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Guidelines on Overweight and Obesity: Electronic Textbook
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7. Other Interventions for Overweight and Obesity Treatment

Other types of interventions considered for overweight and obesity treatment included acupuncture, herbal remedies, supplements, and hypnosis. However, these treatments did not fulfill the a priori inclusion criteria, and for that reason were not included in this review.

Commentary: Do the same treatment approaches for overweight and obesity fit diverse patient populations?

Whether or not the same weight reduction program will accomplish equivalent weight change in ethnically diverse population groups can be questioned on theoretical grounds. Weight reduction programs address motivations and behaviors strongly influenced by sociocultural factors that vary with ethnicity (257, 496, 497).  Sociocultural factors may also influence the relative efficacy of behavioral programs in young, middle, and older adulthood; men or women; or any other patient groups where the motivations and lifestyle factors targeted may vary from those commonly assumed to be in operation. Innate or acquired physiological factors that affect energy metabolism may also influence the relative efficacy of behavioral weight reduction programs. For example, some cross-sectional comparisons have suggested that the relative weight loss achieved for a given degree of calorie restriction will be lower in African Americans than whites because of a lower resting metabolic rate in African Americans (498-501).  Another study suggests metabolic influences on weight loss in premenopausal versus postmenopausal women (502).  The diversity of populations in obesity treatment studies is limited, and there is not a coherent body of studies evaluating systematic differences in the outcomes of overweight and obesity treatment by age, socioeconomic status, or other participant characteristics that might be expected to influence outcome. However, the possibility of differences in the effectiveness of behavioral weight reduction approaches between African Americans and whites has been suggested by reports from several intervention studies (360, 503-505).  In some of these trials, weight reduction was the only intervention; in other instances it was combined with sodium reduction or other dietary or lifestyle changes. Taken together, these studies suggest that, on average, within the same program, weight losses of African Americans are less than those of their white counterparts, particularly among women. A formal analysis of this issue in two RCTs—the Hypertension Prevention Trial and Phase 1 of the Trials of Hypertension Prevention—suggested that the weight gain in control participants was also higher among African Americans than whites, but, in women, the net weight loss (i.e., active intervention minus control) was still less in African Americans. There is ample evidence to support explanations of this differential weight loss on the basis of cultural or behavioral factors related to program adherence (257).  However, data to evaluate the alternative or additional contribution of metabolic factors to this differential are lacking. To date, no published studies permit separation of metabolic and behavioral influences on the observed ethnic differences in weight loss.

Recommendation: The possibility that a standard approach to weight loss will work differently in diverse patient populations must be considered when setting expectations about treatment outcomes. Evidence Category B.
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