Inequalities in the uptake of, adherence to and effectiveness of behavioural weight management interventions: systematic review protocol.
INTRODUCTION
It has been suggested that interventions focusing on individual behaviour change, such as behavioural weight management interventions, may exacerbate health inequalities. These intervention-generated inequalities may occur at different stages, including intervention uptake, adherence and effectiveness. We will synthesise evidence on how different measures of inequality moderate the uptake, adherence and effectiveness of behavioural weight management interventions in adults.


METHODS AND ANALYSIS
We will update a previous systematic literature review from the United States Preventive Services Taskforce to identify trials of behavioural weight management interventions in adults aged 18 years and over that were, or could feasibly be, conducted in or recruited from primary care. Medline, Cochrane database (CENTRAL) and PsycINFO will be searched. Only randomised controlled trials (RCTs) and cluster-RCTs will be included. Two investigators will independently screen articles for eligibility and conduct risk of bias assessment. We will curate publication families for eligible trials. The PROGRESS-Plus acronym (place of residence, race/ethnicity, occupation, gender, religion, education, socioeconomic status, social capital, plus other discriminating factors) will be used to consider a comprehensive range of health inequalities. Data on trial uptake, intervention adherence, weight change and PROGRESS-Plus-related data will be extracted. Data will be synthesised narratively. We will present a Harvest plot for each PROGRESS-Plus criterion and whether each trial found a negative, positive or no health inequality gradient. We will also identify potential sources of unpublished original research data on these factors which can be synthesised through a future individual participant data meta-analysis.


ETHICS AND DISSEMINATION
Ethical approval is not required as no primary data are being collected. The completed systematic review will be disseminated in a peer-reviewed journal, at conferences, and contribute to the lead author's PhD thesis. Authors of trials included in the completed systematic review may be invited to collaborate on a future individual participant data meta-analysis.


PROSPERO REGISTRATION NUMBER
CRD42020173242.
['Birch|Jack Michael|JM|0000-0001-6292-1647', 'Griffin|Simon J|SJ|', 'Kelly|Michael P|MP|', 'Ahern|Amy L|AL|0000-0001-5069-4758']
D000293:Adolescent D000328:Adult D002648:Child D005260:Female D006801:Humans D008297:Male D044623:Nutrition Therapy D009765:Obesity D050177:Overweight D011247:Pregnancy D011788:Quality of Life D000078202:Systematic Reviews as Topic D015431:Weight Loss
primary care preventive medicine public health