A Systematic Review of Behavioral Interventions for Obesity: Challenges for Social Work Research and Practice

Background and Purpose: Obesity is a significant behavioral health issue, presenting a unique social challenge for social workers and mental health professionals throughout the country. Nearly 69% of American adults (over 20) are considered overweight (BMI ≥ 25), and nearly 35% of these individuals are considered obese (BMI ≥ 30) with higher rates found in economically disadvantaged populations (e.g., African Americans). Adult obesity is associated with multiple deleterious outcomes including increased risk of hypertension, stroke, fatty liver disease, type-2 diabetes, depression, anxiety, decreased self-esteem, reduced longevity, and increased risk of mortality. However, few social work studies have addressed this issue. The present study synthesized behavioral health interventions for adult obesity found in recent meta-analyses and systematic reviews (MAs/SRs), as well as in randomized-controlled trials (RCTs) with two aims: (a) to identify primary (physical) and secondary (psychosocial) outcomes; and to (b) identify and evaluate the use of social workers and other mental health professionals within these interventions.

Methods: Two different search strategies across 31 databases were employed targeting MAs/SRs and RCTs separately. Additional electronic searches were conducted in the journals Obesity Reviews and Obesity. Reference lists of included studies were also examined. English-language, peer-reviewed journal articles were included if (a) published between January 1, 2004 and May 1, 2014 and (b) examined behavioral health interventions for adults (over 18) facing obesity. Data (e.g., study design, participants, measures) were extracted by the primary author (SGP), sample verified for accuracy by the fourth author (SEA), and compiled in table form for examination (MAs/SRs, n = 5; RCTs, n = 9)

Results: Regarding Aim 1, behavioral health interventions were associated with modest, positive primary outcomes including reduction in weight and waist circumference despite vast heterogeneity across samples, methods, and measures. However, long-term sustainability remained unexplored. Regarding Aim 2, none of the included studies indicated that social workers were used as behavioral health interventionists. Of all studies (n =14), many did not mention interventionist profession or training or indicated no interventionist was used (i.e., web-based training; n =5). Three studies provided general descriptions of varied interventionist expertise, two studies utilized nutritionists or registered dieticians, and two studies utilized graduate students. Only two studies indicated that mental health professionals were used as interventionists (psychologists).

Implications: A mere two of the fourteen included studies utilized mental health professionals in the intervention of adult obesity and neither study employed social workers. The causes and correlates of adult obesity are multifaceted. Therefore, responses to adult obesity should be similarly multi-systemic and include targeted interventions at the micro, mezzo, and macro levels—the very responses social workers are trained to embody. Behavioral health interventions that incorporate varying strategies for sustainability could hold promise for social work intervention with adults facing obesity, yet the results of this study indicate little examination of this unique skill set is being explored. Future research must investigate the role of mental health professionals, specifically social workers, in addressing adult obesity.