-Term Weight Management
Stubbs, R. J., Duarte, C., O’Driscoll, R., Turicchi, J., Kwaśnicka, D., Sniehotta, F. F., Marques, M. M., Horgan, G. W., Larsen, S. C., Palmeira, A. L., et al. (2021) · Obesity Facts · doi:10.1159/000513042 · Cited by 17 · see citing works
Developing evidence-based behavioural strategies to overcome physiological resistance to weight loss in the general population
Stubbs, R. J., Duarte, C., O’Driscoll, R., Turicchi, J., & Michałowska, J. M. (2019) · Proceedings of The Nutrition Society · doi:10.1017/s0029665119001083 · Cited by 16 · see citing works
Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project
Stubbs, R. J., Duarte, C., Palmeira, A. L., Sniehotta, F. F., Horgan, G. W., Larsen, S. C., Marques, M. M., Evans, E. H., Ermes, M., Harjumaa, M., et al. (2021) · Obesity Facts · doi:10.1159/000515663 · Cited by 15 · see citing works
“Evidence suggests that core features of more effective WLM interventions include behaviour change techniques such as self-monitoring (of weight and behaviour), relapse prevention, goal setting, and action plans for diet and physical activity, which improve self-efficacy [44, 58, 63].”
Background
Approach bias modification training to increase physical activity: A pilot randomized controlled trial in healthy volunteers
Preis, M. A., Zellerhoff, M., & Brockmeyer, T. (2020) · Journal of Health Psychology · doi:10.1177/1359105320913936 · Cited by 13 · see citing works
“In the short term, behavioral interventions that include food intake modification and PA enhancement are effective resulting in significant although little weight reduction (Dombrowski et al., 2010).”
Background
Using a holistic health approach to achieve weight-loss maintenance: results from the Spirited Life intervention
Proeschold‐Bell, R. J., Steinberg, D., Yao, J., Eagle, D. E., Smith, T. W., Cai, G. Y., & Turner, E. L. (2018) · Translational Behavioral Medicine · doi:10.1093/tbm/iby117 · Cited by 13 · see citing works
“Maximum weight losses from behavioral interventions commonly occur at around 6 months, with participants gradually regaining their weight thereafter [8,9].”
Background
The effects of contemporary behavioural weight loss maintenance interventions for long term weight loss: A systematic review
Gilmartin, J., & Murphy, M. (2015) · Journal of Research in Nursing · doi:10.1177/1744987115599671 · Cited by 11 · see citing works
“There is evidence from systematic reviews that suggests behavioural change in relation to eating, physical activity and lifestyle can support a person in maintaining weight loss (Avenell et al., 2004; Dombrowski et al., 2010).”
Background
Low Social Capital as a Predictor for the Risk of Obesity
Muckenhuber, J., Dorner, T. E., Burkert, N. T., et al. (2015) · Health & Social Work · doi:10.1093/hsw/hlv019 · Cited by 12 · see citing works
Health action process approach: promoting physical activity, and fruit and vegetable intake among Australian adults
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“Consequently, the effectiveness of large-scale initiatives often varies (Dombrowski et al. , 2010) and sustaining a newly adopted health behaviour is often difficult for most people (Hills et al. , 2014).”
Background
The Role of Diet in the Cardiovascular Health of Childhood Cancer Survivors—A Systematic Review
Li, R. K., BARKER, A. R., Vlachopoulos, D., Paris, D., Schindera, C., Belle, F. N., & Iniesta, R. R. (2024) · Nutrients · doi:10.3390/nu16091315 · Cited by 12 · see citing works
“Finally, populations were mostly North American and European, with limited diversity, and survivors predominately comprised ALL patients, reducing generalizability to other diagnoses.”
Background
Relationship of social capital with overweight and obesity among female health care workers.
Firouzbakht, M., Riahi, M. E., Hajian‐Tilaki, K., Ebadi, A., Tirgar, A., & Nikpour, M. (2019) · PubMed Central · doi:10.22088/cjim.10.3.281 · Cited by 11 · see citing works
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Electro-acupuncture for central obesity: randomized, patient-assessor blinded, sham-controlled clinical trial protocol
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“Previous studies showed that lifestyle changes include behavioral therapies, diet changes, and physical exercise, which require high self-discipline and need to implement at leaset 6 months or more to achieve significant improvements [19, 20] on body weight control.”
