Abstract
In the United Kingdom, the National Institute for Health and Care Excellence make recommendations to guide the local-level selection and implementation of adult behavioural weight management interventions (BWMIs) which lack specificity. The reporting of BWMIs is generally poorly detailed, resulting in difficulties when comparing effectiveness, quality and appropriateness for participants. This non-standardized reporting makes meta-analysis of intervention data impossible, resulting in vague guidance based on weak evidence, reinforcing the urgent need for consistency and detail within BWMI description. STAR-LITE - a 4-section, 119-item standardized adult BWMI reporting template - was developed and tested using a two-phase process. After initial design, the template was piloted using adult behavioural weight management RCTs and currently implemented UK BWMI mapping information to further refine the template and examine current reporting and variance. Overall, reporting quality of weight management RCTs was poor, and large variance across different components of real-world BWMIs was observed. Non-specific guidance and wide variation in adult BWMIs are likely linked to inadequate RCT reporting quality and the inability to perform reliable comparisons of data. Future use of STAR-LITE would facilitate the consistent, detailed reporting of adult BWMIs, supporting their evaluation and comparison, to ultimately inform effective policy and improve weight management practice.
Highlights
Behavioural weight management interventions (BWMIs), employed in an attempt to tackle rising obesity prevalence in adults,[1] aim to facilitate weight loss through intervening on three main topics - diet, physical activity and behavioural change.1.1 | Intervention guidance and barriers to commissioningIn the United Kingdom, commissioners of these ‘Tier 2’ multicomponent behavioural interventions have identified a ‘lack of clear guidance’, indicating that current National Institute for Health and Care Excellence (NICE) best practice guidelines are too broad to effectively assist local-level BWMI selection.[2]
NICE recommendations aim to direct the delivery of high-quality, effective BWMIs, but the supporting evidence - a meta-analysis and systematic review comparing weight management RCTs3,4 - failed to reliably differentiate between the most effective and ineffective components for weight loss
The reports highlighted the large inconsistency of outcome reporting by BWMIs,[6] with authors identifying the absence of standardized reporting as problematic for data analysis due to heterogeneity.[2]
Summary
There are no participant-specific gold standard BWMIs.[7] Given the wide variation between currently implemented interventions,[2,6] the placement of participants into appropriately tailored BWMIs is crucial to maximize individual success. To facilitate accurate assessments of intervention effectiveness and identification of the most beneficial components for specific participants, delivery information and outcome reporting must be clear, complete and transparent for the readers. The homogeneous, high-quality reporting of BWMI descriptions would facilitate accurate evaluations of interventions within systematic reviews and meta-analyses - findings of which could inform policy and improve current clinical practice. Consequential resource wastage (ie, time and finances) by the implementation of ineffective interventions following vague recommendations could be mitigated by stronger guidelines
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