Behaviour Change Techniques for Lifestyle Changes in People Living with Overweight and Obesity in Primary Care Settings: A Scoping Review of Systematic Reviews

Abstract

Introduction

The prevalence of obesity is increasing worldwide. A combination of diet, physical activity (PA), and behavioural therapy is considered the basic treatment approach. The general practitioner (GP) setting offers a promising opportunity to provide comprehensive care, with behaviour change techniques (BCTs) serving as tools to facilitate its delivery. However, there are few firm recommendations on how BCTs facilitate behaviour change in GP settings and how these strategies can be effectively implemented. This study investigated the use of BCTs within the GP setting in terms of weight management through a scoping review of systematic reviews and meta-analyses.

Methods

Following the Arksey and O’Malley framework, a systematic search was conducted in the MEDLINE (via Ovid), Epistemonikos, and Cochrane databases. Two authors screened the identified articles published between 2013 and 2025. Key information was extracted, including baseline data, intervention details, effects on body weight/body mass index, cardiometabolic parameters, and lifestyle aspects.

Results

A total of 7,264 articles were identified, with 12 studies included in the final review. In general, the use of BCTs in the GP setting is beneficial for managing weight, changing lifestyle, and improving cardiometabolic factors. However, there is considerable heterogeneity regarding the description of the behavioural therapy content, the number of counselling sessions, and the role of GPs. The effectiveness of BCTs varied depending on the objective (e.g., increasing PA or reducing body weight) and the type of intervention (e.g., delivered individually vs. in a group).

Conclusion

These findings suggest that BCTs used in a GP setting can positively influence behavioural change, particularly with regard to weight and lifestyle management, despite the fact that they are not usually delivered by GPs themselves and the techniques used vary widely. Future studies should, therefore, focus on identifying the most effective BCTs and their implementation strategies, with the aim of maximising the contribution of primary care to the fight against obesity.

Introduction

The global prevalence of obesity has more than doubled since 1990 [1]. According to the World Health Organization, in 2022, 43% of adults (≥18 years) were classified as overweight and 16% as living with obesity [2]. Obesity is a complex and chronic condition which increases the risk of various non-communicable diseases and mortality [3]. Obesity increases the risk of diabetes and lipid disorders more than threefold and is linked to psychosocial and functional impairments, including stigma and discrimination [2, 4]. In the European Union, increased weight and obesity cause an estimated 1.2 million deaths annually [4]. According to guidelines, obesity management typically follows a staged approach, beginning with basic interventions such as dietary modification, exercise, and behavioural therapy [2, 5]. Experts recommend at least 30–60 min of physical activity (PA) daily, and reducing fat and/or carbohydrate intake to create a 500 kcal daily deficit [5].

Behavioural interventions are crucial for achieving long-term success in weight management as they allow individuals to make lasting changes to diet and lifestyle [5, 6]. One review comparing combined behavioural and weight management programmes to single-component interventions (e.g., PA or diet) found that combined approaches had significantly greater long-term effectiveness in terms of weight loss after 12–18 months [7]. Participants in programmes with behaviour change techniques (BCTs) lost an average of 1.72 kg more than those in diet-only programmes (95% confidence interval [CI]: −2.80 to −0.64); weight loss was even greater (6.29 kg more than PA-only programmes) after 12–18 months (95% CI: −7.33 to −5.25) [7]. In the context of behavioural therapy, BCTs such as goal setting, self-monitoring, and planning for social support are frequently applied. To ensure comparability of interventions, Michie et al. [8] developed a taxonomy of 93 distinct BCTs grouped into 16 overarching domains. However, there is a lack of recommendations on specific programme design. Studies vary on which BCTs to use, their implementation and duration, and the providers involved [5, 9].

One promising approach in primary care may be to provide brief counselling sessions in the general practitioner (GP) setting [5]. In this review, we define the GP setting as any primary care environment where behaviour change interventions take place. This includes interventions conducted directly in GP practices; those delivered by GPs or other primary care professionals (e.g., nurses, physiotherapists, health coaches); and interventions that are initiated, referred, coordinated, or otherwise facilitated by GPs as part of routine primary care pathways. Optimal conditions for health counselling include a trusting patient-GP relationship and easy access [5, 10–12]. Research on weight management consultations shows that patients receiving weight loss counselling are more likely to attempt weight loss and have a better understanding of the risks associated with obesity [13–15]. However, it has also been noted that consultations in GP settings are often inadequate [11, 13–15], primarily due to time constraints, staffing shortages, and insufficient training. Additionally, providers experience considerable uncertainty about how to address the topic sensitively [11]. This scoping review examined the use of BCTs within GP settings and broader healthcare contexts, focussing on their effects on lifestyle changes such as weight management. It aimed to map existing evidence, identify research gaps, and inform future implementation strategies [16].

Methods

This scoping review was conducted according to the framework of Arksey and O’Malley [17]. The protocol is included in online supplementary Material S1 (for all online suppl. material, see https://doi.org/10.1159/000550631). The literature search and data extraction were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) [18]. The PRISMA checklist is described in online supplementary Material S2. Inclusion criteria were established using the Population, Intervention, Comparator, Outcomes, and Study design (PICOS) framework and are presented in Table 1. Articles were excluded based on the following criteria: patients were aged <18 years and/or had a body mass index (BMI) of <25 kg/m², BMI or lifestyle parameters were not reported or not published as a systematic review (SR) or meta-analysis (MA), or the comorbidity investigated was not a cardiometabolic condition typically associated with obesity. Studies focussing on pregnant women were also excluded.

Table 1.

