Weight Neutral Behavioral Approaches to Type 2 Diabetes Management: A Systematic Review

Weight loss as the primary strategy for diabetes management is often unsuccessful long-term. Interventions can lead to poor mental health and quality of life for individuals due to weight cycling.

The objective of this systematic review was to investigate the effect of weight-neutral approaches for type 2 diabetes management.

APA PsycInfo (EBSCOhost), CINAHL (EBSCOhost), Embase.com (Elsevier), Health Source: Nursing/Academic (EBSCOhost), PubMed, and Web of Science Core Collection (Clarivate) were searched for studies published between January 1, 2000, and May 31, 2022.

Data extraction was conducted using structured narrative synthesis, vote counting, and the Synthesis Without Meta-analysis reporting framework. The inclusion criteria were studies involving humans aged 13 and older and focusing on dietary and/or physical activity interventions. Studies were excluded when caloric restriction or weight loss was the primary objective.

Risk of bias was assessed using the Cochrane Risk of Bias and ROBINS-1 tools.

Of the 3001 articles screened, 243 full texts were assessed, and 55 articles were included. The interventions were categorized into standard Diabetes Self-Management Education (DSME; 23 studies, 4563 participants), Diet and Exercise (23 studies, 3376 participants), and Other (9 studies, 2591 participants), which included comprehensive and motivational interviewing interventions. Among these, 21 studies were rated as having a low risk of bias and 14 were rated as high in methodological quality. DSME without weight loss showed statistically significant improvements by 6 months (effect sizes 0.12-1.02). Diet-only interventions generally did not improve glycemic outcomes. Of the 16 studies involving diet-only interventions, 3 showed significant improvement in glycemic outcomes; 3 of the 5 studies involving exercise-only interventions and both of the studies involving combined interventions also showed significant improvement in glycemic outcomes. Weight-neutral strategies can improve diabetic outcomes, but sustained behavior changes are more effective. These behavior changes require ongoing support and education, and involve improvements in diet quality and physical activity. Healthcare providers may adopt and personalize these strategies to support improvement in patient outcomes and quality of life.

PROSPERO registration No. CRD42022333792.