Birch Jack M, Mueller Julia, Damery Sarah, Sharp Stephen J, Jones Rebecca A, Kelly Michael P, Anderson Annie S, Astbury Nerys, Aveyard Paul, Beeken Rebecca J, Craigie Angela, Greaves Colin, Jebb Susan, McConnachie Alex, Nanchahal Kiran, Stuart Beth, White Martin, Griffin Simon J, Ahern Amy L
MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMJ Public Health. 2025 Aug 7;3(2):e001382. doi: 10.1136/bmjph-2024-001382. eCollection 2025.
Interventions for obesity that require individual behaviour change, such as behavioural weight management interventions, may contribute to health inequalities. We explored if there was evidence of inequalities in the attendance at and effectiveness of behavioural weight management interventions in adults.
Two-stage individual participant data meta-analysis.
Eligible studies were extracted from a previous systematic review and an updated search was completed on PubMed.
UK-based randomised controlled trials of behavioural weight management interventions suitable for use in primary care, published until 31 December 2021.
Multivariable regression analyses were conducted with weight at 12-month follow-up as the primary outcome and included an interaction between inequality characteristic and trial arm (control or intervention). Each model was adjusted for baseline weight, age and gender. Estimated interactions were combined across trials using a random-effects meta-analysis. Intervention attendance was defined as number of in-person sessions attended. Risk of bias was assessed using Cochrane's RoB 2 tool.
Data from 13/16 eligible weight loss trials were analysed (complete case data n=5531 participants). The effect of the intervention on weight at 12 months was greater in male participants (-2.58 kg (95% CI -3.52 to 1.64)) than female participants (-1.71 kg (95% CI -2.79 to -0.63); p value for interaction=0.02, tau=0) and greater for participants of white ethnicity (-2.74 kg (95% CI -4.30 to -1.19)), than those from an ethnic minority background (0.03 kg (95% CI -1.29 to 1.35); p interaction=0.04, tau=0). Age, education, occupation, place of residence and household income did not significantly moderate effectiveness. We did not find evidence of inequalities in intervention attendance by ethnicity, occupation, gender/sex, area-level socioeconomic deprivation or age.
Behavioural weight management interventions had smaller effects in people from ethnic minority backgrounds and larger effects in men. There was no evidence of other differences in intervention effectiveness or adherence. This is the first synthesis study to access individual participant data and quantitatively assess inequalities in these interventions. Future research should further explore reasons for differences in outcomes and consider how to prevent behavioural weight management interventions from potentially exacerbating health inequalities.
需要个人行为改变的肥胖干预措施，如行为体重管理干预，可能会加剧健康不平等。我们探讨了成人行为体重管理干预的参与率和效果方面是否存在不平等的证据。
两阶段个体参与者数据荟萃分析。
符合条件的研究从先前的系统评价中提取，并在PubMed上完成了更新搜索。
截至2021年12月31日发表的、适用于初级保健的英国行为体重管理干预随机对照试验。
以12个月随访时的体重作为主要结局进行多变量回归分析，分析中纳入不平等特征与试验组（对照组或干预组）之间的交互作用。每个模型都根据基线体重、年龄和性别进行了调整。使用随机效应荟萃分析对各试验中的估计交互作用进行合并。干预参与率定义为亲自参加的课程数量。使用Cochrane的RoB 2工具评估偏倚风险。
对16项符合条件的减肥试验中的13项数据进行了分析（完整病例数据n = 5531名参与者）。干预措施对男性参与者12个月时体重的影响更大（-2.58 kg（95%CI -3.52至-1.64）），大于女性参与者（-1.71 kg（95%CI -2.79至-0.63）；交互作用p值 = 0.02，tau = 0），对白人参与者的影响更大（-2.74 kg（95%CI -4.30至-1.19）），大于少数族裔背景的参与者（0.03 kg（95%CI -1.29至1.35）；交互作用p值 = 0.04，tau = 0）。年龄、教育程度、职业、居住地点和家庭收入对效果没有显著的调节作用。我们没有发现种族、职业、性别、地区层面的社会经济剥夺或年龄在干预参与率方面存在不平等的证据。
行为体重管理干预对少数族裔背景人群效果较小，对男性效果较大。没有证据表明在干预效果或依从性方面存在其他差异。这是第一项获取个体参与者数据并定量评估这些干预措施中不平等现象的综合研究。未来的研究应进一步探讨结果差异的原因，并考虑如何防止行为体重管理干预可能加剧健康不平等。