Eligibility criteria for study inclusion in this scoping review of SRs, based on PICOS

Population	Adult (aged ≥18 years) patients living with overweight (body mass index [BMI] ≥25 kg/m2) or obesity (BMI ≥30 kg/m2)
Intervention	Any communication technique (BCTs for lifestyle change, including diet, PA, sleep, and the reduction of sedentary behaviour, or media consumption) that was delivered within the healthcare sector. This includes interventions carried out by or under the supervision of healthcare professionals in medical or healthcare-related settings such as primary care or clinical environments, irrespective of where participants were recruited. Interventions were also included if they were described as part of healthcare delivery or conducted by qualified healthcare professionals, even in cases where the setting, for example, in digital interventions, was not explicitly stated, but the healthcare context was clearly implied
Comparator	Standard of care, no intervention, or alternative interventions
Outcomes	Primary (weight or BMI) and secondary (lifestyle parameters, such as PA, stress, nutrition, sleep, reduction of sedentary behaviour, media consumption, and psychosocial aspects)
Study design	SRs and meta-analyses (MA) that included randomised controlled trials (RCTs)

Information Sources and Search

The MEDLINE database (via Ovid), Cochrane Database of SRs, and Epistemonikos database were searched for relevant MAs and SRs on BCTs for lifestyle interventions in the medical context of individuals classified as overweight and living with obesity published between January 2013 and July 2025. An initial screening was conducted in 2023, covering the previous 10 years, and the search was subsequently updated in July 2025. The search strategies were adapted from the methodology outlined by Samdal et al. [9] and are comprehensively described in online supplementary Material S3, S4, and S5.

Selection of Sources of Evidence

The online collaboration and research software Rayyan was used to screen the identified articles [19]. First, two authors (A.P. and L.K.) independently and blindly screened the titles and abstracts against the inclusion and exclusion criteria. Studies considered inappropriate were excluded. Second, the same authors independently and blindly screened the full texts of the remaining articles. A third author (C.J.) was consulted for clarification when necessary. The screening process is documented in the PRISMA flowchart shown in Figure 1 [18]. Reasons for the exclusion of studies at the full-text screening stage are detailed in online supplementary Material S6. Study overlap was assessed using the corrected covered area (CCA) method by Pieper et al. [20].

Fig. 1.

Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) flow diagram showing the study selection process.

Data Charting Process and Data Items

A standardised extraction table was developed and tested for applicability and completeness based on three articles. The data were systematically recorded in the extraction table independently by two authors (A.P. and L.K.) and then compared. The following information was added for each SR (Table 2):

• Basic information and population data: author, date, number of included randomised controlled trials and participants as reported in the review (women in %), comorbidities (other than obesity), and country

• Intervention: study objective, reported BCTs (identified and classified by domains according to Michie et al.’s [8] taxonomy), and comparator(s)

• Results: effects on body weight/BMI and other health parameters and lifestyle aspects, effectiveness or key information on the BCTs, and conclusions.

Table 2.

