TABLE 3.
Summary of outcome data for studies reporting health outcomes (weight, BMI, blood pressure, and cholesterol)
| Baseline measure (SD), group number (n) | Final/follow-up measure (SD), group number (n) | |||||
|---|---|---|---|---|---|---|
| Study (year) (reference) | Outcome measures | Intervention | Control | Intervention | Control | Effect size |
| Randomized controlled trials | ||||||
| Weight (kg) | ||||||
| Aldana et al. (2005) (45) | Weight (kg) | n = 6689.3 kgSD not reported | n = 7985.9kgSD not reported | 6 wk: n = 626 mo: n = 616 wk: 86.4 kg6 mo: 84.9 kgSD not reported | 6 wk: n = 796 mo: n = 766 wk: 85.5kg6 mo: 84.9kgSD not reported | 6 wk: int: −2.9 kg vs. −0.4 kg in cont (P < 0.0001) 6 mo: int: −4.4 kg vs. −1 kg in cont (P < 0.0001) |
| Choy et al. (2017) (57) | Weight (kg) | n = 2071.89 (11.57) kg | n = 2271.19 (11.31) kg | n = 2070.91 (11.86) kg | n = 2270.88 (11.45) kg | Int: −0.98 kg vs. −0.3 kg in cont (P not reported) |
| Leedo et al. (2017) (24) | Weight (kg) | n = 5970.4 (10.6) kg | n = 5970.4 (10.6) kg | n = 5970.3 (10.8) kg | n = 5970.3 (11) kg | Int: −0.1 kg vs. −0.1 kg in cont (P = 0.461) |
| Lowe et al. (2010) (47) | Weight (kg) | n = 4785.5 (16.2) kg | n = 4978.7 (21) kg | n = 473 mo: 85.9 (16.8) kg6 mo: 86.7 (16.8) kg12 mo: 86.3 (16.9) kg | n = 493 mo: 79.1 (20.5) kg6 mo: 79.6 (20.6) kg12 mo: 80.2 (22) kg | 3 mo: int.: +0.4 kg vs. +0.4 kg in cont6 mo: int: +1.2 kg vs. +0.9 kg in cont12 mo: int: +0.8 kg vs. +1.5 kg in contP not reported |
| Racette et al. (2009) (23) | Weight (kg) | n = 6892.4 (24.9) kg | n = 5584.5 (20.9) kg | n = 6891.6 (25.5) kg | n = 5585.1 (23.2) kg | Int: −0.8 kg vs. +0.6 kg in cont (P = 0.02) |
| Tate et al. (2009) (49) | Weight (kg) | n = 4677.4 (9.4) kg | n = 4578.8 (11.6) kg | n = 333 mo: 73.4 kg6 mo: 73.3 kgSD not reported | n = 323 mo: 77.1 kg6 mo: 77.2 kgSD not reported | 3 mo: int: −4 kg vs. −1.7 kg in cont (P = 0.001)6 mo: int: −4.1 kg vs. −1.6 kg in cont (P = 0.04) |
| BMI | ||||||
| Aldana et al. (2005) (45) | BMI (kg/m²) | n = 6632.1 kg/m²SD not reported | n = 7931. kg/m²SD not reported | 6 wk: n = 626 mo: n = 616 wk: 31 kg/m²6 mo: 30.5 kg/m²SD not reported | 6 wk: n = 796 mo: n = 766 wk: 31.1 kg/m²6 mo: 31.27 kg/m²SD not reported | 6 wk: int: −1.1 kg/m2 vs. −0.2 in cont (P < 0.0001)6 mo: int: −1.6 vs. −0.03 in cont (P < 0.0001) |
| Brug et al. (1999) (55) | BMI (kg/m²) | n = 15224.2 kg/m²SD not reported | n = 16323.9 kg/m²SD not reported | n = 152N/ASD not reported | n = 163N/ASD not reported | Not reported |
