Randomized Controlled Trials to Treat Obesity in Military Populations: A Systematic Review and Meta-Analysis

Davide Gravina; Johanna Louise Keeler; Melahat Nur Akkese; Sevgi Bektas; Paula Fina; Charles Tweed; Gerd-Dieter Willmund; Janet Treasure; Hubertus Himmerich

doi:10.3390/nu15224778

Randomized Controlled Trials to Treat Obesity in Military Populations: A Systematic Review and Meta-Analysis

Nutrients. 2023 Nov 14;15(22):4778. doi: 10.3390/nu15224778.

Authors

Davide Gravina^{1

2}, Johanna Louise Keeler^{1

3}, Melahat Nur Akkese¹, Sevgi Bektas^{1

4}, Paula Fina⁵, Charles Tweed^{3

6}, Gerd-Dieter Willmund⁷, Janet Treasure^{1

3}, Hubertus Himmerich^{1

3}

Affiliations

¹ Centre for Research in Eating and Weight Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College, London SE5 8AF, UK.
² Department of Clinical and Experimental Medicine, University of Pisa, 56127 Pisa, Italy.
³ South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham BR3 3BX, UK.
⁴ Department of Psychology, Hacettepe University, Ankara 06800, Türkiye.
⁵ Faculty of Psychology, Sigmund Freud University Vienna, Freudplatz 1, 1020 Vienna, Austria.
⁶ Royal Navy Reserve, London WC1N 1NP, UK.
⁷ Bundeswehr Center for Military Mental Health, Military Hospital Berlin, 13, 10115 Berlin, Germany.

Abstract

In recent years, overweight and obesity have reached an alarmingly high incidence and prevalence worldwide; they have also been steadily increasing in military populations. Military personnel, as an occupational group, are often exposed to stressful and harmful environments that represent a risk factor for disordered eating, with major repercussions on both physical and mental health. This study aims to explore the effectiveness of weight loss interventions and assess the significance of current obesity treatments for these populations. Three online databases (PubMed, PsycInfo, and Web of Science) were screened to identify randomized controlled trials (RCTs) aiming to treat obesity in active-duty military personnel and veterans. Random-effects meta-analyses were conducted for body weight (BW) and body mass index (BMI) values, both longitudinally comparing treatment groups from pre-to-post intervention and cross-sectionally comparing the treatment group to controls at the end of the intervention. A total of 21 studies were included: 16 cross-sectional (BW: n = 15; BMI: n = 12) and 16 longitudinal (BW: n = 15; BMI: n = 12) studies were meta-analyzed, and 5 studies were narratively synthesized. A significant small overall BW and BMI reduction from baseline to post-intervention was observed (BW: g = -0.10; p = 0.015; BMI: g = -0.32; p < 0.001), together with a decreased BMI (g = -0.16; p = 0.001) and nominally lower BW (g = -0.08; p = 0.178) in the intervention group compared to controls at the post-intervention time-point. Despite limitations, such as the heterogeneity across the included interventions and the follow-up duration, our findings highlight how current weight loss interventions are effective in terms of BW and BMI reductions in military populations and how a comprehensive approach with multiple therapeutic goals should be taken during the intervention.

Keywords: RCT; active-duty military personnel; meta-analysis; military population; obesity; obesity treatment; randomized controlled trial; veterans; weight loss intervention.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Body Weight
Humans
Military Personnel*
Obesity / therapy
Overweight / therapy
Randomized Controlled Trials as Topic
Weight Loss

Grants and funding

J.L.K. acknowledges financial support from a Medical Research Council (MRC)-funded Doctoral Training Partnership stipend (ref: MR/N013700/1). M.N.A. and S.B. acknowledge financial support from the Turkish Ministry of National Education for granting an official scholarship for her PhD education at King’s College London University. The funder had no role in this project. J.T. has received salary support from the NIHR BRC at the South London and Maudsley NHS Foundation Trust (SLaM) and KCL. H.H. has received salary support from the NIHR BRC at the South London and Maudsley NHS Foundation Trust (SLaM) and KCL.