Study characteristics, outcomes, and key insights

Basic information and population data				Intervention			Outcome			Evaluation/conclusion
author (year)	number of participants (% women)/included RCTs	comorbidities	country (number of studies)	study aim	BCTs reported	comparator	effects on BMI or weight	additional effects	effectiveness and key insights on BCTs
Abbott et al. [21] (2021)	2,576 (NA)/7	NA	UK (n = 3), USA (n = 1), Australia (n = 2), Germany (n = 1), Spain (n = 1)	To compare group vs. one-to-one multi-component lifestyle interventions (diet, PA, and behaviour change) for weight management	NA	No specific control group defined; comparisons made between different active interventions	Group interventions produced greater weight loss at 12 months than individual ones (−1.9 kg, 95% CI: −2.6 to −1.3; I2 = 99%) and higher likelihood of ≥5% loss (RR 1.58, 95% CI: 1.25–2.00; I2 = 60%)	NA	NA	Group-based multimodal interventions are more effective for adult weight loss than individual interventions
Carraca et al. [22] (2021)	12,854 (77%)/62	MetS, hypertension, T2DM.	NA	To identify the most effective BCTs for increasing PA in digital and face-to-face behaviour change interventions in adults living with OW/OB	Yes	No intervention, standard care, waitlist control, or active controls (e.g., diet-only interventions without PA counselling)	NA	While assessing PA through both objective and self-report measures, the study found that face-to-face interventions had a larger effect (SMD = 0.78) than digital interventions (SMD = 0.42), with specific and distinct BCTs acting as significant moderators of success in each format	PA was increased in digital interventions through BCTs such as “goal setting behaviour,” “goal setting outcome,” “graded tasks,” and “social incentives” (adjusted R2 = 0.15–0.51). Self-monitoring of behaviour should be avoided due to its negative effect (β = −1.04, p = 0.001; adjusted R2 = 0.23)	The most effective BCTs vary between digital and face-to-face interventions. The selection of BCTs is contingent on the design and structure of the intervention
									PA was increased in face-to-face interventions: prompt behavioural practice and rehearsal (β = 0.47, p = 0.028, adjusted R2 = 0.31)
Chew et al. [23] (2023)	2,478 (NA)/14	NA	USA (n = 10), Australia (n = 1), Belgium (n = 1), Korea (n = 1), Japan (n = 1)	To evaluate the effectiveness of combining self-monitoring apps with health coaching on anthropometric, cardiometabolic, and lifestyle outcomes in individuals living with OW/OB.	Yes	Usual care without digital support or app-based self-monitoring without additional counselling	Combined health coaching and self-monitoring apps significantly improved weight loss by 2.15 kg (95% CI: −3.17 to −1.12, p < 0.001; I2 = 60.3%)	Significant improvements in waist circumference (−2.48 cm, 95% CI: −3.51 to −1.44; I2 = 29%), triglycerides (−0.22 mg/dL, 95% CI: −0.33 to −0.11; I2 = 0%), HbA1c (−0.12%, 95% CI: −0.21 to −0.02; I2 = 0%), and daily calorie intake (−128.3 kcal, 95% CI: −182.7 to −73.9; I2 = 0%); no significant effects on blood pressure, body fat, cholesterol, or PA	Self-monitoring apps already include several BCTs (“self-monitoring,” “goal setting,” “planning,” and “prompts or cues”); thus, the effect of combined interventions is limited. Greater success is likely if coaching incorporates additional strategies, such as intensive feedback, social support, and problem solving	The combined interventions showed significant improvements in weight loss and other parameters; however, there was no evidence that health coaching combined with smartphone apps improves obesity-related outcomes more than smartphone apps alone
							There were no significant effects on BMI (WMD: −0.82 kg/m2, 95% CI: −2.03 to 0.39, p = 0.1)		No further analysis was conducted on the effectiveness of the BCTs. However, the following BCTs were used: “instructions on how to perform behaviour” (14/14 studies), “self-monitoring of behaviours” (14/14 studies), “goal setting and planning” (10/14 studies), “prompts or cues” (9/14 studies), “social support” (7/14 studies), “problem solving” (6/14 studies), “rewards” (5/14 studies), and “reducing negative emotions” (2/14 studies)
De Lannoy et al. [24] (2021)	6,185 (56%)/17	NA	NA	To compare the effectiveness of behaviour-based counselling for obesity management to usual care among participants referred from clinical settings	NA	Control group without counselling or usual care involving routine medical visits with standard behavioural guidance	Significant weight loss occurred in 11/21 interventions (52%) vs. usual care; mean loss 4.9 ± 2.1 vs. 1.0 ± 0.9 kg. Weight regain reported in 13/18 interventions (72%) at 12 months. In the two interventions of >12 months, one showed significant (5.4 kg) loss	Improvements in secondary outcomes were observed in 17/21 interventions, independent of weight loss significance; no data on effect size. Reported outcomes included blood sugar control (8 interventions), blood pressure (5), quality of life (7), and leisure activities (4)	NA	Due to the numerous benefits of healthy lifestyles through regular exercise and a balanced diet, the focus should be on developing and maintaining these habits instead of concentrating exclusively on weight loss, as sustaining weight reduction poses a significant challenge
Hartmann-Boyce et al. [25] (2014)	13,453 (68%)/37	NA	USA (n = 20), Sweden (n = 2), New Zealand (n = 1), Switzerland (n = 1), Belgium (n = 1), UK (n = 3), the Netherlands (n = 2), Brazil (n = 1), Japan (n = 1), Portugal (n = 1), Canada (n = 1), Australia (n = 1), Finland (n = 1), UK/Germany, Australia (n = 1)	To evaluate the effectiveness of BWMP in patients living with OW/OB compared with a control group receiving standard care and explore how programme characteristics influence average weight loss	Yes	Non-BWMP (e.g., self-help, non-specialist contact) or alternative BWMP differing in a predefined component	Pooled mean weight loss: 2.8 kg (95% CI: −3.6 to −2.1, p < 0.001)b	NA	BCTs (by domain): only two domains produced significant weight changes in the univariate analyses	Most behavioural programmes lead to weight loss. Some factors appear to be associated with greater effectiveness
							Factors affecting effectiveness: More frequent contact vs. less contact (n = 6): −0.3 kg (95% CI: −0.7 to 0.2, p = 0.25)b		“Comparison of behaviour”: 1.5 kg weight loss at 12 months (95% CI: −2.9 to −0.1)
							Intervention involved calorie counting: −3.3 kg (95% CI: −4.6 to −2.0, p = 0.027)b		“Modelling/demonstrating behaviour” was one of four BCTs in this domain and was significantly linked to an additional 2.7 kg weight loss at 12 months (95% CI: −4.5 to −0.8)
							Intervention involved contact with a dietitian: −1.5 kg (95% CI: −2.9 to −0.2, p < 0.001)b		“Self-belief techniques”: +2.1 kg (95% CI: 0.1–4.1)
							Programme length (up to 12 months): −0.3 kg (95% CI: 0.5 to −0.1, p < 0.009)
							BCTs comparing participants” behaviour with others: mean difference −1.5 kg (95% CI: −2.9 to −0.1, p = 0.032)
							In-person vs. remote contact (n = 3): mean difference 0.0 kg (95% CI: −1.8 to 1.8, p = 0.06)
							Supervised PA vs. recommended PA sessions (n = 2): +1.1 kg (95% CI: −2.65–4.79, p = 0.08)b
Olander et al. [26] (2013)	NA	NA	NA	To identify which BCTs enhance SE and PA in adults living with OW/OB	Yes	No intervention or usual care control groups with assessment of PA self-efficacy	NA	Higher SE (small effect; d = 0.23, 95% CI: 0.16–0.29, p < 0.001) and increased PA (medium effect; d = 0.50, 95% CI: 0.38–0.63, p < 0.001) were reported. While the extent of these improvements was not detailed, specific BCTs were identified which led to significant increases in both areas	SE: larger effect sizes associated with four BCTs	Several BCTs were associated with increased PA, and some were associated with increased SE. “Prompt self-monitoring of behavioural outcome” and “plan social support/social change” were associated with larger effect sizes for SE and PA. In contrast, “prompting generalisation of a target behaviour” was associated with smaller effect sizes for SE and PA
	Women: M (SD): 79.2% (29.7) for SE and 73.1% (32.7) for PA/58								“Action planning” (d = 0.332, p < 0.05), “prompt self-monitoring” (d = 0.468, p < 0.01), “plan social support/change” (d = 0.258, p < 0.05), “time management” (d = 0.272, p < 0.05); smaller effect sizes with “set graded tasks” (d = 0.287, p < 0.01) and “prompt generalisation” (d = 0.237, p < 0.05)
									PA: larger effect sizes with 21 BCTs (examples: “teach prompts/cues” d = 0.949, “prompt practice” d = 0.725, “prompt rewards” d = 0.830, “prompt self-monitoring” d = 0.468, “plan social support/change” d = 0.804; all p values <0.001–0.01); smaller effect size with “prompt generalisation” (d = 0.552, p < 0.05)	​