Background
Text messaging and financial incentives to encourage weight loss in men with obesity: the Game of Stones feasibility RCT
Dombrowski, S. U., McDonald, M., Pol, M. M. V. D., Grindle, M., Avenell, A., Carroll, P., Calveley, E., Elders, A., Glennie, N., Gray, C. M., et al. (2020) · Public Health Research · doi:10.3310/phr08110 · Cited by 12 · see citing works
Self-citation
The Effect of a Lifestyle-Based Training Package on Weight Gain and Frequency of Gestational Diabetes in Obese and Overweight Pregnant Females
Eslami, E., Mohammad‐Alizadeh‐Charandabi, S., Khalili, A. F., Jafarabadi, M. A., & Mirghafourvand‬‬‬‬‬‬‬‬‬‬‬‬‬‬, M. (2018) · Iranian Red Crescent Medical Journal · doi:10.5812/ircmj.62576 · Cited by 10 · see citing works
“It has further been proposed that congenital anomalies, such as spina-bifida, cardiovascular abnormalities, cleft lip and palate and finger anomalies, are more likely in females with an abnormal BMI compared to females with a normal weight, and the likelihood of delayed onset of spontaneous breath- Copyright © 2018, I…”
BackgroundInfluential
Influence on Adiposity and Atherogenic Lipaemia of Fatty Meals and Snacks in Daily Life
Laguna‐Camacho, A. (2017) · Journal of Lipids · doi:10.1155/2017/1375342 · Cited by 10 · see citing works
Individual’s awareness of healthy lifestyle: A cross sectional study of a rural community in Kedah, Malaysia
Fernandez, K., Kharkwal, K. C., Afrose, T., et al. (2019) · Journal of Biomedical Sciences · doi:10.3126/jbs.v6i2.26812 · Cited by 9 · see citing works
“Page | 6 Some studies recommended that behavioral interventions should be targeted to both the healthy diet and regular physical activities for the betterment of life and to prevent overweight and obesity [21, 22].”
Background
Is It Time to Rethink Our Weight Loss Paradigms?
Gentil, P., Viana, R. B., Naves, J. P. A., Vecchio, F. B. D., Coswig, V. S., Loenneke, J. P., & de Lira, C. A. B. (2020) · Biology · doi:10.3390/biology9040070 · Cited by 9 · see citing works
Theory-based digital intervention to promote weight loss and weight loss maintenance (Choosing Health): protocol for a randomised controlled trial
Kwaśnicka, D., Łuszczyńska, A., Hagger, M. S., Quested, E., Pagoto, S., Verboon, P., Robinson, S., Januszewicz, A., Idziak, P., Palacz-Poborczyk, I., et al. (2020) · BMJ Open · doi:10.1136/bmjopen-2020-040183 · Cited by 8 · see citing works
Semi-automated system for predicting calories in photographs of meals
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“There is very limited data available in regards to assessing the long-term use of interventions in regards to managing obesity in children [9, 10].”
Background
Obesity and mitochondrial uncoupling – an opportunity for the carbon monoxide-based pharmacology of metabolic diseases
Danielak, A., & Magierowski, M. (2025) · Pharmacological Research · doi:10.1016/j.phrs.2025.107741 · Cited by 9 · see citing works
Obesity and Female Reproductive Health; Is There a Role for Glucagon‐Like Peptide‐1 Receptor Agonists?
Roberts, R. L., Markande, A., Kasaven, L. S., Chieveley-Williams, S., Faris, R., Bracewell‐Milnes, T., Thum, Y., Nicopoullos, J. D. M., & Jones, B. P. (2025) · Obesity Reviews · doi:10.1111/obr.70015 · Cited by 8 · see citing works
Construct validation of the Portuguese version of the Restraint Scale
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Supporting the transition from weight loss to maintenance: development and optimisation of a face-to-face behavioural intervention component
Sainsbury, K., Cleland, C., Evans, E. H., Adamson, A., Batterham, A. M., Dombrowski, S. U., Gellert, P. R., Hill, M., Kwaśnicka, D., Scott, D., et al. (2016) · Health Psychology and Behavioral Medicine · doi:10.1080/21642850.2016.1269233 · Cited by 8 · see citing works
Self-citation
BWHealthy Weight Pilot Study: A randomized controlled trial to improve weight-loss maintenance using deposit contracts in the workplace
Cleveland, L. P., Seward, M. W., Simon, D., Rifas‐Shiman, S. L., Lewis, K. H., Bennett-Rizzo, C., Halperin, F., McManus, K. D., & Block, J. P. (2020) · Preventive Medicine Reports · doi:10.1016/j.pmedr.2020.101061 · Cited by 8 · see citing works
“Weight-loss often plateaus after six months of a behavioral intervention and is typically followed by a period of gradual weight regain (Avenell et al., 2004; Dombrowski et al., 2010).”
Background
Continuous quality improvement at the frontline: One interdisciplinary clinical team's four‐year journey after completing a virtual learning program
Robinson, C., Thompto, A. J., Lima, E. N., & Damschroder, L. J. (2022) · Learning Health Systems · doi:10.1002/lrh2.10345 · Cited by 6 · see citing works
Developing the "Choosing Health" Digital Weight Loss and Maintenance Intervention: Intervention Mapping Study
Palacz-Poborczyk, I., Idziak, P., Januszewicz, A., Łuszczyńska, A., Quested, E., Naughton, F., Hagger, M. S., Pagoto, S., Verboon, P., Robinson, S., et al. (2022) · Journal of Medical Internet Research · doi:10.2196/34089 · Cited by 7 · see citing works
“The 6 steps and related tasks of the Intervention Mapping process are described in the following sections and summarized in Multimedia Appendix 1 [9,18,33,36-38].”