| Choy et al. (2017) (57) | BMI (kg/m²) | n = 2028.59 (2.78) kg/m² | n = 2228.95 (3.67) kg/m² | n = 2028.19 (3.01) kg/m² | n = 2228.84 (3.84) kg/m² | Int: −0.4 kg/m2 vs. −0.11 in cont (P not reported) |
| Cockcroft et al. (1994) (53) | BMI (kg/m²) | n = 4024.9 kg/m²SD not reported | n = 4324.48 kg/m²SD not reported | n = 4024.36 kg/m²SD not reported | n = 4324.49 kg/m²SD not reported | Int: −0.54 kg/m² vs. +0.01 in cont (P = 0.025) |
| Gomel et al. (1993) (19) | BMI (kg/m²) | Education: n = 82Behavioral counseling (BC): n = 124BC + incentives: n = 95Education: 25.5 (3.7) kg/m²BC: 25.5 (4) kg/m2BC + incentives: 25.7 (3.9) kg/m² | n = 13025.2 (3.8) kg/m² | Not reported | Not reported | BMI increased over all assessment conditions (P = 0.04) |
| Leedo et al. (2017) (24) | BMI (kg/m²) | n = 5924.1 (3.5) kg/m² | n = 5924.1 (3.5) kg/m² | n = 5924.1 (3.6) kg/m² | n = 5924.07 (3.6) kg/m² | Int: 0 change vs. −0.3 kg/ m² in cont (P = 0.96) |
| Lusczynska and Haynes (2009) (54) | BMI (kg/m²) | n = 104 (int and cont)26.07 (4.96) kg/m² | n = 78 (int and cont)26.07 (4.96) kg/m² | n = 104 (ITT)25.74 (4.33) kg/m² | n = 78 (ITT)27.18 (5.51) kg/m² | Int: −0.33 vs. +1.11 in cont |
| Racette et al. (2009) (23) | BMI (kg/m²) | n = 6834.5 (9.7) kg/m² | n = 5531.1 (7.2) kg/m² | n = 6834.1 (9.8) kg/m² | n = 5531.2 (7.9) kg/m² | Int: −0.4 kg/m² vs. +0.1 in cont (P = 0.02) |
| Blood pressure: systolic and diastolic (mmHg) | ||||||
| Aldana et al. (2005) (45) | Blood pressure (mmHg)SystolicDiastolic | n = 66Systolic: 126.5 mmHgDiastolic: 77.6 mmHgSD not reported | n = 79Systolic: 124.6 mmHgDiastolic: 75.6 mmHgSD not reported | 6 wk: n = 626 mo: n = 616 wk: systolic: 119.3 mmHg6 wk: diastolic: 72.7 mmHg6 mo: systolic: 120.6 mmHg6 mo: diastolic: 71.1 mmHgSD not reported | 6 wk: n = 796 mo: n = 766 wk: systolic: 119.2 mmHg6 wk: diastolic: 73 mmHg6 mo: systolic: 120.7 mmHg6 mo: diastolic: 71.8 mmHgSD not reported | Systolic, 6 wk: int: −7.2 mmHg vs. −5.4 mmHg in cont (P = 0.3028)Diastolic, 6 wk: int: −4.9 mmHg vs. −2.6 mmHg in cont (P = 0.0819)Systolic, 6 mo: int.: −5.9 mmHg vs. −3.9 mmHg in cont (P = 0.305)Diastolic, 6 mo: int: −6.5 mmHg vs. −3.8 mmHg in cont (P = 0.0506) |
| Gomel et al. (1993) (19) | Blood pressureSystolicDiastolic | Education: n = 82Behavioral counseling (BC): n = 124BC + incentives: n = 95Education: systolic: 127.6 (11.6) mmHgDiastolic: 82.6 (9.3) mmHgBC: systolic: 130.1 (12.6) mmHgDiastolic: 81.1 (11.5) mmHgBC + incentives: systolic: 124.6 (12.5) mmHg Diastolic: 81.5 (11.1) mmHg | n = 130Systolic: 126.1 (12.3) mmHgDiastolic: 96.5 (9.4) mmHg | Not reported | Not reported | Short-term decrease followed by an increase in mean blood pressure for BC + incentives vs. BC (P = 0.01)12 mo: decline in mean blood pressure for BC vs. BC + incentives (P = 0.0002) |