Patel et al. [27] (2021)	8,232 (68%)/39	NA	China (n = 1), USA (n = 31), UK (n = 2), Germany (n = 1), Australia (n = 3), New Zealand (n = 1)	To evaluate digital self-monitoring in behavioural weight-loss interventions among adults living with OW/OB	Yes	Standard of care, placebo, no intervention, or active interventions	Self-monitoring associated with greater weight loss in 50/68 cases (74%): dietary self-monitoring 16/20 (80%), PA self-monitoring 8/11 (73%), behaviour change goal monitoring 1/3 (33%), frequent weight monitoring 13/18 (72%), combined behaviour monitoring 12/16 (75%)	NA	“Self-monitoring”	Self-monitoring through digital health tools is frequently associated with weight loss in behavioural obesity treatment
							Greater weight loss was observed in 47% of cases in interventions lasting longer than 12 months and 84% in interventions lasting 12 months or less. Digital passive self-monitoring (e.g., wearables) was found to be effective and to increase patient engagement
Perreault et al. [28] (2023)	2,187 (NA)/7	Pre-existing T2DM, prediabetes, hypertension, dyslipidaemia, MetS	The Netherlands (n = 1), USA (n = 5), Sweden (n = 1)	To evaluate the effectiveness of primary care-based weight-loss interventions including physician training, anti-obesity medication, and intensive lifestyle counselling in people with obesity and risk factors compared with usual care	NA	No specific control group defined; comparisons made between different active interventions	Primary care interventions resulted in a mean weight loss of 3.54 kg (95% CI: −5.61 to 1.47 kg; random-effects model)	NA	NA	Weight loss interventions delivered by PCPs result in modest reductions in body weight. The addition of medication approximately doubles the amount of weight loss. However, the observed decline in treatment effectiveness over time emphasises the necessity for sustained long-term management
							Adding anti-obesity medication enhanced weight loss by 2.94 kg (p < 0.0001)
							Efficacy declined by 0.53 kg per 6 months (95% CI: 0.04–1.0 kg)
							Results showed substantial heterogeneity and signs of publication bias, suggesting that studies with null effects may be underrepresented
Robertson et al. [29] (2017)	NA (0%)/14	NA	USA (n = 6), Australia (n = 4), Finland, Italy (n = 1), UK (n = 1), the Netherlands (n = 1)	To evaluate evidence-based strategies for treating obesity in men. Interventions included diet, PA, BCTs, orlistat, or their combinations compared with each other, placebo, or a no-intervention control group in any setting	NA	Standard of care, placebo, no intervention, or active interventions	Mean weight change after 1 year	The individual studies collected additional parameters; however, these were not compared further due to the variability among the studies and are therefore not listed here	NA	The most effective interventions integrated reducing diets, PA, and BCTs
							Reducing diets vs. PA (−3.2 kg, 95% CL −4.8 to −1.6 kg, p < 0.01)
							Combined reducing diets, PA, and BCT (−4.9 kg, 95% CL −5.9 to −4.0, p < 0.0001)
							Group interventions led to successful weight loss outcomes
Samdal et al. [15] (2017)	11,183 (NA) /48	NA	USA (n = 21), Scotland (n = 2), Brazil (n = 1), Australia (n = 7), New Zealand (n = 1), Belgium (n = 1), Sweden (n = 3), Canada (n = 4), Norway (n = 2), England (n = 2), UK (n = 3), Japan (n = 1)	To explore the heterogeneity of outcomes in interventions promoting PA and healthy eating among adults living with OW/OB by analysing the varying effects of BCTs and other intervention characteristics	Yes	Usual care, waiting list control, or less intensive interventions	NA	PA	ST: positive intervention effect	Similarities and differences exist between effective BCTs for promoting and maintaining healthy eating and PA. There is a difference between short-term and long-term intervention effects. “Goal setting” and “self-monitoring” are particularly effective for both short-term and long-term behaviour changes in dietary and PA interventions
								ST: effect size of 0.36 (95% CI: 0.24–0.47; 30 reports)	“Goal setting of behaviour” (b = 0.480, 95% CI: 0.257–0.705)
								LT: effect size of 0.25 (95% CI: 0.13–0.38; 17 reports)	“Self-monitoring of behaviour” (b = 0.398, 95% CI: 0.164–0.632)
								ST and LT: effect size of 0.31 (95% CI: 0.23–0.40; 47 reports)	“Feedback on behaviour” (b = 0.219, 95% CI: −0.040–0.479)
								Diet	“Feedback on the outcome of behaviour” (b = 0.243, 95% CI: −0.040–0.527)
								ST: effect size of 0.41 (95% CI: 0.20–0.62; 20 reports)	“Demonstration of the behaviour” (b = 0.244, 95% CI: −0.035–0.523)
								LT: effect size of 0.19 (95% CI: 0.07–0.31; 15 reports)	Negative intervention effect
								ST and LT: effect size of 0.29 (95% CI: 0.16–0.42; 35 reports)	“Exploring the pros and cons of behaviour change” (b = −0.252, 95% CI: −0.542 to 0.038)
								Combination of PA and diet	LT: positive intervention effect
								ST: effect size of 0.37 (95% CI: 0.26–0.48; 50 reports)	“Goal setting of behaviour” (b = 0.228, 95% CI: 0.056–0.400)
								LT: effect size of 0.24 (95% CI: 0.15–0.33; 32 reports)	“Self-monitoring of behaviour” (b = 0.184, 95% CI: 0.009–0.360)
								ST and LT: effect size of 0.29 (95% CI: 0.16–0.42; 82 reports)	“Giving feedback on the outcome of behaviour” (b = 0.249, 95% CI: 0.085–0.412)
									“Setting graded task” (b = 0.203, 95% CI: 0.043–0.363)
									“Adding objects to the environment” (b = 0.182, 95% CI: 0.010–0.354)
									“Problem solving” (b = 0.161, 95% CI: −0.005–0.327)
									“Goal setting outcome” (b = 0.256, 95% CI: 0.095–0.416)
									“Review behaviour goals” (b = −0.319, 95% CI: −0.678 to 0.040)
									“Social support” (b = 0.192, 95% CI: −0.011–0.394)
									Other counselling methods (e.g., motivational interviewing) were examined but are not detailed here
Wadden et al. [30] (2014)	3,893 (46.5%–100%)/12	CVD, antihypertensive medication use, ≥2 features of MetS, prediabetes, or MetS, ≥1 CVD risk factor	USA (n = 9), UK (n = 1), Europe (n = 1), Not Specified (n = 1)	To review behavioural counselling for patients living with OW/OB conducted by the PCP alone or in collaboration with trained interventionists (e.g., medical assistants and registered dietitians), or by trained interventionists working independently	NA	Usual care or minimal intervention (e.g., routine PCP visits without structured weight loss counselling)	TBC ( n = 5)	NA	Information on the BCTs used in individual studies was available, but there were no comparisons. There were no findings in which BCTs were effective	TBC: Studies incorporating a calorie-restricted diet and specific activity goals with personal counselling demonstrated a clear dose-response relationship, with weight losses ranging from 3.5 kg with 8 sessions to 6.6 kg with 15 sessions
							PCPs/trained interventionists (n = 3): Moderate weight loss ranged from 0.6 to 4.4 kg over 6–12 months. In 1/3 studies, 47.8% lost ≥5% of their initial weight after 6 months. No studies met the CMSa criteria
							Trained interventionists (n = 2): Weight loss ranged from 4.3 to 6.6 kg after 6 months. In one study, 65.0% of participants achieved a ≥5% weight loss after 6 months. In the other study, 52.7% of participants with remote support only and 46.0% with in-person support achieved the same goal
							Both studies met the CMSa criteria of more than 14 contacts within 6 months
							Alternative behavioural counselling ( n = 7)
							Weight loss was 1.3–2.4 kg over 6–12 months. In one study, 26.3% lost ≥5% of their initial weight. In another, 20.0% achieved this goala
Yoong et al. [12] (2012)	NA (NA)/17	T2DM, hypertension, dyslipidaemia, hypercholesterolaemia, MetS	USA (n = 10), Switzerland (n = 1), UK (n = 1), Italy (n = 1), Australia (n = 1), Denmark (n = 1), UK/Germany, Australia (n = 1)	To examine the effectiveness of behavioural weight-loss interventions involving PCPs in producing weight loss in primary care patients living with OW/OB	NA	Usual care, no intervention (general nonspecific advice), or less intensive interventions such as provision of health education materials	Different interventions were evaluated. No summary information can be provided regarding the amount of weight lost in the individual groups	NA	NA	In conjunction with supportive roles from PCPs, non-medical professionals appear more effective in high-intensity interventions than PCPs alone. Dietitians and commercial weight-loss programmes have proven particularly effective in supporting patients with weight management
							Lifestyle counselling by PCPs (n = 6): 3/6 studies using a structured and tailored protocol to support physicians in counselling showed significant weight loss but no clinically significant weight loss
							Lifestyle counselling by other physicians plus support (n = 9): 4/6 studies reported significant clinical weight loss
							Multi-component interventions (n = 1): showed significant weight loss but no clinically significant weight loss

