Review of strategies regarding target group accessibility, participation motivation, and adherence in prevention programmes for overweight or obese children, adolescents, and adults

Project duration: Mid-April 2023 until Mid-November 2023
Language: German (with English executive summary)
Publication: HTA Project Report No. 155: https://eprints.aihta.at/1486/

Background: According to the World Health Organization (WHO), overweight and obesity are among the century's most significant public health challenges. A recent WHO study showed that 59% of adults (>18 years) in the European region are either overweight or obese [1]. Statistic Austria data from 2019 showed that 34.5% of Austrians aged 15 years and older are overweight, and 16.6% are obese [2]. In addition to adults, children and adolescents are also frequently affected. According to the Childhood Obesity Surveillance Initiative (COSI) report of 2020, the cumulative prevalence of overweight, obesity, and extreme obesity in eight and nine-year-old children across Austria is – depending on the classification –one in four (WHO) to one in six (International Obesity Task Force, IOTF) boys and one in four (WHO) to one in five (IOTF) girls [3]. Results from the 2021/2022 Health Behaviour in School-aged Children (HBSC) survey showed that 17% of girls and 25% of boys in Austria were overweight or obese. The data were based on self-reported weight and height [4].

Being overweight and obese is often associated with physical and psychological health effects. Especially at a young age, it can increase the risk of secondary diseases, such as hypertension or other cardiovascular diseases, type 2 diabetes, lipid metabolism disorders, or osteoarthritis in adulthood [5]. These secondary diseases also lead to further economic consequences, e.g. through increased sick leave [1]. For these reasons, various prevention and treatment programmes have been established for overweight or obese children, adolescents, and adults. These include, for example, school-based or workplace-based, family-based or web-based programmes in individual and/or group settings [6]. In Austria, such prevention programmes are also offered by the Austrian Health Insurance Fund (Österreichische Gesundheitskasse, ÖGK). The multimodal programmes usually cover three pillars: nutrition, exercise/sport, and motivation/behaviour [7]. However, although many of these programmes already exist, essential target groups are often difficult to reach. In addition, participants often dropout of the programmes early, which means that the desired programme goals cannot be achieved [8, 9].

Project aims: The main objective of this project is to systematically review the scientific literature on strategies regarding sustainable target group accessibility (recruitment strategies) and to maintain adherence (motivational strategies) in multimodal overweight or obesity prevention programmes covering the topics of nutrition, exercise/sport and motivation/behaviour. A particular focus will thereby lie on reaching and motivating socially disadvantaged individuals. Furthermore, existing multimodal overweight and obesity prevention programmes for children, adolescents and adults in German-speaking countries (Austria, Germany, Switzerland) and their characteristics will be identified and presented. In addition, the recruitment and motivational strategies applied in these programmes will be presented (if available).

An effectiveness and safety analysis of various prevention programmes for overweight or obese individuals is NOT an aim of this project.

Research questions (RQ): The following research questions arise from the defined project aims:

RQ1:    Which multimodal prevention programmes for overweight and obese individuals (Population 1 & 2) exist in Austria, Germany and Switzerland? Which of these projects have already been evaluated?

• Population 1: Children & adolescents (4-18 years): BMI percentiles 90-97 = overweight, >97-99.5 = obese
• Population 2: Adults (18-65 years): BMI >25-30 = overweight, >30-34.9 = obese (grade 1)

RQ2:    What interventions/strategies effectively reach Population 1 & 2 (in particular individuals with a BMI in the overweight range and socially disadvantaged individuals), and do the recruitment strategies differ between generational groups?

RQ3:    What interventions/strategies/settings can be used to optimise programme adherence of Population 1 & 2, and do the motivational strategies differ between generational groups?

Methods:
Research question 1:

For the overview of multimodal overweight and obesity prevention programmes for children, adolescents and adults in German-speaking countries, as well as existing evaluations, manual searches will be conducted. If necessary, experts will be contacted. After the literature selection, the data will be extracted into predefined tables and narratively summarised. The quality of the evaluation reports will not be systematically assessed.

PICO 1: Inclusion and exclusion criteria of the literature

Research question 2:

A systematic and additional manual search will be conducted to identify recruitment strategies. After the literature selection, the systematic reviews and primary studies data will be extracted into predefined tables and narratively analysed (clustered according to age groups/generations, if reported). Realist review approaches will be used to synthesise the results. A realist review describes not only whether a strategy is effective but how it works for whom and in what circumstances [10].

PICO 2: Inclusion and exclusion criteria of the literature

Research question 3:

Another systematic and supplementary manual search will be conducted to identify motivational strategies. Primary studies will be included or excluded depending on the number of systematic reviews available. The data will be extracted from the systematic reviews and, if applicable, primary studies into predefined tables and narratively summarised (clustered according to age groups/generations, if reported). Realist review approaches will again be used to synthesise the results.

PICO 3: Inclusion and exclusion criteria of the literature

The quality of the identified literature for answering research questions 2 and 3 will be assessed with a suitable tool depending on the study design. All steps (literature selection, quality assessment, data extraction and synthesis) will be carried out by the two authors (IR and SW) in a 4-eyes principle.

Time table

References:

[1] World Health Organisation (WHO). WHO beginnt subregionale Politikdialoge zur Bekämpfung von Adipositas.2022 [cited 18.04.2023]. https://www.who.int/europe/de/news/item/24-06-2022-who-begins-subregional-policy-dialogues-to-fight-obesity.

[2] Statistik Austria. Übergewicht und Adipositas. 2019 [cited 18.04.2023]. https://www.statistik.at/statistiken/bevoelkerung-und-soziales/gesundheit/gesundheitsverhalten/uebergewicht-und-adipositas.

[3] Childhood Obesity Surveillance Initiative (COSI). Bericht Österreich 2020 [cited 18.04.2023]. https://broschuerenservice.sozialministerium.at/Home/Download?publicationId=847.

[4] WHO-HBSC-Survey 2021/22. Gesundheit und Gesundheitsverhalten von österreichischen Schülerinnen und Schülern. [cited 18.04.2023]. https://goeg.at/sites/goeg.at/files/inline-files/%C3%96sterr.%20HBSC-Bericht%202023_bf.pdf.

[5] Aerzteblatt.de. Zahl der adipösen Kinder steigt. 2022 [cited 18.04.2023]. https://www.aerzteblatt.de/nachrichten/138562/Zahl-der-adipoesen-Kinder-steigt.

[6] Aerzteblatt.de. Adipositas: US-Pädiater raten zu konsequenter Therapie. 2023 [cited 18.04.2023]. https://www.aerzteblatt.de/nachrichten/sw/adipositas?s=&p=1&n=1&nid=140158.

[7] Österreichische Gesundheitskasse. Gesundheitsförderung – Regionale Projekte. 2023 [cited 18.04.2023]. https://www.gesundheitskasse.at/cdscontent/?contentid=10007.877661&portal=oegkportal&filter-preselect=%22Lebensstil%22.

[8] Rice J, Thombs D, Leach R, Rehm R: Successes and barriers for a youth weight-management program. Clin Pediatr (Phila) 2008, 47:143–147.

[9] Kinzl JF. Psychische Aspekte der Adipositastherapie: Motivation, Widerstand, Problembereiche. Journal für Ernährungsmedizin 2005; 7 (1): 34-36.

[10] Hunter R, Gorely T, Beattie M, and Harris K. Realist review, 2022. International Review of Sport and Exercise Psychology, 15:1, 242-265, DOI: 10.1080/1750984X.2021.1969674.