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

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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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Author information

Authors and Affiliations

  1. School of Psychology, Quality of Life Office, Level 6, Chris O’ Brien Lifehouse C39Z, University of Sydney, Sydney, NSW, 2006, Australia

    Jordan Martenstyn, Madeleine King & Claudia Rutherford

  2. Cancer Nursing Research Unit (CNRU), Susan Wakil School of Nursing and Midwifery, University of Sydney, Sydney, NSW, Australia

    Claudia Rutherford

Authors
  1. Jordan Martenstyn
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  2. Madeleine King
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  3. Claudia Rutherford
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Corresponding author

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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