| Racette et al. (2009) (23) | Blood pressure (mmHg)SystolicDiastolic | n = 68Systolic: 127 (11) mmHgDiastolic: 84 (11) mmHg | n = 55Systolic:121 (15)Diastolic: 79 (10) | n = 68Systolic: 121(16)Diastolic: 77 (9) | n = 55Systolic: 116 (18)Diastolic: 75 (11) | Systolic: int: −6 mmHg vs. −5 mmHg in cont (P < 0.01 across sites)Diastolic: −7 mmHg vs. −4 mmHg in cont (P < 0.01 across sites) |
| Serum cholesterol (total, HDL, LDL, TG) (mg/dL) | ||||||
| Aldana et al. (2005) (45) | Total cholesterol (mg/dL)HDL (mg/dL)LDL (mg/dL)TG (mg/dL) | n = 66199.6 mg/dL45.8 mg/dL128.4 mg/dL126.3 mg/dLSD not reported | n = 79185.8 mg/dL45.2 mg/dL120.4 mg/dL100.7 mg/dLSD not reported | 6 wk: n = 626 mo: n = 616 wk: 183.6 mg/dL6 mo: 200.4 mg/dL6 wk: 42.7 mg/dL6 mo: 46.1 mg/dL6 wk: 116.1 mg/dL6 mo: 131 mg/dL6 wk: 123.1 mg/dL6 mo: 116.7 mg/dLSD not reported | 6 wk: n = 796 mo: n = 766 wk: 196.2 mg/dL6 mo: 199.5 mg/dL6 wk: 49.4 mg/dL6 mo: 49.6 mg/dL6 wk: 127.6 mg/dL6 mo: 130.1 mg/dL6 wk: 96 mg/dL6 mo: 99.5 mg/dLSD not reported | Total:6 wk: int: −16 mg/dL vs. +10.4 mg/dL in cont (P < 0.0001)6 mo: int: +0.8 mg/dL vs. +13.7 mg/dL in cont (P = 0. 0153)HDL6 wk: int: −3.1 mg/dL vs. +4.2 mg/dL in cont (P = 0.0001)6 mo: int: +0.3 vs +4.4 mg/dL in cont (P = 0.0006)LDL6 wk: int: −12.3 mg/dL vs. +7.2 mg/dL in cont (P = <0.0001)6 mo: int: +2.6 mg/dL vs. +9.7 mg/dL in cont (P = 0.1237)TGs6 wk: int: −3.2 mg/dL vs. −4.7 mg/dL in cont (P = 0.8599)6 mo: int: −9.6 mg/dL vs. −1.2 mg/dL in cont (P = 0. 4411) |
| Barratt et al. (1994) (56) | Total cholesterol (mg/dL) | n = 668 (total)Self-help: 231.3 mg/dLNutrition course: 237.8 mg/dLSD not reported | n = 668 (total)224.7 mg/dLSD not reported | 3 mo: n = 4176 mo: n = 430Self-help:3 mo: 229.3 mg/dL6 mo: 230.53 mg/dLNutrition course:3 mo: 240.11 mg/dL6 mo: 235.8 mg/dLSD not reported | 3 mo: n = 4176 mo: n = 4303 mo: 222 mg/dL6 mo: 224.3 mg/dLSD not reported | Self-help:3 mo: int: −1.93 mg/dL vs. −2.7 mg/dL in cont6 mo: int: −0.77 mg/dL vs. −3.8 mg/dL in cont Nutrition course:3 mo: int: +2.31 mg/dL vs. −2.7 mg/dL in cont6 mo: int: −1.93 mg/dL vs. −3.8 mg/dL in cont |
| Choy et al. (2017) (57) | Total cholesterol (mg/dL)HDL (mg/dL)LDL (mg/dL) | n = 20197.2 (31.6) mg/dL55.5 (15.05) mg/dL122.7 (29.7) mg/dL | n = 22215.8 (38.6) mg/dL50.1 (10.4) mg/dL140.9 (33.6) mg/dL | n = 20193 (37.4) mg/dL51.3 (11.96)116.6 (35.5) mg/dL | n = 22210 (40.9) mg/dL49.8 (10) mg/dL135.9 (30.9) mg/dL | Total: int.: −4.2 mg/dL vs. −5.8 mg/dL in contHDL: int: −4.2 mg/dL vs. −0.3 mg/dL in contLDL: int: −6.1 mg/dL vs. −5 mg/dL in cont |