BCTs, behaviour change techniques; BMI, body mass index: weight (kg) divided by height (m) squared; BWMP, behavioural weight management programme; CL, confidence level; CMS, Centers for Medicare and Medicaid Services; CVD, cardiovascular disease; LT, long-term (≥12 months); M, mean; MA, meta-analysis; MetS, metabolic syndrome; NA, not applicable or available; OW/OB, overweight/obese; PA, physical activity; PCP, primary care physician/provider; RCT, randomized controlled trial; SD, standard deviation: measure of variability around the mean; SE, self-efficacy; SR, systematic review; ST, short-term (≤6 months); T2DM, type 2 diabetes mellitus; TBC, traditional behavioural counselling; SMD, standardised mean difference: effect size comparing two groups, standardised by pooled SD; WMD, weighted mean difference: average difference between groups across studies, weighted by study precision; RR, risk ratio: relative likelihood of an outcome in the intervention group compared with the control group; I², percentage of total variation across studies due to heterogeneity (used in meta-analyses); R², coefficient of determination: proportion of variance in the dependent variable explained by the model; ß/b, regression coefficients: b (unstandardised), ß (standardised); HbA1c, glycated haemoglobin (A1c: reflects average blood glucose levels over the past 8–12 weeks).

^aThe CMS requirements for intensive behavioural therapy for obesity define approved intensive behavioural weight loss counselling as involving 14 face-to-face sessions lasting 10–15 min each over 6 months, delivered by trained professionals according to structured protocols, and including a reduced-calorie diet, at least 150 min of aerobic activity weekly, and behavioural strategies to support adherence. After 6 months, a weight loss of >3 kg must be assessed.

^bMean difference at 12 months.

The BCTs used in the interventions were reviewed and additionally categorised according to the 16 domains of Michie et al.’s [8] BCT taxonomy v1, as summarised in Table 3. Details of the implementation of the intervention, including the recruitment setting, provider, type and duration of contact, and type of intervention, were also recorded descriptively.

Table 3.

