Idiopathic intracranial hypertension (IIH) is associated with obesity; however, there is a lack of clinical consensus on how to manage weight in IIH. The aim of this systematic review was to evaluate weight loss interventions in people with IIH to determine which intervention is superior in terms of weight loss, reduction in intracranial pressure (ICP), benefit to visual and headache outcomes, quality of life, and mental health.

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered with PROSPERO (CRD42023339569). MEDLINE and CINAHL were searched for relevant literature published from inception until December 15, 2022. Screening and quality appraisal was conducted by 2 independent reviewers. Recommendations were graded using Scottish Intercollegiate Guidelines Network methodology.

A total of 17 studies were included. Bariatric surgery resulted in 27.2–27.8 kg weight loss at 24 months (Level 1– to 1++). Lifestyle weight management interventions resulted in between 1.4 and 15.7 kg weight loss (Level 2+ to 1++). Bariatric surgery resulted in the greatest mean reduction in ICP (–11.9 cm H₂O) at 24 months (Level 1++), followed by multicomponent lifestyle intervention + acetazolamide (–11.2 cm H₂O) at 6 months (Level 1+) and then a very low-energy diet intervention (–8.0 cm H₂O) at 3 months (Level 2++). The least ICP reduction was shown at 24 months after completing a 12-month multicomponent lifestyle intervention (–3.5 cm H₂O) (Level 1++). Reduction in body weight was shown to be highly correlated with reduction in ICP (Level 2++ to 1++).

Bariatric surgery should be considered for women with IIH and a body mass index (BMI) ≥35 kg/m² since this had the most robust evidence for sustained weight management (grade A). A multicomponent lifestyle intervention (diet + physical activity + behavior) had the most robust evidence for modest weight loss with a BMI <35 kg/m² (grade B). Longer-term outcomes for weight management interventions in people with IIH are required to determine whether there is a superior weight loss intervention for IIH.

特发性颅内高压（IIH）与肥胖有关；然而，对于如何控制 IIH 患者的体重尚缺乏临床共识。本系统评价的目的是评估 IIH 患者的减肥干预措施，以确定哪种干预措施在减肥、降低颅内压 (ICP)、对视力和头痛结果的益处、生活质量和心理健康方面更优越。

根据系统评价和荟萃分析指南的首选报告项目进行系统评价，并在 PROSPERO 注册（CRD42023339569）。MEDLINE 和 CINAHL 检索了从成立到 2022 年 12 月 15 日发表的相关文献。筛选和质量评估由 2 名独立评审员进行。使用苏格兰校际指南网络方法对建议进行评分。

总共纳入了 17 项研究。减肥手术导致 24 个月时体重减轻 27.2–27.8 公斤（1 级至 1++ 级）。生活方式体重管理干预措施导致体重减轻 1.4 至 15.7 公斤（2+ 至 1++ 级）。_{减肥手术在 24 个月时使 ICP (–11.9 cm H 2} O)平均降低幅度最大(1++ 级)，其次是在 6 个月时采用多组分生活方式干预 + 乙酰唑胺 (–11.2 cm H ₂ O) (1+ 级) ），然后在 3 个月时进行极低能量饮食干预（–8.0 cm H ₂ O）（2++ 级）。_{完成为期 12 个月的多组分生活方式干预 (–3.5 cm H 2} O)后 24 个月时，ICP 降低幅度最小（1++ 级）。体重减轻与 ICP 降低高度相关（2++ 至 1++ 级）。

^{对于患有 IIH 且体重指数 (BMI) ≥35 kg/m 2}的女性，应考虑减肥手术，因为这具有持续体重管理的最有力证据（A 级）。^{多成分生活方式干预（饮食+体力活动+行为）对于BMI <35 kg/m 2}的适度体重减轻有最有力的证据（B 级）。需要对 IIH 患者进行体重管理干预的长期结果来确定是否存在针对 IIH 的更好的减肥干预措施。