A Realist Systematic Review to Understand the Effectiveness of Health-Related Interventions Designed to Decrease Overweight, Obesity and Unemployment in Adults

OBJECTIVES: Obesity, overweight and unemployment are intertwined, with common underlying causes however limited studies have examined this association. Holistic approaches are therefore required to understand this inter-relationship. The aim of this realist synthesis was to identify the common strategies used by health-related interventions to reduce weight and unemployment and to understand the contexts and mechanisms that determine effectiveness. METHODS: Electronic literature searches were conducted in Cochrane library, Medline, SocIndex, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and PsychInfo. Data from included articles were extracted and coded for Context-Outcome-Mechanism configurations (CMOcs). A realist approach to thematic analysis was used to synthesis and refine the final program theory building on the initial program theory. Results are presented using a narrative synthesis. RESULTS: A total of 83 studies meeting the inclusion criteria and assessment for rigor and relevance were included. 17 CMOcs were identified that demonstrated interactions between intervention strategy, context of intervention, responses generated by the intervention (mechanism) and outcomes. Findings indicate implementation of multicomponent interventions tailored to the needs of the target group are more likely to result in positive outcomes. Additionally, consideration of both individual and external contextual factors would enhance the design, delivery and effectiveness of health-related interventions designed to reduce obesity and improve re-employment. CONCLUSIONS: This is the first realist review of health-related interventions implemented to reduce overweight, obesity and unemployment. The findings contribute to a deeper understanding of the determinants of effectiveness and how to holistically address unemployment and obesity using common strategies. FUNDING SOURCES: This work is funded by grants from the EU Interreg European Regional Development Fund.