Behavioural weight management interventions are effective for weight loss during the initial phase, with components including tailoring, flexibility, multimodal referral pathways, in-person delivery, and personalised dietary advice associated with greater weight loss at 12 weeks.
Key Findings
Results
All behavioural weight management interventions in randomised controlled trials led to weight loss at 12 weeks, with Football Fans in Training showing the greatest weight loss compared with all other interventions.
RCT network meta-analysis included individual participant data (n=4051)
Football Fans in Training mean difference: -4.65 kg (95% credible interval -5.24 to -4.07) compared with all other interventions
Analysis used a two-stage Bayesian network meta-analysis of individual participant data
Outcome measured was mean change in weight at 12 weeks of active weight loss sessions
Results
In real-world services, face-to-face intervention with weekly sessions on diet and physical activity was associated with the greatest weight loss, while group-based weekly sessions focusing solely on physical activity was associated with very low weight loss.
Real-world service analysis included data from 19 services (n=76,201)
Programme 1 (face-to-face with weekly sessions on diet and physical activity): mean difference -4.03 kg (95% credible interval -4.12 to -3.94)
Programme 7 (group-based weekly sessions focusing solely on physical activity): mean difference -0.28 kg (95% credible interval -0.40 to -0.15)
There was 'big variation in weight loss achieved at 12 weeks' across programmes
Results
In RCTs, the intervention components associated with weight loss were tailoring, flexibility, and multimodal referral.
Tailoring: mean difference -5.54 kg (95% credible interval -7.72 to -3.35)
Flexibility: mean difference -3.18 kg (95% credible interval -4.29 to -2.07)
Multimodal referral: mean difference -2.57 kg (95% credible interval -4.89 to -0.25)
Component network meta-analysis was used to identify these associations
Results
In real-world services, the components associated with weight loss were multimodal referral, personalised dietary advice, person delivery, and flexibility.
Multimodal referral: mean difference -2.01 kg (95% credible interval -2.13 to -1.88)
Personalised dietary advice: mean difference -1.22 kg (95% credible interval -1.33 to -1.11)
Person (in-person) delivery: mean difference -0.45 kg (95% credible interval -0.52 to -0.38)
Flexibility: mean difference -0.41 kg (95% credible interval -0.47 to -0.35)
Results
Mapping of participating services demonstrated variation between randomised controlled trials and real-world services despite all following National Institute for Health and Care Excellence guidance.
Mapping was performed at service level, not individual level
Components in real-world service interventions were not clearly defined, introducing an element of uncertainty
A questionnaire was used to describe programme components
The RCT and real-world scenarios 'do not inform each other particularly well'
Results
The analyses had several limitations related to missing data and inability to explore component interactions.
Completeness of data from services was an issue in terms of missing weights and dates
Meta-analyses were limited due to missing information about ethnicity and socioeconomic status
Due to limited data, the analysis could not explore the interactions between components
RCT dataset comprised n=4051 and real-world dataset comprised n=76,201 participants