Inequalities in the uptake of, adherence to and effectiveness of behavioural weight management interventions: systematic review protocol

Abstract

IntroductionIt has been suggested that interventions focusing on individual behaviour change, such as behavioural weight management interventions, may exacerbate health inequalities. These intervention-generated inequalities may occur at different stages, including intervention uptake, adherence and effectiveness. We will synthesise evidence on how different measures of inequality moderate the uptake, adherence and effectiveness of behavioural weight management interventions in adults.Methods and analysisWe will update a previous systematic literature review from the United States Preventive Services Taskforce to identify trials of behavioural weight management interventions in adults aged 18 years and over that were, or could feasibly be, conducted in or recruited from primary care. Medline, Cochrane database (CENTRAL) and PsycINFO will be searched. Only randomised controlled trials (RCTs) and cluster-RCTs will be included. Two investigators will independently screen articles for eligibility and conduct risk of bias assessment. We will curate publication families for eligible trials. The PROGRESS-Plus acronym (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) will be used to consider a comprehensive range of health inequalities. Data on trial uptake, intervention adherence, weight change and PROGRESS-Plus-related data will be extracted. Data will be synthesised narratively. We will present a Harvest plot for each PROGRESS-Plus criterion and whether each trial found a negative, positive or no health inequality gradient. We will also identify potential sources of unpublished original research data on these factors which can be synthesised through a future individual participant data meta-analysis.Ethics and disseminationEthical approval is not required as no primary data are being collected. The completed systematic review will be disseminated in a peer-reviewed journal, at conferences, and contribute to the lead author’s PhD thesis. Authors of trials included in the completed systematic review may be invited to collaborate on a future individual participant data meta-analysis.PROSPERO registration numberCRD42020173242.

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

“…This review was completed according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines and the PRISMA‐Equity extension. 21 , 22 Full details of the methods were published in the protocol, 23 and the review was registered on PROSPERO (CRD42020173242).…”

“…We originally planned to use Cochrane's Risk of Bias (RoB) 2 tool to conduct risk of bias assessment. 23 Instead, we aligned our methods for quality assessment with those used in the USPSTF report, 3 as the USPSTF method incorporates risk of bias assessment into its quality assessment of included trials.…”

A systematic review examining socioeconomic factors in trials of interventions for men that report weight as an outcome

“…There are concerns that interventions that rely on a high degree of individual agency may exacerbate inequalities. Inequalities can occur at any stage of trials (i.e., during recruitment, adherence, or outcomes) of weight management programs 106 . For example, in a large RCT of brief opportunistic primary care interventions, participants from lower socioeconomic backgrounds that were assigned to the behavioral weight management program referral group, on average, lost less weight than their counterparts from higher socioeconomic backgrounds 107 .…”

“…Inequalities can occur at any stage of trials (i.e., during recruitment, adherence, or outcomes) of weight management programs. 106 For example, in a large RCT of brief opportunistic primary care interventions, participants from lower socioeconomic backgrounds that were assigned to the behavioral weight management program referral group, on average, lost less weight than their counterparts from higher socioeconomic backgrounds. 107 This was attributed to those from lower socioeconomic backgrounds attending fewer program sessions (i.e., inequalities related to intervention adherence).…”

Are there inequalities in the attendance and effectiveness of behavioural weight management interventions for adults in the UK? Protocol for an individual participant data (IPD) meta-analysis

“…As part of the protocol development for the preceding systematic review, we received comments on a lay summary from a patient and public involvement (PPI) representative on the project aims and our definition of the PROGRESS-Plus characteristics. 38 These aims and definitions have been brought forward into this IPD meta-analysis project. We will seek further PPI input on our harmonisation of the subgroups of the exposure variables to ensure our categorisations are appropriate, and a PPI representative will contribute to the interpretation of data and will coauthor the final manuscript.…”