This systematic review and network meta‐analysis synthesized evidence on the effects of third‐wave cognitive behaviour therapies (3wCBT) on body weight, and psychological and physical health outcomes in adults with overweight or obesity. Studies that included a 3wCBT for the purposes of weight management and measured weight or body mass index (BMI) pre‐intervention and ≥ 3 months post‐baseline were identified through database searches (MEDLINE, CINAHL, Embase, Cochrane database [CENTRAL], PsycINFO, AMED, ASSIA, and Web of Science). Thirty‐seven studies were eligible; 21 were randomized controlled trials (RCT) and included in the network meta‐analyses. Risk of bias was assessed using RoB2, and evidence quality was assessed using GRADE. Random‐effects pairwise meta‐analysis found moderate‐ to high‐quality evidence suggesting that 3wCBT had greater weight loss than standard behavioural treatment (SBT) at post‐intervention (standardized mean difference [SMD]: −0.09, 95% confidence interval [CI]: −0.22, 0.04; N = 19; I² = 32%), 12 months (SMD: −0.17, 95% CI: −0.36, 0.02; N = 5; I² = 33%), and 24 months (SMD: −0.21, 95% CI: −0.42, 0.00; N = 2; I² = 0%). Network meta‐analysis compared the relative effectiveness of different types of 3wCBT that were not tested in head‐to‐head trials up to 18 months. Acceptance and commitment therapy (ACT)‐based interventions had the most consistent evidence of effectiveness. Only ACT had RCT evidence of effectiveness beyond 18 months. Meta‐regression did not identify any specific intervention characteristics (dose, duration, delivery) that were associated with greater weight loss. Evidence supports the use of 3wCBT for weight management, specifically ACT. Larger trials with long‐term follow‐up are needed to identify who these interventions work for, their most effective components, and the most cost‐effective method of delivery.

中文翻译：

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用于体重管理的第三波认知行为疗法：系统评价和网络荟萃分析。


这项系统综述和网络荟萃分析综合了第三波认知行为疗法（3wCBT）对超重或肥胖成年人的体重以及心理和身体健康结果的影响的证据。通过数据库搜索（MEDLINE、CINAHL、Embase、Cochrane 数据库 [CENTRAL]、PsycINFO）确定了包括以体重管理为目的的 3wCBT 以及干预前和基线后 ≥ 3 个月测量体重或体重指数 (BMI) 的研究、AMED、ASSIA 和 Web of Science）。 37 项研究符合条件； 21 项是随机对照试验 (RCT)，并纳入网络荟萃分析。使用 RoB2 评估偏倚风险，并使用 GRADE 评估证据质量。随机效应成对荟萃分析发现中等到高质量的证据表明，干预后 3wCBT 比标准行为治疗 (SBT) 的体重减轻效果更大（标准化均差 [S​​MD]：-0.09，95% 置信区间 [CI ]：-0.22，0.04；N = 19；I ² = 32%），12 个月（SMD：-0.17，95% CI：-0.36，0.02；N = 5；I ² = 33%）和 24 个月（ SMD：-0.21，95% CI：-0.42，0.00；N = 2；I ² = 0%）。网络荟萃分析比较了未在长达 18 个月的头对头试验中测试的不同类型 3wCBT 的相对有效性。基于接受与承诺疗法（ACT）的干预措施具有最一致的有效性证据。只有 ACT 具有超过 18 个月有效性的随机对照试验证据。元回归没有发现任何与体重减轻幅度更大相关的具体干预特征（剂量、持续时间、给药方式）。有证据支持使用 3wCBT 进行体重管理，特别是 ACT。 需要进行更大规模的长期随访试验，以确定这些干预措施的适用对象、最有效的组成部分以及最具成本效益的实施方法。