DIET & NUTRITION 
PATIENT EDUCATION 
OBESITY/WEIGHT MANAGEMENT 
EXERCISE/TRAINING 
LEGAL MATTERS 
GUIDELINES/RECOMMENDATIONS ✅ Clinical Decision Support / Validated Tool
Published in Obesity Reviews, the meta-analysis pooled data from 21 RCTs and 6 additional studies (mean age 54.3, mean BMI 26.6). CBT-I and sleep hygiene interventions outperformed broader sleep approaches across anthropometric, dietary, and biomarker endpoints.
Clinical Considerations
- CBT-I and sleep hygiene reduced BMI by 0.64 overall (P=.0006); patients with obesity saw BMI drops of 1.53 and weight loss of 5.55 kg.
- Caloric intake fell by 147.5 cal/day overall and 238 cal/day among adults with overweight or obesity; sugar intake dropped and protein share rose.
- Sleep duration improved by 40.9 minutes, with meaningful drops in PSQI (-1.47) and ISI (-3.02) scores.
- Biomarker shifts included lower peptide YY, insulin, and TNF-α; ghrelin, leptin, cortisol, CRP, and IL-6 did not change significantly.
Practice Applications
- Consider CBT-I referral as an adjunct to weight management in patients with obesity, type 2 diabetes, and disordered sleep.
- Integrate sleep assessment (PSQI, ISI) into routine workups for adiposity-related complaints.
- Recognize that physical activity, sedentary behavior, and waist circumference did not improve, so sleep alone is not a full intervention.
- Monitor weight, BMI, and glycemic markers in patients who complete CBT-I to capture metabolic benefits over time.
