Lay- Vs Professional-Led Weight Loss Interventions For Overweight And Obese Youth: A Systematic Review And Network Meta-Analysis

Context: In this network meta analysis, we examine the short and long-term effects of professional and lay-led behavioural interventions for obese youth. Objective: The appropriate approach for weight loss among overweight and obese youth remains unclear. We evaluated the comparative effectiveness of behavioural pediatric weight loss interventions led by lay persons and professionals. Data Sources: MEDLINE, Embase, the Cochrane Library, and CINAHL between January 1996 and June 2019. Study Selection: Randomized controlled trials of behavioural lifestyle interventions that enrolled overweight and obese children and adolescents (5-18 years old) administered for at least 12 weeks. Data Extraction: A network meta-analyses using a Bayesian framework and Markov-chain Monte-Carlo simulation methods were used to combine direct and indirect evidence. The immediate and sustained change from baseline in weight (kg) and body mass index (BMI; kg/m2) were primary outcomes. Results: Of 34,384 citations retrieved, we included 78 RCTs (4,556 participants), delivered for 12 to 104 weeks. Compared to standard care, professional-led weight loss interventions were associated with a significant reduction in body weight [-1.6 kg, 95% credible interval (CrI) -2.3, -0.99, 64 trials] that was not sustained long-term [-1.02 kg, 95% CrI -2.2, +0.34, 21 trials]. There was no evidence of a meaningful weight loss for lay-led interventions in the short-term [-1.4 kg; 95% CrI -3.0, +0.26; 5 trials], or long-term [-0.98 kg, 95% CrI -3.6, +1.8, 1 trial] compared to standard care. Direct comparisons revealed expert and lay-led interventions yield similar effects (-0.25 kg, 95%CrI -1.9, +1.3, 5 trials). Conclusions: Professional-led weight loss interventions are the most effective for achieving and sustaining weight reduction among overweight and obese youth. There is a need for high quality trials of lay-led weight loss interventions for obese youth.