| Gomel et al. (1993) (19) | Total cholesterol (mg/dL) | Education: n = 82Behavioral counseling (BC): n = 124BC + incentives: n = 95Education: 196.9 (30.8) mg/dLBC: 199.3 (42.3) mg/dLBC + incentives: 192.3 (38.5) mg/dL | n = 130198.7 (42.3) mg/d | Not reported | Not reported | “No significant change”P not reported |
| Lowe et al. (2010) (47) | Total cholesterol (mg/dL)HDL (mg/dL)LDL (mg/dL)TG (mg/dL) | n = 47192.4 (32.4) mg/dL58.4 (16.6) mg/dL115.4 (31.6) mg/dL92.9 (42.2) mg/dL | n = 49204.1 (41.8) mg/dL58.7 (19.5) mg/dL124.1 (34.4) mg/dL106.5 (68.1) mg/dL | n = 47201.8 (28.9) mg/dL60.9 (16.6) mg/dL121.5 (31.3) mg/dL96.8 (41.9) mg/dL | n = 49197.4 (42.3) mg/dL57 (16.9) mg/dL120.1 (37.4) mg/dL101.6 (45) mg/dL | Int.: +9.4 mg/dL vs. −6.7 mg/dL (P = 0.05)Int: +2.5 mg/dL vs. −1.7 in cont (P = 0.05)Int: +6.1 mg/dL vs. +3 mg/dL in cont (P = 0.08)Int: +3.9 mg/dL vs. −4.9 mg/dL in cont (P = 0.67) |
| Racette et al. (2009) (23) | Total cholesterol (mg/dL)HDL (mg/dL)LDL (mg/dL)TG (mg/dL) | n = 68200 (32) mg/dL56 (16) mg/dL121 (27) mg/dL116 (62) mg/dL | n = 55199 (40) mg/dL54 (17) mg/dL121 (35) mg/dL115 (59) mg/dL | n = 68192 (32) mg/dL62 (18) mg/dL106 (26) mg/dL118 (60) mg/dL | n = 55195 (36) mg/dL61(18) mg/dL109 (32) mg/dL122 (63) mg/dL | Total: int: −8 mg/dL vs. −4 mg/dL in cont (P < 0.01 across sites)HDL: int: +6 mg/dL vs. +7 mg/dL in cont (P < 0.01) across sitesLDL: int: −15 mg/dL vs. −12 mg/dL in cont (P < 0.01) across sitesInt: +2 mg/dL vs. +7 mg/dL in cont (P = 0.29) |
| Baseline measure (SD) and number (n) | Final/follow-up measure (SD) and number (n) | |||||
|---|---|---|---|---|---|---|
| Study (year) (reference) | Outcome measures | Effect size | ||||
| Nonrandomized controlled trials: quasi-experimental | ||||||
| Nepper et al. (2020) (26) | BMI (kg/m²)Weight (kg)Blood pressureSystolicDiastolic(mmHg)Total cholesterolHDLLDLTG(mg/dL) | n = 4137.7 (6.7) kg/m²101.69 (18.58) kgSystolic: 122.2 (16) mmHgDiastolic: 76 (8.9) mmHg188.8 (8) mg/dL55.9 (5.4) mg/dL107.4 (7) mg/dL26.2 (8.5) mg/dL | n = 4135.1 (6.4) kg/m²95.98 (18.58) kgSystolic: 116.5 (17.2) mmHgDiastolic: 68.7 (9.6) mmHg180.6 (8.1) mg/dL60.6 (5.4) mg/dL95 (7.2) mg/dL117.2 (8.7) mg/dL | −2.6 kg/m² from baseline.P < 0.0001 (unadjusted)−5.71 kg from baseline (P < 0.0001)Systolic: −5.7 mmHg from baseline (P = 0.07, unadjusted; 0.16, adjusted)Diastolic: −7.3 mmHg from baseline (P = 0.001, unadjusted; 0.005, adjusted)Total cholesterol:−8.2 mg/dL from baselineP = 0.2 (unadjusted), 0.08 (adjusted).HDL:+4.7 mg/dL from baselineP = 0.33 (unadjusted), 0.32 (adjusted)LDL:−12.4 mg/dL from baselineP = 0.08 (unadjusted), 0.17 (adjusted)TGs:−9 mg/dL from baselineP = 0.22 (unadjusted), 0.13 (adjusted) | ||
