Evaluating the behavioural intervention, organisational and health economic evidence base for adult obesity management

Evaluating the behavioural intervention, organisational and health economic evidence base for adult obesity management

This research included systematic reviews of trials of adult obesity management examining the most effective long-term interventions, behaviour change techniques to use, the effectiveness of group-based interventions, the best length and frequency for follow-up for interventions, the effectiveness of interventions given by community pharmacies, the effectiveness of interventions in older people, the effectiveness of interventions for men, and interventions for people with higher body mass indices. Two studies with patients, providers of services and policy makers, particularly examining the effects of group approaches. Examination of preferences for types of lifestyle intervention. Examination of Scottish health records for obesity related disease risk, prior to the evaluation of alternative approaches to obesity management. Pilot studies of group based lifestyle behaviour change programme, developed from this research.

Using lifestyle behaviour change techniques based on psychological control theory, social cognitive theory, and social comparison theory, improves weight loss. Group-based obesity management is as least as effective as that delivered to the individual. Incentives, such as financial incentives, should be researched to aid weight loss. Simple advice on healthy eating and physical activity, with limited support, are unlikely to produce at least 5-10% long-term weight loss. This degree of long-term weight loss requires more intensive programmes particularly with a focus on a reduction in calorie intake, physical activity and lifestyle behaviour change support. The NHS has limited capacity for this type of support for weight management in obesity. NHS staff need greater training in lifestyle behaviour change techniques and working with groups. Scarce NHS resources need to be targeted at those at highest risk of obesity-related disease, who are most likely to benefit from these programmes.



Ongoing - Data collection


Avenell A, Broom J, Brown TJ, Poobalan A, Aucott L, Stearns SC, Smith WCS, Jung RT, Campbell MK, Grant AM. Systematic review of the long-term effects and economic consequences of treatments for obesity and implications for health improvement. Health Technol Assess 2004; 8(21): 1-458.  

Avenell A, Brown TJ, McGee MA, Campbell MK, Grant AM, Broom J, Jung RT, Smith WCS.   What interventions should we add to weight reducing diets in adults with obesity? A systematic review of randomised controlled trials of adding drug therapy, exercise, behaviour therapy or combinations of these interventions. J Hum Nutr Diet 2004; 17(4): 293-316.

Avenell A, Brown TJ, McGee MA, Campbell MK, Grant AM, Broom J, Jung RT, Smith WCS. What are the long-term benefits if weight reducing diets in adults? A systematic review of randomised controlled trials. J Hum Nutr Diet 2004; 17(4): 317-35.

Avenell A, Sattar N, Lean MEJ. ABC of obesity. Management: Part 1- Behaviour change, diet and activity. BMJ 2006; 333: 740-3.

Dombrowski SU, Sniehotta FF, Avenell A, Coyne JC. Towards a cumulative science of behaviour change: Do current conduct and reporting of behavioural interventions fall short of best practice? Psychol Health 2007; 22: 869-74.

Poobalan AS, Aucott LS, Smith WCS, Avenell A, Jung RT, Broom J. Long-term weight loss effects on all cause mortality in overweight/obese populations. Obes Rev 2007; 8: 503-13.

Paul-Ebhohimhen V, Avenell A. Systematic review of the use of financial incentives in treatments for obesity and overweight. Obes Rev 2008; 9: 355-67.

Paul-Ebhohimhen V, Avenell A. A systematic review of the effectiveness of group versus individual treatment trials for adult obesity.   Obesity Facts 2009; 2: 17-24.

Brown T, Avenell A, Edmunds E, Moore H, Whittaker V, Avery L, Summerbell C and the PROGRESS group. Systematic review of long-term lifestyle interventions to prevent obesity in adults. Obesity Reviews. 2009; 10(6): 627-638.

Witham MD, Avenell A. Systematic review of interventions for weight loss in older people. Age Ageing 2010: 39 (2):176-184.

Dombrowski SU, Avenell A, Sniehotta FF. Systematic review of behavioural interventions in obese adults with risk factors for comorbidities: effects on weight and disease risk factors.  Obesity Facts 2010; 3: 377-96.

Allan K, Hoddinott P, Avenell A.  Groups, classes and clubs: a qualitative study comparing commercial and health service weight loss groups. J Hum Nutr Diet 2011; 24: 23-31.

Gordon J, Watson M, Avenell A. Lightening the load? A systematic review of community pharmacy-based weight  management interventions. Obes Rev 2011; 11: 897-911.

