Abstract
BackgroundScholars have documented presumptions regarding the relationships between diet, exercise, weight, and type 2 diabetes. However, it is unclear to what extent researchers contribute to these presumptions, and how often these relationships are thoroughly delineated within the context of randomized controlled trials (RCTs). Thus, the aim was to conduct a systematic search and qualitative, thematic analysis of RCTs focusing on lifestyle interventions for diabetes prevention or management, to examine how researchers discuss body weight in 1) the rationale and design of their RCTs; and 2) their presentation and interpretation of their findings.MethodsWe completed an electronic search for records published between 2007 and November 2016. Selection criteria included: RCTs with a follow-up period of ≥12 months; adult participants with type 2 diabetes/pre-diabetes; lifestyle interventions classified as dietary, exercise, and/or behavioural; primary outcomes of incident diabetes and complications, mortality, cardiovascular disease, and quality of life; and secondary outcomes of glycemic control and blood pressure. Nineteen articles were identified for inclusion and subject to thematic content analysis.ResultsObesity and weight loss figured prominently in the rationale and outcomes of the majority of the articles, despite intentional exclusion of “weight loss” and “obesity” as search terms. There was ambiguity over whether weight loss was classified as inclusive to the intervention, an outcome, or a measure of adherence. Results revealed that authors frequently engaged in “spin reporting” by pooling data from intervention and control groups to test the relationship between weight lost and outcomes and in their presentation of results.ConclusionsResearchers need to be aware of their biases and assumptions regarding body weight in designing, analyzing, and interpreting lifestyle interventions for diabetes prevention and management.
Highlights
Scholars have documented presumptions regarding the relationships between diet, exercise, weight, and type 2 diabetes
Five studies reported results from the Action for Health in Diabetes (Look AHEAD) trial (Alonso et al, 2015; Jakicic et al, 2013; Look AHEAD, 2010; Look AHEAD, 2013; Zhang et al, 2016), which was an Randomized controlled trial (RCT) originally designed to determine whether intentional weight loss and increased physical activity would reduce cardiovascular morbidity and mortality in overweight individuals with type 2 diabetes undertaken in 16 American centres
Weight and conclusions Weight loss was presented as certain to lead to diabetes prevention, irrespective of whether the studies included diabetes incidence as an outcome (Ackerman et al, 2015; Marrero et al, 2015; Nilsen et al, 2011)
Summary
Scholars have documented presumptions regarding the relationships between diet, exercise, weight, and type 2 diabetes. The aim was to conduct a systematic search and qualitative, thematic analysis of RCTs focusing on lifestyle interventions for diabetes prevention or management, to examine how researchers discuss body weight in 1) the rationale and design of their RCTs; and 2) their presentation and interpretation of their findings. Despite the potential for individuals of any size to develop diabetes, diabetes is often conflated with obesity; both conditions are frequently depicted as caused by similar dietary and exercise-related choices [6]. This conflation has important implications for how diabetes is presented and treated in research, practice, and policy. Obesity is often presented in reductionist terms as a matter of personal responsibility caused by a simplified energy imbalance model [10, 11]
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