Article Text

Inequalities in the uptake of, adherence to and effectiveness of behavioural weight management interventions: systematic review protocol
  1. Jack Michael Birch1,
  2. Simon J Griffin1,2,
  3. Michael P Kelly2,
  4. Amy L Ahern1
  1. 1 MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
  2. 2 Primary Care Unit, University of Cambridge School of Clinical Medicine, Cambridge, Cambridgeshire, UK
  1. Correspondence to Jack Michael Birch; jack.birch{at}


Introduction It 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 analysis We 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 We will also identify potential sources of unpublished original research data on these factors which can be synthesised through a future individual participant data meta-analysis.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 dissemination Ethical 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 number CRD42020173242.

  • primary care
  • public health
  • preventive medicine

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  • Contributors JMB conceived and designed the study, developed the search strategy and drafted the manuscript. SJG conceived the study, contributed to study design and reviewed drafts of the manuscript. MPK contributed to study design and reviewed drafts of the manuscript. ALA conceived the study, contributed to study design and reviewed drafts of the manuscript. All authors have reviewed the manuscript and approved the final version for publication.

  • Funding JMB, SJG and ALA are supported by the Medical Research Council (MRC) (Grant MC_UU_12015/4). The University of Cambridge has received salary support in respect of SJG from the National Health Service in the East of England through the Clinical Academic Reserve.

  • Competing interests ALA is principal investigator on two publicly funded (NIHR, MRC) trials where the intervention is provided by WW (formerly Weight Watchers) at no cost. MPK has undertaken consultancy for Slimming World, and led the clinical and public health guidelines development for NICE from 2005 until 2014.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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