Impact of weight loss interventions on patient-reported outcomes in overweight and obese adults with type 2 diabetes: a systematic review

Abstract

Previous reviews explored weight loss-induced metabolic changes in overweight and obese adults with type 2 diabetes (T2D) but did not report on the impact on patient-reported outcomes (PROs). This systematic review investigated the effect of weight loss interventions on weight loss and PROs in overweight and obese adults with T2D. We searched three electronic databases from inception to March 2018 for randomised controlled trials (RCTs) of weight loss interventions in overweight and obese (according to BMI) adults aged ≥ 18 years reporting changes in PROs from baseline to at least one follow-up assessment during or post-intervention. One reviewer screened abstracts, performed data extraction, and conducted the narrative synthesis, with 25% cross-checking by a second reviewer. We extracted data relating to sample characteristics, intervention and comparison conditions, weight loss, and change in PROs. We identified 540 papers of which 23 met eligibility reporting on 19 RCTs. Four types of interventions (diet, surgery, pharmacological, and multi-component lifestyle interventions) significantly reduced weight. Weight loss was consistently associated with improvements in sexual and physical function across all intervention types, with diet and multi-component lifestyle interventions producing more substantial improvements than surgical or pharmacological interventions. Findings for other PROs, such as HRQOL and depressive symptoms, were inconsistent across studies and intervention types. The four weight loss interventions can be prescribed to engender weight loss in overweight and obese adults with T2D, with multi-component lifestyle interventions generating substantial improvements in physical and sexual function, perhaps due to the potency of exercise in improving PROs.

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Correspondence to Claudia Rutherford.

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Appendices

Appendix 1: Search strategy terms

Weight

  1. 1.

    Obesity.ti,ab,mp

  2. 2.

    Obese.ti,ab

  3. 3.

    BMI.ti,ab

  4. 4.

    (body mass index).ti,ab

  5. 5.

    Overweight.ti,ab

  6. 6.

    Or/1–5

Diabetes

  1. 7.

    Diabetes.ti,ab,mp

  2. 8.

    Diabetic.ti,ab

  3. 9.

    Or/7–8

PROs

  1. 10.

    (patient reported outcome* or PRO or PROM).ti,ab

  2. 11.

    ((quality adj1 life) or QOL or HRQOL or HRQL or HQL or HQOL).ti,ab

  3. 12.

    pain.ti,ab

  4. 13.

    sleep. ti,ab

  5. 14.

    distress.ti,ab

  6. 15.

    depression.ti,ab

  7. 16.

    anxiety.ti,ab

  8. 17.

    (physical function*).ti,ab

  9. 18.

    Physical activit*.ti,ab

  10. 19.

    Social activit*.ti,ab

  11. 20.

    Daily activit*.ti,ab

  12. 21.

    Social function*.ti,ab

  13. 22.

    Isolation.ti,ab

  14. 23.

    (body image).ti,ab

  15. 24.

    sexual*.ab,ti

  16. 25.

    (fatigue or tired*).ab,ti

  17. 26.

    (appetite or satiety or satiate*).ab,ti

  18. 27.

    or/10–26

Weight change outcomes

  1. 28.

    (weight loss).ab,ti

  2. 29.

    (weight reduction*).ab,ti

  3. 30.

    (weight chang*).ab,ti

  4. 31.

    (weight loss intervention*).ab,ti

  5. 32.

    (weight loss program*).ab,ti

  6. 33.

    Or/28–32

Trial design

  1. 34.

    (clinical trial*).sh,ab,ti

  2. 35.

    (randomi$ed controlled trial or controlled clinical trial).pt

  3. 36.

    (randomi$ed or randomly).ab

  4. 37.

    or/34–36

Exclusions terms

  1. 38.

    p$ediatric.ti,ab

  2. 39.

    (children or child or infant).ti,ab

  3. 40.

    Childhood.ti,ab

  4. 41.

    Youth.ti,ab

  5. 42.

    Adolescent*.ti,ab

  6. 43.

    animal*.mp,ti,ab

  7. 44.

    (mouse or rat or mice).ti,ab

  8. 45.

    (review adj3 (record* or image*)).ab

  9. 46.

    incidence.ti,ab

  10. 47.

    prevalence.ti,ab

  11. 48.

    case study.ti,ab

  12. 49.

    (qualitative or (patient interview*)).ti,ab

  13. 50.

    (longitudinal cohort stud*).ab,ti

  14. 51.

    (prospective cohort stud*).ab,ti

  15. 52.

    (prospective stud*).ab,ti

  16. 53.

    (prospective trial).ti,ab

  17. 54.

    (cross-sectional stud*).ti,ab

  18. 55.

    “in vivo”.mp

  19. 56.

    “in vitro”.mp

  20. 57.

    or/38–56

  21. 58.

    6 and 9 and 27 and 33 and 37

  22. 59.

    58 not 57

Appendix 2: PRO measure abbreviations presented in order of appearance in Table 1

PRO measure abbreviation PRO measure full name Construct assessed
POMS Profile of Mood States Mood
BDI-II Beck Depression Inventory II Depression
STAI State-Trait Anxiety Inventory Anxiety
D-39 Diabetes-39 Diabetes-specific quality of life
PAID Problem Areas in Diabetes Diabetes-related distress
SF-36 36-Item Short Form Survey Health status and health-related quality of life
IWQOL-Lite Impact of Weight on Quality of Life-Lite Obesity-specific quality of life
DDS Diabetes Distress Scale Diabetes-related emotional distress
PHQ-9 Patient Health Questionnaire-9 Depression
IIEF-5 International Index of Erectile Function-5 Diagnostic tool for erectile dysfunction
EQ-5D EuroQol-5D Health-related quality of life
BBPA Barriers to Being Physically Active Barriers to engaging in regular exercise
HADS Hospital Anxiety and Depression Scale Anxiety and depression
DTSQ Diabetes Treatment Satisfaction Questionnaire Satisfaction with diabetes treatment regimens
POMSb Profile of Mood States Brief Form Mood
Modified WOMAC Modified Western Ontario and McMaster Universities Osteoarthritis Index Pain, stiffness and physical function of the knee and hip joints
BMA 2.0 Body Morph Assessment Version 2.0 Body image
RSES Rosenberg Self-Esteem Scale Self-esteem
CIS Checklist Individual Strength Fatigue
EDE-Q Eating Disorder Examination Questionnaire Range and severity of eating disorder features
ORWELL 97 Obesity-Related Well-Being 97 Obesity-specific quality of life

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Martenstyn, J., King, M. & Rutherford, C. Impact of weight loss interventions on patient-reported outcomes in overweight and obese adults with type 2 diabetes: a systematic review. J Behav Med 43, 873–891 (2020). https://doi.org/10.1007/s10865-020-00140-7

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Keywords

  • Obesity
  • Patient-reported outcomes
  • Weight loss
  • Type 2 diabetes
  • Systematic review