Lifestyle interventions with motivational stay vs lifestyle interventions alone
Table 1. Summary of findings for lifestyle interventions with motivational stay
Outcomes*
Anticipated absolute effects (95% CI)
Certainty of the evidence
We are uncertain whether lifestyle interventions with motivational stay improve weight change at 1 year
We are uncertain whether lifestyle interventions with motivational stay improve weight change at 2 years
We are uncertain whether lifestyle interventions with motivational stay improve weight change at 5 years
CI: Confidence interval; MD: Mean difference; N/A: not available; RCT: randomized, controlled trial;
* Weight change is shown as the adjusted mean weight change. Higher MD means less weight reduction in the intervention group relative to the comparison group.
a Blinding of patients and personnel was not possible due to nature of the intervention. Interventions were not consistent with current treat-ment practise in Norway.
b High heterogeneity between studies
c Low precision (wide CI) of effect estimates.
d Single RCT including small number of patients
Source: Avenell et al. (2018) Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 22(68)
22 Supplement 2. Summary of Findings
Lifestyle interventions with pharmacological treatments vs lifestyle inter-ventions alone
Table 2. Summary of findings for lifestyle interventions with anti-obesity pharma-cological treatment
120 mg orlistat
Outcomes*
Anticipated absolute effects
(95% CI) Relative effect (95% CI)
Number of participants
(studies)
Certainty of the evidence
(GRADE) Comments
Risk with
placebo Risk with 120 mg orlistat Weight
Lifestyle interventions with 120 mg orlistat may improve weight change at 1 year
Weight
Lifestyle interventions with 120 mg orlistat may improve weight change at 2 years
Weight
Lifestyle interventions with 120 mg orlistat may improve weight change at 4 years
Total
Lifestyle interventions with 120 mg orlistat may slightly im-prove total cholesterol at 1 year
LDL
Lifestyle interventions with 120 mg orlistat may slightly im-prove LDL cholesterol at 1 year
HDL
Lifestyle interventions with 120 mg orlistat may make no or little difference to HDL cholesterol at 1 year
Lifestyle interventions with 120 mg orlistat may make no or little difference to triglycerides at 1 year
7,8,11,12,14,15,24-26
⊕⊕⊝⊝
LOW a-c
Lifestyle interventions with 120 mg orlistat may slightly im-prove systolic blood pressure at 1 year
23 Supplement 2. Summary of Findings
Lifestyle interventions with 120 mg orlistat may slightly im-prove diastolic blood pressure at 1 year
Lifestyle interventions with 120 mg orlistat may make no or little difference to plasma HbA1c at 1 year
7,9,12,14,15,24-26
⊕⊕⊝⊝
LOW a-c
Lifestyle interventions with 120 mg orlistat may slightly im-prove blood glucose at 1 year
60 mg orlistat
Outcomes*
Anticipated absolute effects
(95% CI) Relative effect (95% CI)
Number of participants
(studies)
Certainty of the evidence (GRADE)
Comments Risk with
placebo Risk with 60 mg orlistat Weight
Lifestyle interventions with 60 mg orlistat may improve weight change at 1 year
Lifestyle interventions with 60 mg orlistat may improve weight change at 2 years
Naltrexone-bupropion
Outcomes*
Anticipated absolute effects (95% CI)
Certainty of the evidence (GRADE)
Comments Risk with
placebo Risk with nal-
Lifestyle interventions with nal-trexone-bupropion probably im-prove weight change at 13 months
Liraglutide
Outcomes*
Anticipated absolute effects
(95% CI) Relative effect
Certainty of the evidence
(GRADE) Comments
Risk with
placebo Risk with liraglutide
Lifestyle interventions with lira-glutide probably improve weight change at 13 months
24 Supplement 2. Summary of Findings
CI: Confidence interval; LDL: low-density lipoprotein; HbA1c: hemoglobin A1c (glycated haemoglobin); HDL: high-density lipoprotein; MD:
Mean difference; N/A: not available; RCT: randomized, controlled trial;
* Weight change is shown as the adjusted mean weight change. Lower MD means greater weight reduction in the intervention group rela-tive to the comparison group.
a Possible attrition bias due to incomplete outcome data
b Unclear how allocation to treatment was randomized. Unclear whether allocation to treatment was concealed.
c Conflict of interest, affiliation with pharmaceutical industry and/or study authors received honoraria/financial support
d Included patients with body mass index below morbidly obese. Unclear whether patients suffered from overweight-related comorbidities.
e Unclear whether outcome data assessment was blinded
f High heterogeneity between studies
Sources: Avenell et al. (2018) Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 22(68); Khera et al. (2016) Association of Pharmacological Treat-ments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis. JAMA 315(22):2424–2434.
