- Email: [email protected]
A systematic review of the cost-effectiveness of non-surgical obesity interventions in men
Abstracts/Appetite 87 (2015) 371–403
A systematic review of weight loss interventions for obese men in the UK. The ROMEO Project C. ROBERTSON a , A. AVENELL a , F. STEWART a , D. ARCHIBALD a , F. DOUGLAS a, P. HODDINOTT, E. VAN TEIJLINGEN, D. BOYERS a. a University of Aberdeen, Aberdeen, UK. [email protected] A higher proportion of men than women are overweight but men are under-represented in services for obesity treatment in the UK, suggesting that service provision is sub-optimal. We aimed to evaluate the evidence for the effectiveness of UK weight management programmes and strategies for engaging men with these services. We conducted a systematic review of interventions for men only or for men and women where results are presented by sex, with obesity (BMI ≥30 kg/m2 [or BMI ≥28 kg/m2 with cardiac risk factors based on orlistat guidance]) in the UK, any setting, any study design, any duration. We identified 15 men-only (n = 7160) and 10 mixed sex reports. Men represented 11.7% (n = 8501) of the population of mixed-sex studies. Studies were heterogeneous and of short duration (<12 weeks for the majority [60.7%] of studies). Successful programmes for men included an exercise programme with dietary advice and individual tailoring, e.g. personalised feedback. Men preferred to lose weight through exercise than with restricted diets. Strategies to promote engagement included male-friendly language, humour, and venues that promoted camaraderie through shared sporting interests. Some men (but not all) preferred interventions delivered in men-only rather than mixed sex groups. There is a paucity of weight management research with men in the UK. This review highlights the need for long-term (>1 year) randomised controlled trials to identify effective weight loss strategies that will appeal to diverse groups of men. This project was funded by the National Institute of Health Research, Health Technology Assessment programme. The authors have no conflict of interest. http://dx.doi.org/10.1016/j.appet.2014.12.114
A systematic review of the cost-effectiveness of non-surgical obesity interventions in men D. BOYERS a , A. AVENELL a , F. STEWART a , C. ROBERTSON a , D. ARCHIBALD a, F. DOUGLAS a, P. HODDINOTT, E. VAN TEIJLINGEN. a University of Aberdeen, Aberdeen, UK. [email protected] Increasing obesity related health conditions have a substantial burden on population health and healthcare spending. Obesity may have a sex-specific impact on disease development and hence the cost-effectiveness of interventions to address obesity. However, there is no clear indication of cost-effective treatments for men. This systematic review summarises the literature reporting the costeffectiveness of non-surgical weight-management interventions for men. Whilst none of the included studies set out to determine the cost-effectiveness of treatment for men, five studies reported results for subgroups of men. Interventions were grouped into lifestyle interventions (three studies) and orlistat (two studies). Studies were fully data extracted and quality assessed. The included studies showed promising evidence of cost-effectiveness of lifestyle interventions and orlistat, especially when interventions were targeted at high-risk groups, such as those with impaired glucose toler-
375
ance. Whilst some minor differences in estimates of cost-effectiveness were observed between men and women, these were small in magnitude and did not lead to sex-specific recommendations to decision makers about cost-effectiveness. Studies were not designed to compare men and women, and therefore may have failed to pick up any differences which may exist. The economic evidence was highly uncertain, and limited by variable methodological quality. It was not possible to draw strong conclusions on cost-effectiveness. Future studies are required to demonstrate the cost-effectiveness of interventions specifically targeted towards weight loss for men and to explicitly compare outcomes for men and women. Funding: National Institute of Health Research, Health Technology Assessment programme. The authors have no conflict of interest. http://dx.doi.org/10.1016/j.appet.2014.12.115
Are grandparents the key to childhood obesity prevention in China? Evidence from a mixed methods study B. LI, P. ADAB, K. KEUNG CHENG. University of Birmingham, Birmingham, UK. [email protected] Childhood obesity is increasing at a rapid rate in China, exceeding the trends seen in many other countries. The role of the family and parental factors has been implicated as important contributors to childhood obesity. In Chinese households, grandparents have a dominant role in caring for children, and the aim of this study was to examine the influence of grandparents on childhood obesity. We used a mixed-methods approach, combining data from qualitative and cross-sectional studies obtained from populations in 4 socioeconomically distinct urban districts in China. Ninety-five stakeholders (including parents, grandparents and school staff) participated in 17 focus groups and 4 primary school head teachers took part in interviews which explored perceived causes of childhood obesity. Thematic analysis was used. The cross-sectional study examined the relationship between the role of grandparents in child care and the child’s diet and physical activity levels (obtained from parent questionnaires; n = 497) and childhood weight status (using routinely collected height and weight data of third year pupils (8– 10 years)). Multiple regression analysis was used. In the qualitative study, live-in grandparents emerged as a dominant theme contributing to childhood obesity, related to attitude (fat children are healthy and well cared for), behaviours (e.g. overfeeding and preventing the single family treasure from doing chores), and a lack of health knowledge (e.g. obesity related diseases can only happen in adults). In the cross-sectional analysis, children who were mainly cared for by their grandparents were more likely to be overweight/obese (adjusted OR 2.03; 95 % CI 1.19–3.47); and to consume more unhealthy snacks and sugar-added drinks (B = 2.13, 95 % CI 0.87–3.40), compared to children who were mainly cared for by their parents or other adult. Grandparents have important influence on Chinese children’s weight status and should be targeted in future prevention interventions. http://dx.doi.org/10.1016/j.appet.2014.12.116