Behaviour change techniques (BCTs), classification by domains, used in the reviews

Domains per Michie et al. [8] (2013)	Hartmann-Boyce et al. [25] (2014)	Chew et al. [23] (2023)	Olander et al. [31] (2013)	Carraca et al. [22] (2021)	Patel et al. [27] (2021)	Samdal et al. [15] (2017)	Number of uses of the domain
1. Goals and planning	Yes	Yes	Yes	Yes	No	Yes	5
2. Feedback and monitoring	Yes	Yes	Yes	Yes	Yesa	Yes	6a
3. Social support	Yes	Yes	Yes	Yes	No	Yes	5
4. Shaping knowledge	Yes	Yes	Yes	Yes	No	Yes	5
5. Natural consequences	Yes	No	Yes	Yes	No	Yes	4
6. Comparison of behaviour	Yes	No	Yes	Yes	No	Yes	4
7. Associations	Yes	Yes	Yes	Yes	No	Yes	5
8. Repetition and substitution	Yes	No	Yes	Yes	No	Yes	4
9. Comparison of outcomes	No	No	No	Yes	No	Yes	2
10. Reward and threat	Yes	Yes	Yes	Yes	No	No	4
11. Regulation	Yes	Yes	Yes	Yes	No	Yes	5
12. Antecedents	Yes	No	Yes	Yes	No	Yes	4
13. Identity	Yes	No	No	Yes	No	Yes	3
14. Scheduled consequences	No	No	No	Yes	No	No	1
15. Self-belief	Yes	No	Yes	Yes	No	No	3
16. Covert learning	Yes	No	No	Yes	No	No	2

N.B. Abbott et al. [21], de Lannoy et al. [24], Perreault et al. [28], Robertson et al. [29], Wadden et al. [30], and Yoong et al. [12] could not be included since no specific information was provided or there were gaps in the information on which BCTs were used. Online supplementary Figure S8 provides an overview of which BCTs were specifically used in the respective studies.

^aCategorised independently; the review provided no information on this.

Results

Selection of Sources of Evidence

The searches identified 7,264 articles, of which 368 duplicates were removed. Of the remaining studies, 6,896 were excluded after screening the title and abstract based on the established selection criteria. Next, the full texts of 54 articles were screened, of which 42 were excluded; the reasons for exclusion are outlined in online supplementary Material S6. Finally, 12 articles were included in the data extraction process, comprising 5 SRs and 7 MAs. The CCA was calculated as 1.65%, indicating a slight overlap among the included reviews (see online supplementary Material S7 for the full table and calculation details). Table 2 provides detailed information on the included studies, including author and year, sample size, study population, intervention characteristics, comparators, reported BCTs, and outcomes (weight/BMI and secondary effects).

BCT Implementation in Interventions

The 12 articles that were included used various communication techniques in the context of weight management; however, detailed descriptions of the BCTs were only found in 6 articles (Table 2). The remaining 6 reviews did not explicitly report the use of specific BCTs; however, the interventions included behavioural elements, for example, caloric restriction within “goals and planning” or app-based instructions for “shaping knowledge,” but no clear classification was conducted in the reviews themselves. The focus was instead on comparing the BCTs explicitly reported across the reviews.

In general, combined interventions incorporating behavioural technique elements were more effective after 12 months than less intensive approaches such as usual care, which usually involved minimal or nonspecific behavioural support. de Lannoy et al. [24] and Robertson et al. [29] reported that the most effective interventions led to a mean additional weight loss of 4.9 kg, compared with ≤1.0 kg in the no-intervention groups under usual care and no intervention, respectively. Hartmann-Boyce et al. [24, 25, 29, 30] observed a 2.8 kg reduction compared with mostly self-help or non-specialist support. Similarly, multi-component interventions combining pharmacological and behavioural strategies and physician-led approaches tended to yield greater and more sustained weight loss than minimal lifestyle advice. Perreault et al. [28] reported an average reduction of 3.54 kg compared with usual care across all included studies, with interventions incorporating an anti-obesity medication component achieving an additional loss of 2.94 kg. Abbott et al. [21] suggested that the superior effects of group interventions, which resulted in an additional 1.9 kg weight loss, could be partly explained by social support.

Specific BCT Elements

According to the taxonomy of Michie et al. [8], the following strategies, grouped into domains, were primarily used: “feedback and monitoring,” “goals and planning,” “social support,” “shaping knowledge,” “comparison of behaviour,” and “regulation” (Table 3; see also online supplementary Material S8 for additional details) [8].

Among these domains, “feedback and monitoring” was associated with significant weight loss [23, 27]. Chew et al. [23] found that combining a self-monitoring app with health coaching resulted in an average weight loss of 2.15 kg (95% CI: −3.17 to −1.12 kg) compared with controls (usual care or app alone). Patel et al. [27] observed greater weight loss with digital self-monitoring in 74% of cases, although heterogeneity precluded pooling. Techniques from the “comparison of behaviour” domain were also linked to weight reduction, with Hartmann-Boyce et al. [25] reporting a 1.5 kg greater loss when such strategies were applied.

Regarding PA, individual BCTs shown to significantly increase engagement included “teaching the use of prompts/cues,” “prompting practice,” “rewarding effort or progress,” “prompting self-monitoring of behavioural outcomes,” and “social support or planning for social change” [31]. Carraca et al. [22] suggested that certain techniques, such as “goal setting (behaviour)” and “social incentives,” can effectively enhance PA, whereas “self-monitoring of behaviour” may not always contribute positively.

Samdal et al. [9] found positive effects of multiple BCTs on both PA and healthy eating, particularly “goal setting (behaviour)” and “self-monitoring of behaviour.” Additional techniques with beneficial or borderline effects included “feedback on behaviour,” “feedback on the outcome of behaviour,” “demonstration of behaviour,” “goal setting (outcome),” “graded tasks,” and “adding objects to the environment.” “Problem solving” and “social support” were moderately effective, while “review of behavioural goals” showed no significant impact [9]. However, no specific operational definitions of improved PA or eating behaviour were reported.

