Factors Associated with Successful Group Weight Management: A Systematic Style Review

Abstract

Background: Obesity is a growing problem in the developed world affecting 23% of the UK population [1]. Current treatment relies on 1:1 counselling, group support, pharmacological management and surgery [2]. Group weight loss has been shown to be effective and may offer a scalable cost effective obesity therapy solution. A range of group therapies are in existence ranging from commercial organisations to sessions run by healthcare professionals within the NHS; the success of the groups may differ due to variability in how groups are managed and delivered. Specific factors attributed to successful weight loss outcomes are therefore of interest in the development of future programmes.  Aim: To identify features of group weight loss interventions associated with increased weight loss outcomes to inform the development of group interventions.  Methods: Medline, Embase, Scopus and PsychI NFO were used to select research papers investigating the effects of a group weight loss intervention on long term weight loss (>6 months) most commonly measured by group leader or research staff. Internet or telephone based interventions were excluded along with paediatric studies and those losing weight following bariatric surgery. Papers published in English within the past 15 years were included. These papers were quality assessed using an adapted Newcastle Ottawa scale. Results:15 papers were included in this review having fulfilled the inclusion criteria. 9 of the 15 authors investigated modest energy reductions whilst 5 implemented a more prescriptive energy restriction; 1 other studied the use of orlistat. 14 of the studies stated the use of behaviour modification strategies of which stages of change, goal setting and self-monitoring were most common. Weight loss ranged from 0.1-14.1kg with 10 studies reporting a clinically significant weight loss of >5%.  Discussion: Group weight management is shown to result in significant weight loss. A range of contributing factors has been identified alongside social support. A worksite based intervention showed the greatest weight loss at 12 months suggesting that easy access and environment may be key influences [3]. Whilst behaviour change strategies were frequently included, groups led by those with a background in psychology showed greater weight loss. Prescriptive dietary regimes did not appear to be more effective than modest energy restriction and there was no apparent correlation between lengths of intervention or group size on weight loss.  Conclusion: Group therapy can be an effective obesity treatment; however, variation exists between groups. Accessible interventions delivered in a supportive environment with the use of behaviour modification strategies are associated with improved weight loss outcomes.