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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Jordan Martenstyn, Madeleine King, and Claudia Rutherford state that she or he does not have any conflict of interest.
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Appendix 1: Search strategy terms
(body mass index).ti,ab
(patient reported outcome* or PRO or PROM).ti,ab
((quality adj1 life) or QOL or HRQOL or HRQL or HQL or HQOL).ti,ab
(fatigue or tired*).ab,ti
(appetite or satiety or satiate*).ab,ti
Weight change outcomes
(weight loss intervention*).ab,ti
(weight loss program*).ab,ti
(randomi$ed controlled trial or controlled clinical trial).pt
(randomi$ed or randomly).ab
(children or child or infant).ti,ab
(mouse or rat or mice).ti,ab
(review adj3 (record* or image*)).ab
(qualitative or (patient interview*)).ti,ab
(longitudinal cohort stud*).ab,ti
(prospective cohort stud*).ab,ti
6 and 9 and 27 and 33 and 37
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
- Patient-reported outcomes
- Weight loss
- Type 2 diabetes
- Systematic review