A systematic scoping review of adult obesity policy actions and weight-related services in a region of the United Kingdom using the Behaviour Change Wheel

Obesity is a global health challenge associated with increased risk of co-morbidity and mortality. Existing government policies have failed to adequately address obesity. Mapping obesity policy actions (including prevention initiatives and weight-management services (WMS)) using behavioural science can offer insights into how approaches to prevention/management could be improved. This research aimed to identify strengths and gaps in adult obesity policy actions/WMS in Northern Ireland (NI) by conducting a systematic scoping review of grey literature. Obesity policy actions/WMS were mapped out and coded using the Behaviour Change Wheel (BCW), then assessed against obesity risk factors identified from the Foresight Obesity System Map. The breadth of obesity policy actions/WMS was mapped using Google Advanced Searches, grey literature database searches, targeted website searches and stakeholder consultations. Policy actions/WMS were categorised using the UK weight-management tiered system. Policy actions/WMS were coded by BCW intervention type. Foresight variables were coded according to the Capability-Opportunity-Motivation-Behaviour (COM-B) Model. Policy actions/WMS were subsequently mapped against Foresight variables and displayed using a heat map. Twelve Google Advanced Searches, three database searches, n=17 targeted website searches and three stakeholder interviews were conducted (and updated in 2024) identifying a wide range of relevant records (N=127). Results included policies/strategies/guidelines/campaigns/services targeting weight management/obesity. Of the identified policy actions/WMS, 72% were classified as tier 1 (health promotion); 21% tier 2 (community-based weight management programmes); 2% tier 3 (specialist obesity services), 5% were tier 2/3 services and 0% were tier 4 services (metabolic surgery). Education and persuasion were the most commonly coded intervention types from the BCW, followed by enablement and training. Environmental restructuring was limited, as was modelling and incentivisation approaches. Behavioural mapping of obesity policy actions/WMS is a novel approach with the potential to influence policy/service development. In NI, using this method illustrated policy gaps and significant opportunities to improve WMS provision.