Background Health inequalities are a public health priority. The extent to which behavioural weight management interventions impact health inequalities is uncertain, as is the extent to which trials of these interventions consider inequalities. We conducted a systematic review synthesising evidence on how different measures of inequality impact the uptake of, adherence to and effectiveness of behavioural weight management interventions in adults with overweight and obesity.
Methods We updated a systematic review from the US Preventive Services Taskforce to identify (cluster-) randomised controlled trials of primary care applicable behavioural weight management interventions in adults with overweight and obesity published prior to 5th March 2020. Two investigators independently screened articles for eligibility and conducted risk of bias assessment. We curated publication families for each trial. The PROGRESS-Plus framework (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) was used to consider a comprehensive range of health inequalities. Data on trial uptake, intervention adherence or attendance, and weight change outcomes by PROGRESS-Plus criteria were extracted. Data were synthesised narratively, and Harvest plots were produced to summarise the impact of each criterion on uptake, adherence, and effectiveness.
Results One hundred and three studies (89 from previous review; 14 from updated search) were identified. The majority (n=91) are trials of behavioural weight loss interventions; 12 are trials of behavioural weight maintenance interventions. At baseline, all studies reported age (n=103) and 101 (98%) reported gender/sex; 67 (65%) studies reported race/ethnicity and 57 (55%) education. The least reported criteria were place of residence (n=3, 2%) and religion (n=1, 1%). Ten studies (10%) examined the impact of at least one PROGRESS-Plus criteria on uptake, 10 (10%) on intervention adherence or attendance, 31 (30%) on trial attrition, and 30 (29%) on weight change. Due to heterogeneity in intervention type and measures used to assess PROGRESS-Plus criteria, a meta-analysis was not conducted. Further results will be synthesised by August 2021, including Harvest plots summarising inequalities at each stage by different PROGRESS-Plus criteria.
Conclusion We identified a lack of consideration of inequalities in trials of behavioural weight management interventions for adults, especially in relation to trial uptake and adherence, and substantial heterogeneity in measures used to assess PROGRESS-Plus criteria. Current evidence does not align with public health policy which prioritises health inequalities. Researchers should consider health inequities in the design, conduct and targeting of interventions to best inform policy decisions and practice.
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