Method
An evaluation of a multi-component adult weight management on referral intervention in a community setting
Birnie, K., Thomas, L., Fleming, C., Phillips, S. M., Sterne, J. A. C., Donovan, J., & Craig, J. (2016) · BMC Research Notes · doi:10.1186/s13104-016-1901-1 · Cited by 7 · see citing works
“Systematic reviews of RCTs have demonstrated that calorie restricted diets alone are more effective for weight loss than physical activity alone [20–22].”
Background
Effect of education and counseling on anthropometric measures and healthy lifestyle behavior among overweight and obese women
Cingil, D., & Göger, S. (2019) · Translational Behavioral Medicine · doi:10.1093/tbm/ibz084 · Cited by 8 · see citing works
Study protocol: behaviour change intervention to promote healthy diet and physical activity in overweight/obese adults with diabetes attending health care facilities in Muscat: a cluster rendomised control trial
Ghafri, T. A., Anwar, H., Hinai, E. A., Harthi, T. A., Jufaili, F. A., Siyabi, R. A., Harthi, S. A., Hasani, S. A., Harthi, M. A., & Harthi, S. A. (2021) · BMC Public Health · doi:10.1186/s12889-021-11549-3 · Cited by 6 · see citing works
“Incorporating behavior change techniques (BCTs) in PA interventions has been shown to effectively move individuals from ‘inactive’ to ‘active’ stages of change for PA [27] and in weight management [28].”
Method
Characterizing behavior change techniques used in the self-management of binge eating and weight: Applying a user-centered design approach
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Effect of instruction and experience on students’ learning strategies
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“…generally more receptive to shifts in behavior when they are shown rather than told, while, at the same time, explicitly addressing misconceptions that direct experience with more effective strategies often produces (e.g., Carpenter et al., 2013; Curioni & Lourenco, 2005; Dombrowski et al., 2010).”
Pilot evaluation of a personalized commercial program on weight loss, health outcomes, and quality of life
Hales, S. B., LaFata, E. M., Turner, T. F., Malcolm, R. J., Wojtanowski, A. C., Rethorst, C. D., Pinto, A. M., Foster, G. D., & O'Neil, P. M. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab110 · Cited by 6 · see citing works

OP109 Multiple risk behaviour interventions in overweight and obese adults: systematic review and meta-analysis
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The systematic development of a behaviour change intervention for obese adults with additional risk factors
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Self-citation
Behavioral lifestyle interventions for moderate and severe obesity: A systematic review
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The effectiveness of behavioural interventions in obese adults with additional risk factors – findings from a systematic review
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Self-citation
Identifying active ingredients in complex behavioural interventions for obese adults with obesity-related co-morbidities or additional risk factors for co-morbidities: a systematic review
Dombrowski, S. U., Sniehotta, F. F., Avenell, A., Johnston, M., MacLennan, G., & Araújo-Soares, V. (2012) · Health Psychology Review · doi:10.1080/17437199.2010.513298 · Cited by 504 · see citing works
Self-citation

Authors: Dombrowski, S. U., Avenell, A., & Sniehott, F. F.
Affiliations: University of Aberdeen (GB)
ORCID: Dombrowski, Stephan U.
Avenell, Alison
Venue: Obesity Facts
Publisher: S. Karger AG
Published: 2010
Volume: 3
Issue: 6
Pages: 377-396
ISSN: 1662-4025 (ISSN-L)
1662-4033
DOI: 10.1159/000323076
PMC: PMC6515855
OpenAlex: W2019706121
Semantic Scholar: aa9cff551fb09354d78fb1f42971a4275c3e192e
Cited by: 156
References: 77
Citations by year: 2026: 6 · 2025: 6 · 2024: 9 · 2023: 6 · 2022: 9 · 2021: 19 · 2020: 12 · 2019: 11 · 2018: 5 · 2017: 17 · 2016: 16 · 2015: 15 · 2014: 10 · 2013: 5 · 2012: 4
FWCI: 0.64
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Obesity Facts (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Aberdeen University Research Archive (Aberdeen University) (submittedVersion)
Newcastle University ePrints (Newcastle Univesity)
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Health Sciences › Health Professions › Pharmacy › Obesity and Health Practices
Social Sciences › Psychology › Applied Psychology › Behavioral Health and Interventions
Keywords: obesity, behavioral interventions, adults, comorbid risk factors, weight loss, dietary behavior change, physical activity, cardiovascular risk factors, diet and exercise intervention
MeSH terms: Adult, Aged, Behavior Therapy, Body Weight, Cardiovascular Diseases, Feeding Behavior, Female, Humans, Male, Middle Aged, Obesity, Risk Factors, Time Factors, Randomized Controlled Trials as Topic, Treatment Outcome, Risk Assessment, Evidence-Based Medicine

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Behavioural Interventions for Obese Adults with Additional Risk Factors for Morbidity: Systematic Review of Effects on Behaviour, Weight and Disease Risk Factors

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