The efficacy of behavioural interventions for weight management in multi-ethnic adults with overweight or obesity in Asia: a systematic review and meta-analysis

Obesity is a global public health challenge, especially in Asia. While the efficacy of behavioural interventions for weight management has been extensively studied in the Western populations, it remains inadequately evaluated in Asian countries. Therefore, we performed a systematic review and meta-analysis to assess the efficacy of behavioural interventions in weight management in Asia. We searched 6 databases for randomised controlled trials (RCTs) of behavioural interventions published between 2008 and 2023 involving adults with overweight or obesity in Asia. We considered 3 adiposity indices: body weight, body mass index (BMI) and waist circumference. We (i) conducted meta-analyses using random-effects models; (ii) analysed the network of Behaviour Change Technique (BCT) clusters implemented and (iii) performed stratified meta-regressions adjusting for 13 covariates potentially associated with changes in adiposity. Of 25,950 records screened, 55 RCTs (11,092 participants) were included. The most frequently utilised BCT components were shaping knowledge (19.9%), feedback and monitoring (18.5%) and goals and planning (18.2%). Behavioural interventions were associated with statistically significant but clinically small reductions in body weight, BMI and waist circumference (unadjusted: -2.12 Kg [95% CI -2.39 to -1.85; 43 RCTs; I 2 = 99.4%], -0.81 Kg/m 2 [95% CI -0.94 to -0.68; 41 RCTs; I 2 = 99.7%] and − 2.64 cm [95% CI -3.10 to -2.17; 33 RCTs; I 2 = 99.8%], respectively), corresponding to approximately 2.8% of baseline adiposity measures. In stratified meta-regressions, behavioural interventions incorporating the 3 most frequent BCT clusters show slightly greater pooled reductions in adiposity (-2.24 Kg [95% CI -2.57 to -1.91], -0.88 Kg/m 2 [95%CI -1.05 to -0.72] and − 2.70 cm [95% CI -3.26 to -2.14], respectively. However, these findings should be interpreted cautiously given substantial clinical, methodological and statistical heterogeneity across studies. Behavioural interventions in Asia are associated with statistically significant but clinically small improvements in adiposity. Future research should prioritise culturally adapted, theory-driven interventions with longer follow-up and integration into local healthcare settings.