Adherence to Behavioral Weight Management: A Scoping Review of Definitions, Measurement, and Components

Adherence to weight management is an essential indicator of weight management success. However, the conceptualization and operationalization of adherence show substantial variability, posing limitations for research, surveillance efforts, policy formulation, and comparisons across studies. This study aimed to identify in the literature of weight management interventions for people with obesity and overweight: (a) adherence definitions, (b) adherence components, (c) adherence metrics and measurement methods, and (d) behavior change techniques used to enhance it. A scoping review was conducted following PRISMA-ScR guidelines. A comprehensive search strategy was used (Web of Science, PubMed/MEDLINE, Scopus, and Cochrane). A total of 182 papers were included. Findings from the data synthesis showed variability in the definition, operationalization, and measurement of adherence across studies. The most frequent components of adherence in the context of weight management included (1) adherence to dietary behaviors, (2) adherence to physical activity, (3) attendance at intervention sessions, (4) self-monitoring of weight, (5) adherence to exercise, (6) adherence to medication, (7) attrition, (8) retention, and (9) dropout. The WHO's definition and framework to operationalize adherence are recommended, with modifications adjusted to the specific weight management context, as well as the use of standardized measurement metrics. Furthermore, behavior change techniques associated with adherence were summarized, with self-monitoring behavior and social support reported as strategies to improve adherence.