Primary care–based interventions for treatment of obesity: a systematic review

Abstract

Objective

The objective of this study was to synthesise evidence from primary care–based interventions for the treatment of obesity in adults and the elderly.

Study design

Systematic review.

Methods

Eight electronic databases (MEDLINE, Lilacs, Embase, Psycinfo, Cochrane, WHOLIS, Open Gray and Scholar Google) were searched. There was no limitation on publication period; articles published in English, Portuguese or Spanish were included. The selection, data extraction and quality analyses were performed by three reviewers.

Results

A literature search retrieved 6464 publications, of which 5120 publications were excluded after reading the title/abstract and 293 after reading the full text. In total, 56 publications, representing 72 interventions were included. All studies were published between 2000 and 2020. Most studies were conducted in high-income countries. The mean duration of interventions was 11.5 months (SD: 7.5), ranging from 3 to 44 months. Most interventions were effective for body mass index reduction, weight loss and waist circumference change.

Conclusion

Our study showed that most interventions were effective for outcomes analysed in adults and the elderly. We also found some literature gaps, such as the need to implement and evaluate obesity after intervention and the requirement to carry out more studies in low- and middle-income countries.

Introduction

The prevalence of obesity is increasing worldwide.¹ The multifactorial aetiology and significant health consequences of obesity for all age groups, such as hypertension, hyperinsulinism, dyslipidaemia, type 2 diabetes, metabolic syndrome, atherosclerosis, cardiovascular diseases and cancer, increases the challenge of prevention and treatment.^2,3

In addition, the burden of obesity on healthcare systems is non-negligible.^1,4,5 For instance, medical costs rise progressively as the average body mass index (BMI)⁶ increases. According to Wang et al. (2011)⁷ and Finkelstein et al. (2012),⁸ these costs are expected to continue rising over the next 15 years. Therefore, obesity should not be considered a responsibility of the individual, but rather a concern to the healthcare sector,⁹ and developing and implementing interventions for the treatment of this disease should be a priority.

Several studies have developed and applied strategies to treat obesity at the individual and population level to try and mitigate the sharp increase in global prevalence. The healthcare sector, especially primary care, is a setting where a broad range of interventions has been tested.^10,11 This is a good strategy because primary care is the gateway to the health service. In addition, primary care is characterised by care integrality,¹² and attention is focused on building a continuous and strong relationship between the patient and healthcare team. These features make the primary health sector a favourable situation for the introduction of interventions addressing overweight and obesity.

Nevertheless, systematic reviews built on primary care–based obesity interventions in adults and elderly people are scarce.^13,14 Barnes and Ivezaj (2015)¹³ and Mitchell et al. (2017)¹⁴ analysed only a specific type of primary care–based obesity intervention in adults (i.e. motivational interview and dietetic appointments, respectively). A broad systematic review could provide guidance and better inform policy makers of the best evidence-based health policies available. To fill this gap, this study aims to synthesise evidence from primary care–based interventions to treat overweight or/and obesity in adults and the elderly.