Unpacking weight management interventions measuring eating disorder risk in adults: coding of components of interventions in a systematic review

Introduction Adult weight management interventions are complex; better understanding of the intervention components that may impact eating disorder (ED) risk is required.

Methods Weight management randomized controlled trials (RCTs) for adults with overweight/obesity that measured ED risk were systematically searched in four databases and two trial registries. A project-specific codebook was used to code 84 delivery features and 89 intervention strategies of trials. Individual strategies were grouped into 20 clusters which were further grouped into five broad categories. Trial investigators verified coding and narrative synthesis using descriptive statistics of findings was reported.

Results Of 14,880 identified, 58 eligible trials were coded, of which 26 trials with 64 intervention arms were verified and therefore included. Intervention arms included a mean (SD) of 24 (11) intervention strategies. Commonly used intervention strategy clusters were nutrition education (91%), dietary behavior change strategies (84%), physical activity education (81%), and dietary self-monitoring (80%). Few interventions used strategies in the category of psychological components (13–41%). The median (range) intervention duration was 27 (4–104) weeks, and contacts with participants typically included a staged approach of weekly to monthly contact.

Conclusion Adult weight management interventions are multifactorial with varying delivery features and intervention strategies. Despite this, psychological (e.g. weight stigma) and sleep-health related strategies are either rarely used or are underreported. Breaking down intervention components using our framework can help identify which strategies influence outcomes, including eating disorder risk, and inform the design and reporting of future interventions.

Plain English summary Some adults seeking weight management for obesity may have an eating disorder or disordered eating behaviors. Research shows most people who take part in behavioral weight management programs have an improvement in eating disorder symptoms, however a small number may experience worsening symptoms. In this study, we break down behavioral weight management programs that measure eating disorder risk to better understand the features they use. We found that these programs vary widely in the number and type of strategies they use, as well as in how they are delivered, such as the length of the program. Strategies that focus on psychological factors (for example, addressing weight stigma) and sleep health were rarely used or reported. These findings are useful in guiding the design and reporting of future behavioral weight management programs. They can also be used in future research to determine which specific program features improve or worsen outcomes such as eating disorder risk.