Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Jun;23(6):e13438.
doi: 10.1111/obr.13438. Epub 2022 Mar 3.

A systematic review of inequalities in the uptake of, adherence to, and effectiveness of behavioral weight management interventions in adults

Jack M Birch  1 , Rebecca A Jones  1 , Julia Mueller  1 , Matthew D McDonald  2 , Rebecca Richards  1 , Michael P Kelly  3 , Simon J Griffin  1   3 , Amy L Ahern  1
Affiliations

A systematic review of inequalities in the uptake of, adherence to, and effectiveness of behavioral weight management interventions in adults

Jack M Birch et al. Obes Rev. 2022 Jun.

Abstract

The extent to which behavioral weight management interventions affect health inequalities is uncertain, as is whether trials of these interventions directly consider inequalities. We conducted a systematic review, synthesizing evidence on how different aspects of inequality impact uptake, adherence, and effectiveness in trials of behavioral weight management interventions. We included (cluster-) randomized controlled trials of primary care-applicable behavioral weight management interventions in adults with overweight or obesity published prior to March 2020. Data about trial uptake, intervention adherence, attrition, and weight change by PROGRESS-Plus criteria (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) were extracted. Data were synthesized narratively and summarized in harvest plots. We identified 91 behavioral weight loss interventions and 12 behavioral weight loss maintenance interventions. Fifty-six of the 103 trials considered inequalities in relation to at least one of intervention or trial uptake (n = 15), intervention adherence (n = 15), trial attrition (n = 32), or weight outcome (n = 34). Most trials found no inequalities gradient. If a gradient was observed for trial uptake, intervention adherence, and trial attrition, those considered "more advantaged" did best. Alternative methods of data synthesis that enable data to be pooled and increase statistical power may enhance understanding of inequalities in behavioral weight management interventions.

Keywords: inequalities; interventions; obesity; weight management.

PubMed Disclaimer

Conflict of interest statement

ALA is principal investigator on two publicly funded (NIHR, MRC) trials where the intervention is provided by WW (formerly Weight Watchers) at no cost. SJG is principal investigator on a publicly funded (NIHR) trial in which the intervention is provided by WW (formerly Weight Watchers) at no cost. MPK has undertaken consultancy for Slimming World, and led the obesity and weight management guidelines development for NICE from 2005 until 2014.

Figures

FIGURE 1
FIGURE 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) flow diagram for the inclusion of studies
FIGURE 2
FIGURE 2
Number of trials reporting PROGRESS‐Plus (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) criteria at each trial stage
FIGURE 3
FIGURE 3
Harvest plot of inequalities in trial uptake
FIGURE 4
FIGURE 4
Harvest plot of inequalities in intervention uptake
FIGURE 5
FIGURE 5
Harvest plot of inequalities in adherence to behavioral weight management interventions
FIGURE 6
FIGURE 6
Harvest plot of inequalities in trial attrition
FIGURE 7
FIGURE 7
Harvest plot of inequalities in weight outcome
See this image and copyright information in PMC

References

    1. Lauby‐Secretan B, Scoccianti C, Loomis D, Grosse Y, Bianchini F, Straif K. Body fatness and cancer—viewpoint of the IARC working group. N Engl J Med. 2016;375(8):794‐798. doi: 10.1056/NEJMsr1606602 - DOI - PMC - PubMed
    1. Forouzanfar MH, Afshin A, Alexander LT, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016;388(10053):1659‐1724. doi: 10.1016/s0140-6736(16)31679-8 - DOI - PMC - PubMed
    1. LeBlanc ES, Patnode CD, Webber EM, Redmond N, Rushkin M, O'Connor EA. Behavioral and pharmacotherapy weight loss interventions to prevent obesity‐related morbidity and mortality in adults: updated evidence report and systematic review for the US preventive services task force. JAMA. 2018;320(11):1172‐1191. doi: 10.1001/jama.2018.7777 - DOI - PubMed
    1. Ma C, Avenell A, Bolland M, et al. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease, and cancer: systematic review and meta‐analysis. BMJ. 2017;359:j4849. doi: 10.1136/bmj.j4849 - DOI - PMC - PubMed
    1. Adams J, Mytton O, White M, Monsivais P. Why are some population interventions for diet and obesity more equitable and effective than others? The role of individual agency. PLoS Med. 2016;13(4):e1001990. doi: 10.1371/journal.pmed.1001990 - DOI - PMC - PubMed

Publication types