Mapping components of behavioural weight management interventions using electronic survey and component selection by expert consensus: the BE:COME Study

Logue, Jennifer (2026) Mapping components of behavioural weight management interventions using electronic survey and component selection by expert consensus: the BE:COME Study. Health Technology Assessment, 30 (23). pp. 17-44. ISSN 1366-5278

Abstract

Background Behavioural weight management interventions are the main funded interventions for people living with obesity in the United Kingdom, but there is high intervention variability, including mode of delivery, dietary, physical activity and behavioural components. Objective To map individual components of behavioural weight management interventions used in pragmatic clinical trials and those commissioned in the real world. To decide on the components which vary across the interventions and are hypothesised to be of importance to attendance, completion and weight loss. Design Cross-sectional survey. Setting Behavioural weight management interventions in two separate scenarios: randomised controlled trials and real-world services (local authority and commercial) Main outcome measure Identification of components of interest that demonstrate variation in both settings. Methods Mapping exercise of randomised controlled trials and real-world services using the standardized reporting of adult behavioural weight management interventions to aid evaluation. Selection of components by expert group consensus derived from online survey and discussion. Data sources Mapping performed by a local contact for real-world services and by one BECOME researcher for randomised controlled trials. Study expert group provided their opinions via online survey and discussion. Results Real-world services providing data on 19 services and 6 randomised controlled trials were mapped using an intervention template. Survey and discussion led to expert group consensus of components for analysis within a meta-analysis. Summary descriptions are provided for each programme displaying variability in eligibility and exclusion criteria. Results provide a description of real-world services and randomised controlled trials, demonstrating variation between the programme components, for example, programme delivery (face-to-face group based was the most common answer for 28.6% randomised controlled trials and 63.2% real-world services), setting (community centre was the most common answer for 0% of randomised controlled trials and 69.2% real-world services) and total duration of the programme (12 weeks for 7.1% randomised controlled trials and 57.9% real-world services). Limitations The standardised reporting template is lengthy and can take up to 1.5 hours to complete. The template for randomised controlled was not completed by the trials themselves. An expert group derived the components of interest, which could produce different results with a different group of people. Conclusions Our work has provided an example of how standardized reporting of adult behavioural weight management interventions to aid evaluation can be implemented. Interventions were included in this study if they were compliant with National Institute for Health and Care Excellence guidance. We have described important differences between interventions used in randomised controlled trials and in existing services. The interventions vary in many components, particularly between real-world services and randomised controlled trials; United Kingdom trials differed to those delivered in the real world. This lack of evidence to inform decision-making as to the most effective components of behavioural weight management interventions will ultimately hamper the commissioning of such programmes. Future work There were components that were of interest to the expert group, which were not either suitable for analysis or part of the standardized reporting template of adult behavioural weight management interventions to aid evaluation template; there were also population subgroups that we were unable to include in future research as we did not include this information on the data request. This research is preparatory work for the BECOME study, and further planned work will determine which components are effective and their effects on different subgroups, along with a cost-effectiveness analysis of any effective component. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR129523.