| Nonrandomized controlled trial: longitudinal | ||||||
| Winick et al. (2002) (51) | Weight (kg) | M: n = 18101.82 (17) kgF: n = 13282.95 (17.4) kg | M: n = 1595.45 (18.45) kgF: n = 8178.6 (18) kg | M: −6.37 kg from baselineF: −4.35 kg from baselineP values not reported | ||
| Nonrandomized controlled trials: pre- and post-test | ||||||
| Weight (kg) | ||||||
| Hussain et al. (2018) (36) | Weight (kg) | n = 13185.09 (11.85) kg | n = 13180.5 (12.25) kg | −4.59 kg from baseline (P < 0.001) | ||
| Lahiri and Faghri (2012) (40) | Weight (kg) | Incentivized:n = 35NRNon-incentivized:n = 37NR | Incentivized:n = 35NRNon-incentivized:n = 37NR | Incentivized: −3.31 kg vs. −0.95 kg in non-incentivized (P = 0.01) | ||
| Rigsby et al. (2009) (42) | Weight (kg) | Individuals participating as a group: n = 4289.40 (25.85) kgIndividuals participating individually: n = 3093.07 (22.86) kg | Individuals participating as a group: n = 4285.95 (25.76) kgIndividuals participating individually: n = 3091.26 (22.68) kg | Group: −3.45 kg from baselineIndividual: −1.81 kg from baselineP values not reported “Decreased significantly” | ||
| Ross and Wing (2016) (43) | Weight (kg) | n = 7586.42 (1.94) kg | 3 mo: n = 7080.64 (5.01) kg6 mo: n = 6781.74 (2.53) kg | 3 mo: −5.78 kg from baseline (P < 0.001)3–6 mo: +1.1 kg (P = 0.009)0–6 mo: −4.68 kg (P <0.0001) | ||
| Torquati et al. (2018) (34) | Weight (kg) | n = 4776.3 (17.3) kg | 3 mo: n = 276 mo: n = 123 mo: 76.2 (17.1) kg6 mo: 70.4 (15.7) kg | 3 mo: −0.1 kg from baseline.3–6 mo: −5.8 kgP values not reported. Weight not addressed. | ||
| Townsend et al. (2018) (50) | Weight (kg) | Health centers:81.09 (14.47) kgHealth systems:88.98 (23.83) kg | Health centers:79.37 (23.2) kgHealth systems:87.14 (23.2) kg | Health centers: −1.72 kg from baseline (P = 0.001)Health centers: −1.84 kg from baseline (P = 0.001) | ||
| BMI | ||||||
| Hussain et al. (2018) (36) | BMI (kg/m²) | n = 13134.56 (4.23) kg/m² | n = 13132.86 (4.18) kg/m² | −1.71 kg/m² from baseline (P < 0.001) | ||
| Rigsby et al. (2009) (42) | BMI (kg/m²) | Individuals participating as a group: n = 4232.3 (9.8) kg/m²Individuals participating individually: n = 3034.6 (8.4) kg/m² | Individuals participating as a group: n = 4230.9 (9.8) kg/m²Individuals participating individually: n = 3033.8 (8.3) kg/m² | Group:−1.4 kg/m² from baseline.P: NR; “decreased significantly”Individual:−0.8 kg/m² from baseline.P: NR; “decreased significantly” | ||