25 Supplement 2. Summary of Findings
Lifestyle interventions with surgical treatments vs lifestyle interventions alone
Table 3. Summary of findings for lifestyle interventions with gastric bypass surgery
Outcomes*
Anticipated absolute effects (95% CI)
Certainty of the evidence
Lifestyle interventions with gastric bypass probably improve weight change at 1 year
Lifestyle interventions with gastric bypass probably improve weight change at 2 years
Lifestyle interventions with gastric bypass probably improve weight change at 3 years
Lifestyle interventions with gastric bypass probably improve weight change at 4 years
Lifestyle interventions with gastric bypass probably improve weight change at 5 years
Lifestyle interventions with gastric bypass may make no or little dif-ference to cholesterol at 1 year
LDL
Lifestyle interventions with gastric bypass may make no or little dif-ference to LDL cholesterol at 1 year
Lifestyle interventions with gastric bypass probably slightly elevate HDL cholesterol at 1 year
Tri-
Lifestyle interventions with gastric bypass probably slightly improve triglycerides at 1 year
26 Supplement 2. Summary of Findings Outcomes*
Anticipated absolute effects (95% CI)
Certainty of the evidence
Lifestyle interventions with gastric bypass may slightly improve sys-tolic blood pressure at 1 year
Diastolic
Lifestyle interventions with gastric bypass may slightly improve dias-tolic blood pressure at 1 year
HbA1c
Lifestyle interventions with gastric bypass probably slightly improve plasma HbA1cat 1 year Blood
Lifestyle interventions with gastric bypass probably slightly improve blood glucose at 1 year
CI: Confidence interval; LDL: low-density lipoprotein; HbA1c: hemoglobin A1c (glycated haemoglobin); HDL: high-density lipoprotein; MD:
Mean difference; N/A: not available; RCT: randomized, controlled trial;
* Weight change is shown as the adjusted mean weight change. Lower MD means greater weight reduction in the intervention group rela-tive to the comparison group.
a Blinding of patients and personnel not possible due to nature of the intervention. Conflict of interest, affiliation with pharmaceutical indus-try and/or study authors received honoraria/financial support.
b Possible reporting bias due to selective outcome reporting
c Single RCT including small number of patients
d Low accuracy (non-overlapping CI) of effect estimates
Source: Avenell et al. (2018) Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 22(68)
27 Supplement 2. Summary of Findings
Table 4. Summary of findings for lifestyle interventions with sleeve gastrectomy
Outcomes*
Anticipated absolute effects (95% CI)
Certainty of the evidence
Lifestyle interventions with sleeve gastrectomy may improve weight change at 1 year
Lifestyle interventions with sleeve gastrectomy may improve weight change at 2 years
Lifestyle interventions with sleeve gastrectomy may improve weight change at 3 years
Lifestyle interventions with sleeve gastrectomy may improve weight change at 4 years
Lifestyle interventions with sleeve gastrectomy may improve weight change 5 years
Total
Lifestyle interventions with sleeve gastrectomy may make little or no difference to total cholesterol at 1 year
Lifestyle interventions with sleeve gastrectomy may make little or no difference to LDL cholesterol at 1 year
Lifestyle interventions with sleeve gastrectomy may slightly elevate HDL cholesterol at 1 year
Tri-
Lifestyle interventions with sleeve gastrectomy may slightly improve triglycerides at 1 year
28 Supplement 2. Summary of Findings Outcomes*
Anticipated absolute effects (95% CI)
Certainty of the evidence
We are uncertain whether lifestyle interventions with sleeve gastrec-tomy improve systolic blood pres-sure at 1 year
We are uncertain whether lifestyle interventions with sleeve gastrec-tomy improve diastolic blood pressure at 1 year
HbA1c
Lifestyle interventions with sleeve gastrectomy may slightly improve plasma HbA1c at 1 year Blood
Lifestyle interventions with sleeve gastrectomy may slightly improve blood glucose at 1 year
CI: Confidence interval; LDL: low-density lipoprotein; HbA1c: hemoglobin A1c (glycated haemoglobin); HDL: high-density lipoprotein; MD:
Mean difference; N/A: not available; RCT: randomized, controlled trial;
* Weight change is shown as the adjusted mean weight change. Lower MD means greater weight reduction in the intervention group rela-tive to the comparison group.
a Blinding of patients and personnel not possible due to nature of the intervention. Conflict of interest, affiliation with pharmaceutical indus-try and/or study authors received honoraria/financial support.
b Low accuracy (non-overlapping CI) of effect estimates
c Single RCT including small number of patients
d Low precision (wide CI) of effect estimates
Source: Avenell et al. (2018) Bariatric surgery, lifestyle interventions and orlistat for severe obesity: the REBALANCE mixed-methods systematic review and economic evaluation. Health Technol Assess 22(68)
Published by the Norwegian Institute of Public Health November 2020
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