Effects of weight control interventions on cardiovascular outcomes: an umbrella review of systematic reviews and meta-analyses.

Abstract

Background: Obesity and overweight are major risk factors for cardiovascular diseases. Although various weight control interventions have been evaluated individually, their comparative effectiveness across outcomes and populations remains uncertain.

Objectives: To evaluate the effects of weight control interventions on all-cause mortality and cardiovascular outcomes.

Methods: A comprehensive search was conducted in PubMed, Embase, Web of Science, and the Cochrane Library from inception to June 2024. Meta-analyses reporting pooled effect sizes for all-cause mortality or cardiovascular outcomes were included. Reviews without quantitative synthesis were excluded. Risk of bias and methodological quality were assessed using A Measurement Tool to Assess Systematic Reviews and the Grading of Recommendations Assessment, Development and Evaluation approach. No new meta-analysis was conducted, relevant data were re-analyzed when required to ensure consistency. This review was registered in PROSPERO (CRD42024573542).

Results: Forty-seven effect sizes from 31 articles were extracted. Among pharmacologic interventions, high- to moderate-quality evidence showed that glucagon-like peptide-1 receptor agonists (GLP1-RAs) were associated with reduced all-cause mortality, major adverse cardiovascular events, stroke, cardiovascular mortality, myocardial infarction, and heart failure among individuals with type 2 diabetes or overweight/obesity. Bariatric surgery was consistently associated with reduced risks for all cardiovascular outcomes except atrial fibrillation. For dietary strategies, low-fat diets were linked to lower all-cause mortality, while Mediterranean and Nordic diets showed benefits for stroke and cardiovascular mortality. Physical activity was associated with reduced all-cause and cardiovascular mortality. Comprehensive lifestyle interventions showed no significant cardiovascular benefit. Most evidence was of moderate or low certainty due to methodological limitations, including bias, imprecision, and inconsistency.

Conclusion: Weight control interventions are associated with improved all-cause mortality and cardiovascular outcomes. High- to moderate-quality evidence supported benefits of GLP1-RAs in individuals with type 2 diabetes or overweight. Dietary, surgical, and exercise interventions showed modest effects. No consistent cardiovascular benefit was observed for comprehensive lifestyle interventions. Weight Control Interventions and Cardiovascular Outcomes. Associations between five categories of weight control interventions-pharmacological interventions, bariatric surgery, dietary interventions, exercise interventions, and comprehensive lifestyle interventions-and seven cardiovascular outcomes are illustrated. Beneficial associations are indicated in pink, and interventions with no observed associations are shown in green. Created in BioRender. Chen, X. (2025) https://BioRender.com/km8jw8h .