Dombrowski SU, Sniehotta FS, Avenell A, Johnston M, MacLennan G, Araujo-Soares V. Identifying active ingredients in complex behavioural interventions for obese adults with additional risk factors: a systematic review.  Health Psychology Review 2012; 6: 7-32.

Robertson C, Archibald D, Avenell A, Douglas F, Hoddinott P, van Teijlingen E, Boyers D, Stewart F, Boachie C, Fioratou E, Wilkins D, Street T, Carroll P, Fowler C. Systematic reviews of and integrated report on the quantitative, qualitative and economic evidence base for the management of obesity in men. Health Technol Assess 2014; 18: 35.

Dombrowski SU, Knittle K, Avenell A, Araujo-Soares V, Sniehotta FF. Long term maintenance of weight loss with non-surgical interventions in obese adults: systematic review and meta-analyses of randomised controlled trials. BMJ 2014; 348: g2646.

Stewart F, Avenell A. Lifestyle management interventions for severe obesity before and/or after bariatric surgery: a systematic review and meta-analysis. Obesity Surgery 2015 DOI 10.1007/s11695-015-1873-6.

Ryan M, Yi D, Avenell A, Douglas F, Aucott L, Van Teijlingen E, Vale LD. Gaining pounds by losing pounds: preferences for lifestyles to reduce obesity. Health Economics, Policy and Law 2015: 10: 161-82.

Best D, Avenell A, Bhattacharya S. How effective are weight-loss interventions for improving fertility in women and men who are overweight or obese? A systematic review and meta-analysis of the evidence. Human Reproduction Update 2017: https://doi.org/10.1093/humupd/dmx027.

Ma C, Avenell A, Bolland MJ, Hudson J, Stewart F, Robertson C, Sharma P, Fraser C, MacLennan G. Effects of weight loss interventions for adults who are obese on mortality, cardiovascular disease and cancer: a systematic review and meta-analysis. BMJ 2017; 359:j4849 doi: 10.1136/bmj.j4849.

Avenell A, Robertson C, Skea Z, Jacobsen E, Boyers D, Cooper D, et al. REview of Behaviour And Lifestyle interventions for severe obesity: AN evidenCE synthesis (REBALANCE). Systematic reviews and economic evaluations. Health Technol Assess 2018 https://doi.org/10.3310/hta22680.

Jacobsen E, Boyers D, Avenell A. Challenges of systematic reviews of economic evaluations: a review of recent reviews and an obesity case study. Pharmacoeconomics 2020;38:259-267.

Dombrowski SU, McDonald M, van der Pol M, Grindle M, Avenell A, Carroll P, Calveley E, Elders A, Glennie N, Gray CM, Harris FM, Hapca A, Jones C, Kee F, McKinley MC, Skinner R, Tod M, Hoddinott P. Game of Stones: Feasibility randomised controlled trial of how to engage men with obesity in text message and incentive interventions for weight loss. BMJ Open 2020; 10(2):e032653.

Boyers D, Retat L, Jacobsen E, Avenell A, Aveyard P, Corbould E, Jaccard A, Cooper D, Robertson C, Aceves Martins M, Xu B, Skea Z, de Bruin M, and the REBALANCE team. Cost-effectiveness of bariatric surgery and non-surgical weight management programmes for adults with severe obesity: A decision analysis model. International Journal of Obesity 2021;45:2179–2190. https://doi.org/10.1038/s41366-021-00849-8.

Hunter E, Avenell A, Meshwari A, Stadler G, Best D. The effectiveness of weight-loss lifestyle interventions for improving fertility in women and men who are overweight and obese with infertility: a systematic review update of evidence from randomised controlled trials. Obesity Reviews 2021 Dec;22(12):e13325. doi: 10.1111/obr.13325.

McDonald MD, Hunt K, Sivaramakrishnan H, Moullin J, Avenell A, Kerr DA, Moyo Z, Birch J, Nikos Ntoumanis N, Quested E. A systematic review examining socioeconomic factors in trials of interventions for men that report weight as an outcome. Obesity Reviews. 2022;e13436.doi:10.1111/obr.13436.

Robertson C, Aceves-Martins M, Cruickshank M, Imamura M, Avenell A. Does weight management research for adults with severe obesity represent them? Analysis of systematic review data. BMJ Open 2022 May 31;12(5):e054459. doi: 10.1136/bmjopen-2021-054459.

Street S, Avenell A. Are individual or group interventions more effective for long-term weight loss in adults with obesity? A systematic review. Clin Obes 2022 Oct;12(5):e12539. doi: 10.1111/cob.12539.