Environmental risk factors and nonpharmacological and nonsurgical interventions for obesity: An umbrella review of meta-analyses of cohort studies and randomized controlled trials.
Por:
Solmi M, Köhler CA, Stubbs B, Koyanagi A, Bortolato B, Monaco F, Vancampfort D, Machado MO, Maes M, Tzoulaki I, Firth J, Ioannidis JPA and Carvalho AF
Publicada:
1 dic 2018
Ahead of Print:
13 jul 2018
Resumen:
BACKGROUND: Multiple environmental factors have been implicated in obesity, and multiple interventions, besides drugs and surgery, have been assessed in obese patients. Results are scattered across many studies and meta-analyses, and they often mix obese and overweight individuals. MATERIALS AND METHODS: PubMed and Cochrane Database of Systematic Reviews were searched through 21 January 2017 for meta-analyses of cohort studies assessing environmental risk factors for obesity, and randomized controlled trials investigating nonpharmacological and nonsurgical therapeutic interventions for obesity. We excluded data on overweight participants. Evidence from observational studies was graded according to criteria that included the statistical significance of the random-effects summary estimate and of the largest study in a meta-analysis, the number of obesity cases, heterogeneity between studies, 95% prediction intervals, small-study effects and excess significance. The evidence of intervention studies for obesity was assessed with the GRADE framework. RESULTS: Fifty-four articles met eligibility criteria, including 26 meta-analyses of environmental risk factors (166 studies) and 46 meta-analyses of nondrug, nonsurgical interventions (206 trials). In adults, the only risk factor with convincing evidence was depression, and childhood obesity, adolescent obesity, childhood abuse and short sleep duration had highly suggestive evidence. Infancy weight gain during the first year of life, depression and low maternal education had convincing evidence for association with paediatric obesity. All interventions had low or very-low-quality evidence with one exception of moderate-quality evidence for one comparison (no differences in efficacy between brief lifestyle primary care interventions and other interventions for paediatric obesity). Summary effect sizes were mostly small across compared interventions (maximum 5.1 kg in adults and 1.78 kg in children) and even these estimates may be inflated. CONCLUSIONS: Depression, obesity in earlier age groups, short sleep duration, childhood abuse and low maternal education have the strongest support among proposed risk factors for obesity. Furthermore, there is no high-quality evidence to recommend treating obesity with a specific nonpharmacological and nonsurgical intervention among many available, and whatever benefits in terms of magnitude of weight loss appear small.
Filiaciones:
Solmi M:
Department of Neurosciences, University of Padova, Padova, Italy
Köhler CA:
Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
Stubbs B:
Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
Faculty of Health, Social Care and Education, Anglia Ruskin University, Chelmsford, UK
Koyanagi A:
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujadas, 42, Sant Boi de Llobregat, Barcelona, 08830, Spain
Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5 Pabellón 11, Madrid, 28029, Spain
Bortolato B:
Department of Mental Health ULSS 10 Veneto Orientale, Venice, Italy
Monaco F:
Department of Neurosciences, University of Padova, Padova, Italy
Vancampfort D:
Department of Rehabilitation Sciences, KU Leuven, University of Leuven, Leuven, Belgium
University Psychiatric Centre, KU, Leuven
University of Leuven, Leuven-Kortenberg, Belgium
Machado MO:
Department of Clinical Medicine and Translational Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
Maes M:
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
IMPACT Strategic Research Center, Deakin University, Geelong, Australia
Tzoulaki I:
Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, W2 1PG, UK
MRC-PHE Centre for Environment, School of Public Health, Imperial College London, London, W2 1PG, UK
Department of Hygiene and Epidemiology, University of Ioannina Medical School, Ioannina, Greece
Firth J:
NICM, School of Science and Health, University of Western Sydney, Sydney, Australia
Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
Ioannidis JPA:
Department of Medicine, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, 94305, USA
Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, 94305, USA
Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, CA, 94305, USA
Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, 94305, USA
Carvalho AF:
Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
Centre for Addiction Mental Health (CAMH), Toronto, ON, M6J 1H4, Canada
Bronze, Green Published
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