What do we want to know?
Multi-component weight management programmes (WMPs), i.e. those that address both diet and exercise, have been shown to be broadly effective for reducing weight among adults with overweight or obesity. However, some programmes are more effective than others and detail about the critical features of WMPs remains largely unknown.
Who wants to know?
This systematic review was commissioned by the Policy Research Programme in the Department of Health England. The aim was to provide decision-makers, such as service commissioners and providers in Local Authorities in the UK, with an understanding of the critical features of WMPs to help them determine which kinds of programmes they should be providing. The novel systematic review methods used will be of interest to researchers examining complex interventions.
What did we find?
Research on the views of service users and providers from the UK indicates that supportive relationships with providers and peers in their WMP group are perceived to be the most critical feature of WMPs. These relationships are seen as an essential first step in a weight management journey, since they provide a much-needed external motivator or ‘hook’ for people to engage with a WMP and to initiate healthy behaviours. Longer-term maintenance of a healthy weight is felt to depend upon this initial engagement as individuals are able to experience their own ability to engage in activities such as exercise, and experience the various benefits afforded it.
Examination of 40 rigorous WMP evaluations revealed that the features identified as important by service users and providers were associated with greater weight-loss. The ten most effective WMPs were characterised by fostering supportive relationships with either providers or peers and encouraging long-term maintenance, whilst the ten least effective WMPs were characterised by an absence of these features.
Discussions with WMP providers and commissioners in Local Authorities in England indicated that they would welcome guidance about the critical features of WMPs and that their own experiences and research corresponded with our research findings.
What are the conclusions?
Supportive relationships between service users and providers, and between services users and their weight management peers, are critical to the success of WMPs. Self-regulation and maintenance of a healthy weight depend upon individuals’ experiencing their own ability to engage in activities such as exercise, and experiencing the various benefits afforded it. Thus relationships are an essential first step in a weight management journey, since they provide a much-needed external motivator or ‘hook’ for people to engage with a WMP and to initiate healthy behaviours.
How did we get these results?
This systematic review involved a comprehensive review of the literature to identify the critical features of weight management programmes (WMPs) for adults.
The review comprised of three stages:
1. Analysis of service users’ and providers’ views: In the first stage, we sought to understand which weight management programme features are perceived as key to successful weight loss and the mechanisms through which these features are perceived to lead to successful weight loss according to those with direct experience of services; we examined studies reporting the views of people in the UK who had used or delivered weight management programmes.
2. Analysis of service evaluations: In the second stage, we sought to test whether features perceived to be important are actually associated with greater weight loss; we examined the presence or absence of identified features in weight management programmes evaluated in randomised controlled trials (RCTs). Selecting RCTs from a previous review of 40 studies (Hartmann-Boyce et al. 2013), we compared the ten most effective weight management programmes with the ten least effective ones.
3. Case studies: In the third stage of the review we aimed to ensure that the findings of the review could be put to best use by local authorities; thus we conducted case studies with two local authorities to explore the nature of current weight management provision and to consider the implications of the review findings for future provision.
This report should be cited as:
Sutcliffe K, Richardson M, Rees R, Burchett H, Melendez-Torres GJ, Stansfield C, Thomas J (2016) What are the critical features of successful Tier 2 weight management programmes for adults? A systematic review to identify the programme characteristics, and combinations of characteristics, that are associated with successful weight loss. London: EPPI-Centre, Social Science Research Unit, UCL Institute of Education, University College London.