Effects of lifestyle interventions that include a physical activity component in class II and III obese individuals: a systematic review and meta-analysis

Abstract

Background: In class II and III obese individuals, lifestyle intervention is the first step to achieve weight loss and treat obesity-related comorbidities before considering bariatric surgery. A systematic review, meta-analysis, and meta-regression were performed to assess the impact of lifestyle interventions incorporating a physical activity (PA) component on health outcomes of class II and III obese individuals.

Methods: An electronic search was conducted in 4 databases (Medline, Scopus, CINAHL and Sportdiscus). Two independent investigators selected original studies assessing the impact of lifestyle interventions with PA components on anthropometric parameters, cardiometabolic risk factors (fat mass, blood pressure, lipid and glucose metabolism), behaviour modification (PA and nutritional changes), and quality of life in adults with body mass index (BMI) ≥ 35 kg/m2. Estimates were pooled using a random-effect model (DerSimonian and Laird method). Heterogeneity between studies was assessed by the Cochran's chi-square test and quantified through an estimation of the I².

Results: Of the 3,170 identified articles, 56 met our eligibility criteria, with a large majority of uncontrolled studies (80%). The meta-analysis based on uncontrolled studies showed significant heterogeneity among all included studies. The pooled mean difference in weight loss was 8.9 kg (95% CI, 10.2-7.7; p < 0.01) and 2.8 kg/m² in BMI loss (95% CI, 3.4-2.2; p < 0.01). Long-term interventions produced superior weight loss (11.3 kg) compared to short-term (7.2 kg) and intermediate-term (8.0 kg) interventions. A significant global effect of lifestyle intervention on fat mass, waist circumference, blood pressure, total cholesterol, LDL-C, triglycerides and fasting insulin was found (p<0.01), without significant effect on HDL-C and fasting blood glucose.

Conclusions: Lifestyle interventions incorporating a PA component can improve weight and various cardiometabolic risk factors in class II and III obese individuals. However, further high quality trials are needed to confirm this evidence, especially beyond weight loss.

Fig 1. PRISMA 2009 Flow Diagram.

Fig 2. Forest plot of mean body mass index changes according to the intervention length in class II and III obese individuals.

Fig 3. Forest plot of mean fat mass changes according to the intervention length in class II and III obese individuals.

Fig 4. Forest plot of mean systolic blood pressure, LDL cholesterol, HDL cholesterol and triglycerides differences according to the intervention length in class II and III obese individuals.

Notes: A (upper corner left): systolic blood pressure; B (upper corner right): LDL cholesterol; C: HDL cholesterol; D: Triglycerides. Letters inserted with the references (b, c, d) represent the different arms of intervention from the same study. A description of each intervention is given in Table 1