Intervention Format

Of the 12 reviews, 11 included studies conducted in individual and group settings or both [9, 12, 21, 23–25, 27–31]. One review provided no information regarding this aspect [22]. Three reviews specifically compared group and individual interventions, demonstrating that group interventions were more effective [12, 21, 29]. Overall, group interventions were associated with an additional mean weight loss of 1.9 kg after 12 months and a higher proportion of participants achieving clinically meaningful weight loss (≥5%) [12, 29, 30, 21].

Mode of Delivery

Of the 12 reviews, 4 provided only general or no information on delivery channels [12, 25, 28, 29]. The remaining eight reviews described in detail which channels were used across studies [9, 21–24, 27, 30, 31]. In summary, BCTs varied by delivery format, including physical (face-to-face or telephone), digital (web, email, app, short messaging service, or website), written (fax, post, or workbooks), and multimedia approaches (voice response, portable devices, or interactive electronic scales). In terms of effects, Hartmann-Boyce et al. [25] found no significant differences in weight loss at 12 months between face-to-face and non-face-to-face contact, with a pooled mean difference of 0.0 kg (95% CI: −1.8 to +1.8). In contrast, the PA results showed that face-to-face interventions had a greater effect (standardised mean difference [SMD] = 0.78) than digital interventions (SMD = 0.42) [22].

Total Duration and Contact Intensity

Of the 12 reviews, 11 reported the intervention durations [9, 12, 21–25, 27–30], ranging from 2 weeks to 52 months, with a mean of just under 17 months. One review provided no information regarding duration [31]. Data on session number and frequency were too heterogeneous for a quantitative summary, and session duration was sometimes unclear.

Higher contact frequency, however, appeared to be associated with greater weight loss [24, 30]. In interventions with ≥14 sessions over 6–24 months, mean weight loss ranged from 6.1 to 6.6 kg, with 50%–65% of participants losing ≥5% of baseline weight, compared with only 0.6–1.7 kg in less frequent sessions [30]. de Lannoy et al. [24] reported that studies with significant weight loss had an average of 22 contacts in the first 6 months vs. 10 contacts in studies without significant effects. Abbott et al. [21] suggested that the superior effects of group interventions may also relate to higher intervention intensity (12–55 vs. 2.5–11 h in individual interventions), although this was not formally tested [21]. Hartmann-Boyce et al. [25], however, found no differences between higher and lower contact frequencies. Overall, longer interventions appear important, as weight loss typically peaks between 6 and 12 months then lessens, followed by regain; about 70% of programmes reported weight regain of up to 2.7 kg within 12 months [24, 28]. Regarding duration, different BCTs were effective for short-term (≤6 months) and long-term (≥12 months) outcomes (Table 2), with varying effects on PA and healthy eating [9].

Recruitment and Intervention Provider

Regarding recruitment, all included reviews were relevant to healthcare settings. Of the 12 reviews, 4 recruited patients exclusively in the primary care setting [12, 24, 28, 30], and 5 recruited patients in other settings (e.g., community, health clubs, or sports clubs) besides primary care [9, 21, 22, 29, 31]. Three reviews provided no information regarding this aspect [23, 25, 27]. Of the 12 reviews, 9 provided specific information on the professions delivering the interventions, from physicians (e.g., GPs, endocrinologists) and other medical staff (e.g., pharmacists, psychologists, nurses) to dietitians, exercise professionals, lifestyle coaches, and lay counsellors [9, 12, 21, 23, 24, 28–31]. Three reviews did not provide any information about who delivered the intervention [22, 25, 27]. Details on the full range of professions are presented in online supplementary Material S9.

GP Involvement

GP consultations within usual care typically resulted in <1 kg weight loss and did not achieve the clinically relevant 5% reduction from baseline [12, 24, 28, 30]. Evidence suggests that greater effects can be achieved when patients receive more than the usual care. One study reported a mean weight loss of about 3 kg in such cases, and around 6 kg when anti-obesity medication was added [28]. These interventions, delivered in primary care over at least 6 months, included medication alone, medication combined with intensive lifestyle coaching and meal replacements, or physician training for enhanced lifestyle support [28]. Regular, intensive support by non-physicians, supplemented by GP monitoring, was also linked to clinically significant weight loss, highlighting the facilitating role of GPs even if they were not the main deliverer [12, 30]. For example, counselling by dietitians was associated with an additional 1.5 kg reduction [25]. Intensive counselling delivered by trained interventionists, who worked largely independently of GPs, led to an average weight loss of more than 5 kg within 6 months, which was sustained for up to 24 months [30]. Despite these findings, patients generally preferred support from their GP [28], and the integration of primary care physicians (PCPs) or GPs into programmes improved uptake [12]. In other studies, GP involvement was sometimes indirect, unclear, or not reported.

Discussion

To our knowledge, this scoping review is the first to examine the use of BCTs and their effects in interventions delivered in healthcare settings relevant to primary care, in which GP involvement ranged from direct to partial or indirect, or was not reported. The findings from SRs and MAs suggest that behavioural interventions in medical settings support weight management, promote lifestyle changes such as increased PA [9, 31] and dietary modifications [9], and improve other cardiometabolic factors [23, 24]. These results are consistent with the recommendations of current guidelines, which advocate a combination of PA, diet, and behavioural therapy [5, 24, 25, 29, 30]. However, there are still unresolved issues regarding implementation. Many reviews did not report the provider or techniques used, complicating interpretation of the findings. Of the 12 reviews, only 6 explicitly identified and categorised BCTs using the taxonomy of Michie et al. [8].

