| Objective:Overweight and obesity among adolescents have become important global public health issues.Based on the fact that lifestyle interventions can change unhealthy behaviors in overweight and obese adolescents to achieve weight loss success,a systematic review has confirmed the effectiveness of lifestyle interventions for overweight and obese adolescents,but the contextual effects and mechanisms have not yet been explored.This study aims to explore the context and key mechanisms through which lifestyle interventions can promote or hinder behavioral changes and related long-term weight loss maintenance outcomes in overweight and obese adolescents.Methods:This research was a systematic review with narrative synthesis that followed PRISMA guidelines and used realist analysis and RAMESES quality and publication guidelines.The initial scheme theory is carried out through literature research and external stakeholders,and retrieved four databases to improve,include Embase 、 MEDLINE 、Psych INFO and CINAHL,Time since built libraries to January 31,2023,no language limit.The initial systematic search resulted in 7930 studies.After deleting 2099 duplicate items,5831 articles were selected by title and abstract,and the full text of 127 articles was evaluated based on inclusion and exclusion criteria.After reading the full text,94 articles were excluded,and 33 studies were included.There articles found and evaluated from the reference citations and research process were added.Finally,36 items met the inclusion criteria and were included in the final realist review.Qualitative and qualitative studies were evaluated using the Critical Assessment Skills Program(CASP)and the Effective Public Health Practice Project(EPHPP)for the final included literature,the data analysis adopts a framework approach,using the Capability Opportunity Motivation Behavior Model(COM-B)and the Theoretical Domains Framework(TDF)to synthesize in a narrative manner to produce the final scenario theory,including all situational mechanism outcome configurations.Results:A total of 36 articles were included,including 2 mixed studies,22 quantitative studies,and 12 qualitative studies.Under the framework of ability,opportunity,motivation behavior model,and theoretical domain,two themes were summarized in a narrative manner:integrating healthy lifestyle changes into daily life and self change in response to life events.Four "situation mechanism outcome" configurations were identified:(1)Obese and overweight adolescents can develop identification,responsibility,and self-efficacy under the influence of subjective norms in a family context with strong family cohesion,Thus maintaining weight loss;(2)Long term adversity can easily lead to negative effects such as low confidence,low motivation,and low perceived behavioral control in overweight and obese adolescents,leading to skill transfer failure and difficulty in maintaining weight loss;(3)The health issues in the old environment have not been resolved,but the successful transfer of skills has given overweight and obese adolescents confidence,enhanced self-efficacy and empowerment awareness,and enabled them to actively respond to stressful life events and successfully maintain weight loss;(4)Individuals’ failure to achieve behavioral skill transfer leads to a lack of motivation,low self-efficacy,and often choose to avoid or passively respond to life events,resulting in weight loss and maintenance failure.Conclusion:This study explains the reasons for the success and failure of weight loss maintenance in overweight and obese adolescents within 6 months after lifestyle intervention.Emphasis should be placed on the motivation,self-efficacy,perceived behavioral control,and empowerment awareness of overweight and obese adolescents,utilizing skill transfer and environmental subjective norms to maintain long-term weight loss. |
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