A systematic review of weight loss interventions for obese men in the UK. The ROMEO Project C. ROBERTSON a , A. AVENELL a , F. STEWART a , D. ARCHIBALD a , F. DOUGLAS a, P. HODDINOTT, E. VAN TEIJLINGEN, D. BOYERS a. a University of Aberdeen, Aberdeen, UK. [email protected] A higher proportion of men than women are overweight but men are under-represented in services for obesity treatment in the UK, suggesting that service provision is sub-optimal. We aimed to evaluate the evidence for the effectiveness of UK weight management programmes and strategies for engaging men with these services. We conducted a systematic review of interventions for men only or for men and women where results are presented by sex, with obesity (BMI ≥30 kg/m2 [or BMI ≥28 kg/m2 with cardiac risk factors based on orlistat guidance]) in the UK, any setting, any study design, any duration. We identified 15 men-only (n = 7160) and 10 mixed sex reports. Men represented 11.7% (n = 8501) of the population of mixed-sex studies. Studies were heterogeneous and of short duration (<12 weeks for the majority [60.7%] of studies). Successful programmes for men included an exercise programme with dietary advice and individual tailoring, e.g. personalised feedback. Men preferred to lose weight through exercise than with restricted diets. Strategies to promote engagement included male-friendly language, humour, and venues that promoted camaraderie through shared sporting interests. Some men (but not all) preferred interventions delivered in men-only rather than mixed sex groups. There is a paucity of weight management research with men in the UK. This review highlights the need for long-term (>1 year) randomised controlled trials to identify effective weight loss strategies that will appeal to diverse groups of men. This project was funded by the National Institute of Health Research, Health Technology Assessment programme. The authors have no conflict of interest. http://dx.doi.org/10.1016/j.appet.2014.12.114
A systematic review of the cost-effectiveness of non-surgical obesity interventions in men D. BOYERS a , A. AVENELL a , F. STEWART a , C. ROBERTSON a , D. ARCHIBALD a, F. DOUGLAS a, P. HODDINOTT, E. VAN TEIJLINGEN. a University of Aberdeen, Aberdeen, UK. [email protected] Increasing obesity related health conditions have a substantial burden on population health and healthcare spending. Obesity may have a sex-specific impact on disease development and hence the cost-effectiveness of interventions to address obesity. However, there is no clear indication of cost-effective treatments for men. This systematic review summarises the literature reporting the costeffectiveness of non-surgical weight-management interventions for men. Whilst none of the included studies set out to determine the cost-effectiveness of treatment for men, five studies reported results for subgroups of men. Interventions were grouped into lifestyle interventions (three studies) and orlistat (two studies). Studies were fully data extracted and quality assessed. The included studies showed promising evidence of cost-effectiveness of lifestyle interventions and orlistat, especially when interventions were targeted at high-risk groups, such as those with impaired glucose toler-
375
ance. Whilst some minor differences in estimates of cost-effectiveness were observed between men and women, these were small in magnitude and did not lead to sex-specific recommendations to decision makers about cost-effectiveness. Studies were not designed to compare men and women, and therefore may have failed to pick up any differences which may exist. The economic evidence was highly uncertain, and limited by variable methodological quality. It was not possible to draw strong conclusions on cost-effectiveness. Future studies are required to demonstrate the cost-effectiveness of interventions specifically targeted towards weight loss for men and to explicitly compare outcomes for men and women. Funding: National Institute of Health Research, Health Technology Assessment programme. The authors have no conflict of interest. http://dx.doi.org/10.1016/j.appet.2014.12.115
Are grandparents the key to childhood obesity prevention in China? Evidence from a mixed methods study B. LI, P. ADAB, K. KEUNG CHENG. University of Birmingham, Birmingham, UK. [email protected] Childhood obesity is increasing at a rapid rate in China, exceeding the trends seen in many other countries. The role of the family and parental factors has been implicated as important contributors to childhood obesity. In Chinese households, grandparents have a dominant role in caring for children, and the aim of this study was to examine the influence of grandparents on childhood obesity. We used a mixed-methods approach, combining data from qualitative and cross-sectional studies obtained from populations in 4 socioeconomically distinct urban districts in China. Ninety-five stakeholders (including parents, grandparents and school staff) participated in 17 focus groups and 4 primary school head teachers took part in interviews which explored perceived causes of childhood obesity. Thematic analysis was used. The cross-sectional study examined the relationship between the role of grandparents in child care and the child’s diet and physical activity levels (obtained from parent questionnaires; n = 497) and childhood weight status (using routinely collected height and weight data of third year pupils (8– 10 years)). Multiple regression analysis was used. In the qualitative study, live-in grandparents emerged as a dominant theme contributing to childhood obesity, related to attitude (fat children are healthy and well cared for), behaviours (e.g. overfeeding and preventing the single family treasure from doing chores), and a lack of health knowledge (e.g. obesity related diseases can only happen in adults). In the cross-sectional analysis, children who were mainly cared for by their grandparents were more likely to be overweight/obese (adjusted OR 2.03; 95 % CI 1.19–3.47); and to consume more unhealthy snacks and sugar-added drinks (B = 2.13, 95 % CI 0.87–3.40), compared to children who were mainly cared for by their parents or other adult. Grandparents have important influence on Chinese children’s weight status and should be targeted in future prevention interventions. http://dx.doi.org/10.1016/j.appet.2014.12.116