The Influence of Relationships Within Behavioral Weight Management Interventions: An Overview

Behavioral weight management interventions have been shown to be effective for weight loss. However, a common challenge is difficulty in engaging with the public, participants, or service-users across the research continuum. User-provider relationships are key in weight management and may be integral to continuing engagement. This overview aimed to understand the nature of relationships within behavioral weight management interventions delivered in research studies and healthcare settings, how these may influence retention as well as potential relationship barriers and facilitators. Six databases were searched; 20 reviews (27 reports) were included. Most reviews investigated weight management delivered face-to-face by healthcare professionals across different settings. The Theoretical Domains Framework guided the synthesis of qualitative and quantitative data regarding user-provider relationships. GRADE CER-Qual was used to assess the confidence of findings. Thirty-eight findings were categorized to domains in the framework in addition to two cross-cutting themes. High confidence evidence demonstrated that the domains of knowledge, skills, social/professional role or identity, environmental context and resources, and behavioral regulation provided challenges as well as enabling relationships in weight management. The central domain underpinning the influence of relationships on retention was social influences, with weight stigma a pervasive theme recurring across domains. Application of a theoretical lens to consider cognitive, affective, social, and environmental influences helped better understand user-provider relationships as a potential mechanism through which retention-related behaviors in weight management can be driven or deterred. This overview suggests that improving user-provider relationships should be considered a useful retention strategy in weight management programs.