Objective To determine if the characteristics of behavioural weight loss programmes influence the rate of change in weight after the end of the programme. Design Systematic review and meta-analysis. Data sources Trial registries, 11 electronic databases, and forward citation searching (from database inception; latest search December 2019). Randomised trials of behavioural weight loss programmes in adults with overweight or obesity, reporting outcomes at ≥12 months, including at the end of the programme and after the end of the programme. Review methods Studies were screened by two independent reviewers with discrepancies resolved by discussion. 5% of the studies identified in the searches met the inclusion criteria. One reviewer extracted the data and a second reviewer checked the data. Risk of bias was assessed with Cochrane’s risk of bias tool (version 1). The rate of change in weight was calculated (kg/month; converted to kg/year for interpretability) after the end of the programme in the intervention versus control groups by a mixed model with a random intercept. Associations between the rate of change in weight and prespecified variables were tested. Results Data were analysed from 249 trials (n=59 081) with a mean length of follow-up of two years (longest 30 years). 56% of studies (n=140) had an unclear risk of bias, 21% (n=52) a low risk, and 23% (n=57) a high risk of bias. Regain in weight was faster in the intervention versus the no intervention control groups (0.12-0.32 kg/year) but the difference between groups was maintained for at least five years. Each kilogram of weight lost at the end of the programme was associated with faster regain in weight at a rate of 0.13-0.19 kg/year. Financial incentives for weight loss were associated with faster regain in weight at a rate of 1-1.5 kg/year. Compared with programmes with no meal replacements, interventions involving partial meal replacements were associated with faster regain in weight but not after adjustment for weight loss during the programme. Access to the programme outside of the study was associated with slower regain in weight. Programmes where the intensity of the interaction reduced gradually were also associated with slower regain in weight in the multivariable analysis, although the point estimate suggested that the association was small. Other characteristics did not explain the heterogeneity in regain in weight. Conclusion Faster regain in weight after weight loss was associated with greater initial weight loss, but greater initial weight loss was still associated with reduced weight for at least five years after the end of the programme, after which data were limited. Continued availability of the programme to participants outside of the study predicted a slower regain in weight, and provision of financial incentives predicted faster regain in weight; no other clear associations were found. Study registration PROSPERO CRD42018105744. Data are from published research and therefore are mostly in the public domain. Extracted data are available on request from the corresponding author (jamie.hartmann-boyce{at}phc.ox.ac.uk).

中文翻译：

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行为减肥计划特征与计划结束后体重变化的关联：系统评价和荟萃分析

目的 确定行为减肥计划的特征是否会影响计划结束后的体重变化率。设计系统审查和荟萃分析。数据来源 试验注册、11 个电子数据库和前向引文检索（从数据库开始；最新检索 2019 年 12 月）。超重或肥胖成人行为减肥计划的随机试验，报告≥12 个月的结果，包括计划结束时和计划结束后。审查方法 研究由两名独立审查员筛选，分歧通过讨论解决。搜索中确定的研究中有 5% 符合纳入标准。一位评审员提取数据，另一位评审员检查数据。使用 Cochrane 的偏倚风险工具（版本 1）评估偏倚风险。在干预组与对照组的程序结束后，通过随机截距的混合模型计算体重的变化率（公斤/月；为了可解释性转换为公斤/年）。测试了体重变化率与预设变量之间的关联。结果 数据分析来自 249 项试验 (n=59 081)，平均随访时间为两年（最长 30 年）。56% (n=140) 的偏倚风险不明确，21% (n=52) 为低风险，23% (n=57) 为高偏倚风险。与无干预对照组相比，干预组的体重恢复更快（0.12-0.32 公斤/年），但组间差异至少保持了五年。计划结束时每减轻一公斤体重，体重就会以 0.13-0.19 公斤/年的速度快速恢复。减轻体重的经济激励与以 1-1.5 公斤/年的速度更快地恢复体重有关。与没有代餐的计划相比，涉及部分代餐的干预措施与更快的体重恢复相关，但在计划期间调整体重减轻后则不然。在研究之外访问该计划与体重恢复较慢有关。在多变量分析中，交互强度逐渐降低的项目也与体重恢复较慢有关，尽管点估计表明这种关联很小。其他特征不能解释体重恢复的异质性。结论 体重减轻后体重恢复更快与初始体重减轻幅度更大有关，但在计划结束后至少五年内，初始体重减轻幅度更大仍与体重减轻有关，此后数据有限。对研究之外的参与者继续提供该计划预测体重恢复较慢，提供经济奖励预测体重恢复较快；没有发现其他明确的关联。学习注册 PROSPERO CRD42018105744。数据来自已发表的研究，因此大部分属于公共领域。可向相应作者 (jamie.hartmann-boyce{at}phc.ox.ac.uk) 索取提取数据。但在计划结束后至少五年内，初始体重减轻幅度更大仍与体重减轻有关，此后数据有限。对研究之外的参与者继续提供该计划预测体重恢复较慢，提供经济奖励预测体重恢复较快；没有发现其他明确的关联。学习注册 PROSPERO CRD42018105744。数据来自已发表的研究，因此大部分属于公共领域。可向相应作者 (jamie.hartmann-boyce{at}phc.ox.ac.uk) 索取提取数据。但在计划结束后至少五年内，初始体重减轻幅度更大仍与体重减轻有关，此后数据有限。对研究之外的参与者继续提供该计划预测体重恢复较慢，提供经济奖励预测体重恢复较快；没有发现其他明确的关联。学习注册 PROSPERO CRD42018105744。数据来自已发表的研究，因此大部分属于公共领域。可向相应作者 (jamie.hartmann-boyce{at}phc.ox.ac.uk) 索取提取数据。并提供经济激励措施，预计体重会更快恢复；没有发现其他明确的关联。学习注册 PROSPERO CRD42018105744。数据来自已发表的研究，因此大部分属于公共领域。可向相应作者 (jamie.hartmann-boyce{at}phc.ox.ac.uk) 索取提取数据。并提供经济激励措施，预计体重会更快恢复；没有发现其他明确的关联。学习注册 PROSPERO CRD42018105744。数据来自已发表的研究，因此大部分属于公共领域。可向相应作者 (jamie.hartmann-boyce{at}phc.ox.ac.uk) 索取提取数据。