| Scapellato et al. (2018) (44) | BMI (kg/m²) | n = 16727.1 (4.3) kg/m² | n = 16726.9 (4.4) kg/m² | −0.2 kg/m² from baselineP = 0.03 | ||
| Torquati et al. (2018) (34) | BMI (kg/m²) | n = 4728.3 (6.1) kg/m² | 3 mo: n = 276 mo: n = 123mo: 28.2 (6) kg/m²6 mo: 26.1 (5.7) kg/m² | 3 mo: −1 kg/ m² from baseline. P: NR..3–6 mo: −2.1 kg/m² from baseline. P: NR. | ||
| Townsend et al. (2018) (50) | BMI (kg/m²) | Health centers: n = 6431.38 (5.7) kg/m²Health systems: n = 3134.16 (7.61) kg/m² | Health centers: n = 6430.72 kg/ m²SD: NRHealth systems: n = 3133.45 kg/ m²SD: NR | Health centers: −0.66 kg/m² from baseline (P not reported)Health systems:−0.71 kg/ m² from baseline (P not reported).P values not reported; “not significant” | ||
| Blood pressure: systolic and diastolic (mmHg) | ||||||
| Scapellato et al. (2018) (44) | Blood pressureSystolicDiastolic(mmHg) | n = 167Systolic: 129.9 (13.4) mmHgDiastolic: 83 (7.6) mmHg | n = 167Systolic: 125.4 (13.4) mmHgDiastolic: 80.5 (8.7) mmHg | Systolic: −5.5 mmHg from baseline (P < 0.001)Diastolic: −2.5 mmHg from baseline (P < 0.001) | ||
| Torquati et al. (2018) (34) | Blood pressureSystolicDiastolic(mmHg) | n = 47Systolic: 114.9 (15.2) mmHgDiastolic: 78 (10.1) mmHg | 3 mo: n = 276 mo: n = 123 mo: Systolic: 114.4 (14.1) mmHg; diastolic: 76.8 (10.1) mmHg6 mo: Systolic: 112.6 (13.6) mmHg; diastolic: 74.1 (8.1) mmHg | 3 mo:Systolic: −0.5 mmHg from baselineDiastolic: −1.2 mmHg from baseline3–6 mo:Systolic: −1.8 mmHgDiastolic: −2.7 mmHgP values not reported | ||
| Townsend et al. (2018) (50) | Blood pressureSystolicDiastolic(mmHg) | Health centers:Systolic: 122.2 (15.58) mmHgDiastolic: 78.87 (10.29) mmHgHealth systems:Systolic: 126.68 (16.46) mmHgDiastolic: 80.56 (9.45) mmHg | Health centers:Systolic: 123.1 (11.1) mmHgDiastolic: 77.39 (7.37) mmHgHealth systems:Systolic: 121.87 (13.83) mmHgDiastolic: 78.28 (8.18) mmHg | Health centers:Systolic: +0.97 mmHgDiastolic: −1.48 mmHgHealth systems:Systolic: −4.81 mmHgDiastolic: −2.19 mmHgP values not reported; “not significant” | ||
| Serum cholesterol (total, HDL, LDL, TGs) (mg/dL) | ||||||
| Scapellato et al. (2018) (44) | Total cholesterolHDLLDLTG(mg/dL) | n = 167Total cholesterol:216.1 (31.9) mg/dLHDL:58.9 (16) mg/dLLDL:146.1(28.5) mg/dLTGs:113.8 (57.8) mg/dL | n = 167Total cholesterol:203.9 (31.4) mg/dLHDL:55.5 (14.5) mg/dLLDL:137.3 (29.6) mg/dLTGs:112.8 (89) mg/dL | Total cholesterol:−12.2 mg/dL from baselineP < 0.001HDL:−3.4 mg/dL from baselineP < 0.001LDL:−8.8 mg/dL from baselineP < 0.001TGs:−1 mg/dL from baseline.P = 0.87 | ||
Cont, control; EI, energy intake; Int, intervention; ITT, intention to treat; NR, not reported; TG, triglyceride.