Are there inequalities in the attendance at and effectiveness of behavioural weight management interventions for adults in the UK? An individual participant data meta-analysis
Objectives Interventions for obesity that require individual behaviour change, such as behavioural weight management interventions, may contribute to health inequalities. We explored if there was evidence of inequalities in the attendance at and effectiveness of behavioural weight management interve...
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BMJ Publishing Group
2025-08-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/3/2/e001382.full |
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| author | Annie S Anderson Martin White Stephen J Sharp Beth Stuart Paul Aveyard Alex McConnachie Rebecca J Beeken Sarah Damery Colin Greaves Simon J Griffin Rebecca A Jones Amy L Ahern Julia Mueller Michael P Kelly Susan Jebb Kiran Nanchahal Nerys Astbury Jack M Birch Angela Craigie |
| author_facet | Annie S Anderson Martin White Stephen J Sharp Beth Stuart Paul Aveyard Alex McConnachie Rebecca J Beeken Sarah Damery Colin Greaves Simon J Griffin Rebecca A Jones Amy L Ahern Julia Mueller Michael P Kelly Susan Jebb Kiran Nanchahal Nerys Astbury Jack M Birch Angela Craigie |
| author_sort | Annie S Anderson |
| collection | DOAJ |
| description | Objectives Interventions for obesity that require individual behaviour change, such as behavioural weight management interventions, may contribute to health inequalities. We explored if there was evidence of inequalities in the attendance at and effectiveness of behavioural weight management interventions in adults.Design Two-stage individual participant data meta-analysis.Data sources Eligible studies were extracted from a previous systematic review and an updated search was completed on PubMed.Eligibility criteria UK-based randomised controlled trials of behavioural weight management interventions suitable for use in primary care, published until 31 December 2021.Data extraction and synthesis Multivariable regression analyses were conducted with weight at 12-month follow-up as the primary outcome and included an interaction between inequality characteristic and trial arm (control or intervention). Each model was adjusted for baseline weight, age and gender. Estimated interactions were combined across trials using a random-effects meta-analysis. Intervention attendance was defined as number of in-person sessions attended. Risk of bias was assessed using Cochrane’s RoB 2 tool.Results Data from 13/16 eligible weight loss trials were analysed (complete case data n=5531 participants). The effect of the intervention on weight at 12 months was greater in male participants (−2.58 kg (95% CI −3.52 to 1.64)) than female participants (−1.71 kg (95% CI −2.79 to –0.63); p value for interaction=0.02, tau2=0) and greater for participants of white ethnicity (−2.74 kg (95% CI −4.30 to –1.19)), than those from an ethnic minority background (0.03 kg (95% CI −1.29 to 1.35); p interaction=0.04, tau2=0). Age, education, occupation, place of residence and household income did not significantly moderate effectiveness. We did not find evidence of inequalities in intervention attendance by ethnicity, occupation, gender/sex, area-level socioeconomic deprivation or age.Conclusions Behavioural weight management interventions had smaller effects in people from ethnic minority backgrounds and larger effects in men. There was no evidence of other differences in intervention effectiveness or adherence. This is the first synthesis study to access individual participant data and quantitatively assess inequalities in these interventions. Future research should further explore reasons for differences in outcomes and consider how to prevent behavioural weight management interventions from potentially exacerbating health inequalities. |
| format | Article |
| id | doaj-art-998a4116ef014c8694fb0fe186bf0df7 |
| institution | Kabale University |
| issn | 2753-4294 |
| language | English |
| publishDate | 2025-08-01 |
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| spelling | doaj-art-998a4116ef014c8694fb0fe186bf0df72025-08-20T04:02:22ZengBMJ Publishing GroupBMJ Public Health2753-42942025-08-013210.1136/bmjph-2024-001382Are there inequalities in the attendance at and effectiveness of behavioural weight management interventions for adults in the UK? An individual participant data meta-analysisAnnie S Anderson0Martin White1Stephen J Sharp2Beth Stuart3Paul Aveyard4Alex McConnachie5Rebecca J Beeken6Sarah Damery7Colin Greaves8Simon J Griffin9Rebecca A Jones10Amy L Ahern11Julia Mueller12Michael P Kelly13Susan Jebb14Kiran Nanchahal15Nerys Astbury16Jack M Birch17Angela Craigie18School of Medicine, University of Dundee, Dundee, UKprofessor of population health researchMRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge CB2 0QQ, UKQueen Mary University of London, London, UKNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UKRobertson Centre for Biostatistics, University of Glasgow, Glasgow, UKBehavioural Science and Health, University College London, London, UK1 Institute for Applied