Michael L. Dansinger, MD, MS; Athina Tatsioni, MD; John B. Wong, MD; Mei Chung, MPH; Ethan M. Balk, MD, MPH
Disclaimer: The authors of this report are responsible for its content. Statements in the report should not be construed as endorsement by the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
Acknowledgment: The authors thank Ingram Olkin, PhD, Stanford University, for his invaluable assistance with our analyses.
Grant Support: This article is based on research conducted by the Tufts-New England Medical Center Evidence-based Practice Center funded under contract no. 290-02-0022 from the Agency for Healthcare Research and Quality of the U.S. Department of Health and Human Services. Dr. Dansinger is supported by National Institutes of Health grant K23RR020709.
Corresponding Author: Michael L. Dansinger, MD, Tufts-New England Medical Center, 750 Washington Street, NEMC #216, Boston, MA 02111; e-mail, firstname.lastname@example.org.
Potential Financial Conflicts of Interest: None disclosed.
Dansinger M., Tatsioni A., Wong J., Chung M., Balk E.; Meta-analysis: The Effect of Dietary Counseling for Weight Loss. Ann Intern Med. 2007;147:41-50. doi: 10.7326/0003-4819-147-1-200707030-00007
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Published: Ann Intern Med. 2007;147(1):41-50.
Dietary and lifestyle modification efforts are the primary treatments for people who are obese or overweight. The effect of dietary counseling on long-term weight change is unclear.
To perform a meta-analysis of the effect of dietary counseling compared with usual care on body mass index (BMI) over time in adults.
Early studies (1980 through 1997) from a previously published systematic review; MEDLINE and the Cochrane Central Register of Controlled Trials from 1997 through July 2006.
English-language randomized, controlled trials (â‰¥16 weeks in duration) in overweight adults that reported the effect of dietary counseling on weight. The authors included only weight loss studies with a dietary component.
Single reviewers performed full data extraction; at least 1 additional reviewer reviewed the data.
Random-effects model meta-analyses of 46 trials of dietary counseling revealed a maximum net treatment effect of âˆ’1.9 (95% CI, âˆ’2.3 to âˆ’1.5) BMI units (approximately âˆ’6%) at 12 months. Meta-analysis of changes in weight over time (slopes) and meta-regression suggest a change of approximately âˆ’0.1 BMI unit per month from 3 to 12 months of active programs and a regain of approximately 0.02 to 0.03 BMI unit per month during subsequent maintenance phases. Different analyses suggested that calorie recommendations, frequency of support meetings, inclusion of exercise, and diabetes may be independent predictors of weight change.
The interventions, study samples, and weight changes were heterogeneous. Studies were generally of moderate to poor methodological quality. They had high rates of missing data and failed to explain these losses. The meta-analytic techniques could not fully account for these limitations.
Compared with usual care, dietary counseling interventions produce modest weight losses that diminish over time. In future studies, minimizing loss to follow-up and determining which factors result in more effective weight loss should be emphasized.
Dallas Diabetes and Endocrine Center of Dallas
July 25, 2007
Why reporting change in BMI?
In their meta-analysis Dansinger et al report on the change in BMI achieved by dietary counseling. I am still trying to find a reasonable explanation as to why the authors chose this endpoint rather than absolute weight loss or percentage of excess weight loss. I adults, the height is expected to be constant. In fact, in many studies the height is only measured at the initial visit so by definition will be constant. If studies measure the height at every visit this will only introduce an error based on itraindividual variability. I do not question the value of BMI measurement for classification of nutritional status and for risk assessment but why report BMI changes when the title of the meta-analysis is effect in WEIGHT loss? As a clinician I understood that the article was going to tell my if dietary counseling works? and if so how much WEIGHT loss should I expect? The article did not provide a clear answer.
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Cardiology, Endocrine and Metabolism, Diabetes, Obesity, Coronary Risk Factors.
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