Interventions to prevent or treat obesity in adult Indigenous Australians: A systematic review

BACKGROUND: Aboriginal and Torres Strait Islander (Indigenous) Australians experience a disproportionately higher prevalence of obesity compared with non-Indigenous Australians. We aimed to describe existing research into lifestyle, pharmacological or surgical interventions for preventing or treating obesity in Indigenous Australians.

METHODS: A systematic review of published and grey literature was performed. Medline, Embase, Emcare (on the OVID platform), Web of Science and website searches were conducted to April 2024. Observational and randomised studies of adult Indigenous Australians were included if an intervention was implemented to prevent and/or treat obesity and post-intervention results were reported. The PRISMA systematic review reporting methods was used to collate data.

RESULTS: Of 1019 records screened, 17 were included; most described educational initiatives or lifestyle programs for improving diet and exercise. There were no reports of pharmacotherapies for weight management. The effect of lifestyle programs on weight reduction was modest (∼2-4 kg after 4-12 months). There were five reports on short-term (12 week) structured exercise programs. Two non-randomised studies of structured exercise showed reduction in weight in the highest weight groups whilst the two randomised trials showed ∼2 kg weight reduction compared with control. One observational study described mean ∼26 kg weight reduction at two years after laparoscopic adjustable gastric banding in 26 Indigenous Australians.

CONCLUSIONS: Community-based lifestyle interventions to manage excess weight can be successfully conducted in Indigenous Australians, but with generally limited efficacy. Providing background community-based lifestyle programs may facilitate the conduct of randomised trials of newer, effective anti-obesity pharmacotherapy in this high priority population.