Health Research, University of Birmingham, Birmingham, UKSchool of Sport, Exercise and Rehabilitation Science, University of Birmingham, Birmingham, UKDepartment of Public Health and Primary Care, University of Cambridge, Cambridge, UKMRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK1 MRC Epidemiology Unit, University of Cambridge, Cambridge, UKMRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UKNIHR Policy Research Unit in Behavioural Science, Newcastle University, Newcastle upon Tyne, UK1 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UKlecturer in medical statisticsGastrointestinal Sciences, University of Manchester, Hope Hospital, Salford, UKMRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UKSchool of Medicine, University of Dundee, Dundee, UKObjectives Interventions for obesity that require individual behaviour change, such as behavioural weight management interventions, may contribute to health inequalities. We explored if there was evidence of inequalities in the attendance at and effectiveness of behavioural weight management interventions in adults.Design Two-stage individual participant data meta-analysis.Data sources Eligible studies were extracted from a previous systematic review and an updated search was completed on PubMed.Eligibility criteria UK-based randomised controlled trials of behavioural weight management interventions suitable for use in primary care, published until 31 December 2021.Data extraction and synthesis Multivariable regression analyses were conducted with weight at 12-month follow-up as the primary outcome and included an interaction between inequality characteristic and trial arm (control or intervention). Each model was adjusted for baseline weight, age and gender. Estimated interactions were combined across trials using a random-effects meta-analysis. Intervention attendance was defined as number of in-person sessions attended. Risk of bias was assessed using Cochrane’s RoB 2 tool.Results Data from 13/16 eligible weight loss trials were analysed (complete case data n=5531 participants). The effect of the intervention on weight at 12 months was greater in male participants (−2.58 kg (95% CI −3.52 to 1.64)) than female participants (−1.71 kg (95% CI −2.79 to –0.63); p value for interaction=0.02, tau2=0) and greater for participants of white ethnicity (−2.74 kg (95% CI −4.30 to –1.19)), than those from an ethnic minority background (0.03 kg (95% CI −1.29 to 1.35); p interaction=0.04, tau2=0). Age, education, occupation, place of residence and household income did not significantly moderate effectiveness. We did not find evidence of inequalities in intervention attendance by ethnicity, occupation, gender/sex, area-level socioeconomic deprivation or age.Conclusions Behavioural weight management interventions had smaller effects in people from ethnic minority backgrounds and larger effects in men. There was no evidence of other differences in intervention effectiveness or adherence. This is the first synthesis study to access individual participant data and quantitatively assess inequalities in these interventions. Future research should further explore reasons for differences in outcomes and consider how to prevent behavioural weight management interventions from potentially exacerbating health inequalities.https://bmjpublichealth.bmj.com/content/3/2/e001382.full |
| spellingShingle | Annie S Anderson Martin White Stephen J Sharp Beth Stuart Paul Aveyard Alex McConnachie Rebecca J Beeken Sarah Damery Colin Greaves Simon J Griffin Rebecca A Jones Amy L Ahern Julia Mueller Michael P Kelly Susan Jebb Kiran Nanchahal Nerys Astbury Jack M Birch Angela Craigie Are there inequalities in the attendance at and effectiveness of behavioural weight management interventions for adults in the UK? An individual participant data meta-analysis BMJ Public Health |
| title | Are there inequalities in the attendance at and effectiveness of behavioural weight management interventions for adults in the UK? An individual participant data meta-analysis |
| title_full | Are there inequalities in the attendance at and effectiveness of behavioural weight management interventions for adults in the UK? An individual participant data meta-analysis |
| title_fullStr | Are there inequalities in the attendance at and effectiveness of behavioural weight management interventions for adults in the UK? An individual participant data meta-analysis |
| title_full_unstemmed | Are there inequalities in the attendance at and effectiveness of behavioural weight management interventions for adults in the UK? An individual participant data meta-analysis |
| title_short | Are there inequalities in the attendance at and effectiveness of behavioural weight management interventions for adults in the UK? An individual participant data meta-analysis |
| title_sort | are there inequalities in the attendance at and effectiveness of behavioural weight management interventions for adults in the uk an individual participant data meta analysis |
| url | https://bmjpublichealth.bmj.com/content/3/2/e001382.full |
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