More men than women are overweight or obese in the UK but men are less likely to perceive their weight as a problem and less likely to engage with weight-loss services, particularly those from the commercial sector.

The NIHR Health Technology Assessment programme funded Professor Alison Avenell and researchers from the Universities of Aberdeen, Stirling and Bournemouth to systematically review evidence-based engagement and management strategies for treating obesity in men. This was a mixed-method systematic review integrating the quantitative, qualitative and health economic evidence base.

The impact of weight loss on health problems and the desire to improve appearance, without looking too thin, are motivators for weight loss amongst men. Interventions delivered in social settings are preferred to health-care settings. Programmes with a sporting context, where participants have a strong sense of affiliation, show low dropout rates and high satisfaction. Group-based programmes show benefits by facilitating support for men with similar health problems, and some individual tailoring of advice assists weight loss. Preferences for men-only versus mixed-sex weight-loss group programmes are divided.

Men are more likely than women to benefit if physical activity is part of a weight-loss programme, but reducing diets produce more favourable weight loss than physical activity alone.  Low-fat reducing diets, some with meal replacements, combined with physical activity and behaviour change training give the most effective long-term weight change in men, and can prevent type 2 diabetes in men and improve erectile dysfunction. Although fewer men join weight-loss programmes, once recruited they are less likely to drop out than women.