Behavioural weight management interventions for the treatment of obesity : network meta-analysis of trial and real-world individual participant data

Jaiswal, Nishant and Gregg, Rebecca and Hawkins, Neil and Sharif-Hurst, Sahar and Avenell, Alison and Ells, Louisa and Jayacodi, Sandra and Mackenzie, Ruth and Simpson, Sharon Anne and Wu, Olivia and Logue, Jennifer (2025) Behavioural weight management interventions for the treatment of obesity : network meta-analysis of trial and real-world individual participant data. Health Technology Assessment. ISSN 1366-5278

Abstract

Behavioural weight management interventions are the primary treatment for obesity in the United Kingdom. These interventions focus on diet, physical activity and behaviour change, and are typically delivered over a period of 12 weeks. Although National Institute for Health and Care Excellence guidance makes recommendations on the content of behavioural weight management interventions, there are substantial variations in practice. As a result, what constitutes the most effective composition of behavioural weight management interventions is unclear. To determine the effectiveness of different types of behavioural weight management interventions in achieving weight loss, using individual participant data from randomised controlled trials and real-world services. A network meta-analysis of individual participant data. Behavioural weight management interventions delivered in the community. Anonymous individual participant data of adults (> 18 years), living in the United Kingdom and attending behavioural weight management interventions in the real world (  = 76,201) and randomised controlled trial's (  = 4051). Mean change in weight at 12 weeks. Two-staged Bayesian network meta-analysis of individual participant data from included randomised controlled trials and real-world services was performed. Risk of bias was assessed for randomised controlled trials using Cochrane Risk of Bias 2.0. Prior to analysis, received data were checked, for consistency with the requests and cleaned for all anomalies. All behavioural weight management interventions resulted in weight loss compared to usual care. In the randomised controlled trials, the 52-week weightloss programme referrals for adults in primary care (WRAP) with participants attending intervention achieved the greatest weight reduction at 12 weeks (mean difference = -2.58 kg, 95% credible interval -3.19 to -1.96). However, when a male-only intervention (football fans in training) was included in a sensitivity analysis, it demonstrated the largest short-term weight loss (mean difference = -4.65 kg, credible interval -5.24 to -4.07). In the real-world services, several programmes achieved substantial weight loss, with greater programme attendance associated with improved outcomes. The behavioural weight management intervention in both real-world services and randomised controlled trials are effective for weight loss, but there is a variation in the weight loss achieved at the end of active weight loss period depending upon the structure of intervention and participant engagement. Dismantling the interventions into component parts will help determine which components or combination of components are associated with greater weight loss. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR129523.