The objectives of BCTs include increasing PA, modifying eating behaviour, and enhancing self-efficacy; self-monitoring and goal setting are effective in both the short and long terms, while social support and problem-solving support sustain changes in behaviour [9, 22, 23, 31]. The remaining reviews did not provide sufficient detail to extract information on specific BCTs or their effectiveness. This limited reporting highlights the need for more consistent use and documentation of BCT frameworks in future research. In addition, the specific format of BCTs is important; for example, self-monitoring using wearables proved more popular in promoting engagement than active methods (e.g., inputting dietary intake into an app), possibly due to ease of use [27]. However, active methods were more strongly associated with weight loss, likely because they require greater cognitive engagement and foster awareness of one’s behaviour [27]. The effectiveness of BCTs depends on the delivery format. While digital and face-to-face interventions show different outcomes, telephone counselling can provide a cost-effective option where access is limited [22, 27, 30]. Digital tools can support weight loss and patient engagement but require technological competence and attention to privacy and quality and should complement rather than replace face-to-face counselling [5, 23, 27].

Beyond digital approaches, the format of interventions also plays a role; group interventions often lead to greater weight loss and longer-term success than individual interventions, possibly due to stronger social support and more frequent sessions [12, 21, 29, 30]. While regular patient-provider contact appears important for preventing weight regain [24, 30, 32], its impact on effectiveness remains unclear as Hartmann-Boyce et al. [25] found no difference between high- and low-frequency contact. The choice of healthcare provider delivering the intervention is also significant. Evidence suggests that non-physician specialists, such as dietitians, may achieve better outcomes in terms of weight loss than GPs [12, 24, 25, 30]. This may be attributed to the specialised training and expertise of professionals providing weight management counselling [30]. GPs may under-prioritise obesity treatment due to concerns about effectiveness, cost, sustainability, limited expertise, and suboptimal treatment conditions [5, 33]. Patients report experiencing stigma in healthcare settings, including from GPs, due to stereotypical assumptions, inadequate advice, and time constraints during consultations [7, 32]. As lifelong follow-up is crucial for the long-term management of obesity, GPs remain relevant as gatekeepers in primary care interventions, even though BCTs are often implemented by non-medical professionals in the literature [5, 34]. The evidence also suggests that patients prefer to receive weight loss support from their GPs [28], and that the integration of GPs or PCPs into interventions can enhance uptake and engagement [12].

These recommendations primarily emphasise the pivotal role of GPs in complementing standard care, which is often fragmented, with additional evidence-based strategies where appropriate [23]. Furthermore, patients should be supported in selecting the most suitable weight-reduction interventions and encouraged to engage in self-monitoring and self-management to promote sustainable outcomes [21, 27]. Overall, these findings emphasise the urgent need to train all healthcare professionals, particularly GPs, to implement weight-loss interventions effectively and improve patient outcomes.

Limitations

A limitation of this scoping review is that only data extracted from SRs and MAs were included. The aim was to obtain an overview of the BCTs used; however, this approach may have overlooked more detailed information available in primary studies. However, even at the selected level, considerable variability in the reporting of the individual studies was observed. The studies differed not only in design and content but also in the type of comparator groups used, ranging from no intervention to usual care or active controls. Moreover, the conditions were highly heterogeneous, and incomplete data further complicated interpretation. In some cases, critical information was lacking, such as the profession of the individual delivering the intervention, the overall duration, contact time, number of sessions, type of contact, and mode of intervention (group or individual). Furthermore, some authors noted that their statistical analyses were limited, which further reduced the ability to generalise those results. In addition, follow-up data were infrequently reported, rendering the long-term effects of the interventions uncertain. These gaps make it challenging to draw conclusions about the outcomes of specific techniques and their effectiveness in terms of lifestyle changes. Some reviews did not clearly report the recruitment setting, although interventions were delivered within the healthcare sector, and GP involvement was sometimes implied, indirect or not reported.

Conclusion

This scoping review provides an overview of the current application of BCTs in primary care weight management interventions, highlighting common delivery formats, the role of different healthcare providers, and gaps in reporting that should be addressed in future research. The findings show that BCTs delivered in primary care–relevant interventions, with varying degrees of GP involvement, are effective for patients living with obesity, particularly for weight management, lifestyle changes (e.g., PA and dietary behaviour), and improvements in cardiometabolic factors. These results are consistent with current German S3 guidelines on obesity treatment, which recommend a combination of PA, dietary changes, and behavioural therapy. However, as BCTs are used heterogeneously, no approach can be clearly recommended. Although most interventions were carried out by non-medical professionals, using BCTs in GP settings shows promise. GPs’ closer involvement in appropriate counselling that incorporates elements of BCTs may enhance treatment effectiveness. Future research should, therefore, aim for higher quality studies with standardised methods and clearly defined interventions to identify the most effective BCTs, while also addressing current gaps in reporting and implementation.

Statement of Ethics

An ethics statement is not applicable because this study is based exclusively on the published literature.

Conflict of Interest Statement

C.J. received speaker honoraria from Novo Nordisk, Amgen, Berlin Chemie, Merck Sharp & Dohme, Novartis, AbbVie, Pfizer, Janssen, Lilly, and Daiichi Sankyo and Chiesi. C.J. is a member of a Novo Nordisk Advisory Board on obesity in children and adolescents. Other authors have no conflicts of interest to declare.

Funding Sources

This study was financed by an unrestricted grant from Novo Nordisk. The funding source had no role in the design; collection, analysis and reporting of data; and preparation of the manuscript.

Author Contributions

A.P., L.K., and C.J. developed the concept, designed the study, and authored the protocol. A.P. and L.K. conducted the literature review, screening, search, and data extraction. A.P. analysed the data and drafted the manuscript. C.J. supervised the project.

Funding Statement

This study was financed by an unrestricted grant from Novo Nordisk. The funding source had no role in the design; collection, analysis and reporting of data; and preparation of the manuscript.

Data Availability Statement

All data generated or analysed during this study, as well as the information in this review, are included in this article and its supplementary material files and are derived from published literature. Further enquiries can be directed to the corresponding author.