Views and experiences of weight management for people living with mobility-limiting conditions, intellectual disabilities or severe mental illness: a qualitative evidence synthesis
Clinical Snapshot
PICO Framework
| P — Population | Adults and potentially young people living with mobility-limiting conditions (e.g., physical disabilities, musculoskeletal conditions), intellectual disabilities, or severe mental illness (e.g., schizophrenia, bipolar disorder, major depressive disorder); also includes carers and healthcare/programme providers |
| I — Intervention | Behavioural weight management programmes (including structured lifestyle interventions, dietary programmes, physical activity programmes, and combined behavioural approaches) |
| C — Comparator | No formal comparator specified — this is a qualitative evidence synthesis exploring experiences, perceptions, and contextual factors rather than comparing interventions |
| O — Outcomes | Individuals' experiences with weight and weight-management programmes; barriers and facilitators to healthy weight management and programme access; impact of stigma and discrimination on engagement and outcomes; perspectives of programme providers and healthcare practitioners; inclusive research co-production insights |
Bottom Line
This Cochrane qualitative evidence synthesis protocol addresses a critical gap in obesity and weight management research: the experiences of people with mobility-limiting conditions, intellectual disabilities, and severe mental illness — three populations who carry a disproportionate burden of obesity yet are systematically excluded from mainstream weight management trials and programmes. The protocol is methodologically sound, with clearly defined objectives, an equity-focused framework incorporating intersectionality and co-production with lived experience experts, and the credibility of Cochrane and UCL EPPI Centre oversight. However, clinicians should note that this is a protocol only — no findings are yet available. The completed review will not generate quantitative effect sizes but will produce qualitative thematic evidence assessed using GRADE-CERQual, informing how programmes can be made more accessible, inclusive, and effective. For Australian practitioners, the relevance is immediate: antipsychotic-related weight gain, NDIS-funded support contexts, and the chronic disease burden in people with intellectual disabilities all demand better-evidenced, tailored approaches. This review, once completed, has the potential to meaningfully reshape clinical guidelines and programme design. Clinicians and commissioners should monitor for the full review publication.
Key Findings
P Value: Not applicable — qualitative methodology
Effect Size: Not applicable — qualitative evidence synthesis; no quantitative effect sizes will be generated. Findings will be expressed as analytical themes with GRADE-CERQual confidence ratings.
Primary Outcome: No results available — this is a published protocol for a qualitative evidence synthesis. The primary outcome of the completed review will be synthesised qualitative themes addressing experiences of behavioural weight management across the three target populations.
Nnt Or Sensitivity: Not applicable — qualitative evidence synthesis does not generate NNT, sensitivity, or hazard ratio statistics. Transferability and confidence in findings (via GRADE-CERQual) will serve as the qualitative analogue of precision.
Confidence Interval: Not applicable at protocol stage
Clinical Application
The completed review will generate qualitative evidence to inform the design and delivery of more inclusive, accessible, and effective behavioural weight management programmes. Feasibility of implementation will depend on healthcare system capacity to adapt existing programmes (e.g., modified physical activity components for mobility-limited individuals, communication-adapted materials for intellectual disability, metabolic monitoring integration for antipsychotic-related weight gain). The review's explicit focus on structural and system-level barriers will be directly actionable for programme commissioners and policymakers. This review is highly relevant to Australian clinical practice. People with severe mental illness in Australia face a 20–25 year reduction in life expectancy, with cardiovascular disease and metabolic syndrome — heavily influenced by weight — as leading contributors. Antipsychotic-related weight gain is a recognised clinical challenge under TGA-approved medications (e.g., olanzapine, clozapine). The RACGP has highlighted the need for tailored weight management approaches for people with disabilities and mental illness. The National Disability Insurance Scheme (NDIS) context means that weight management support may intersect with funded support plans, creating both opportunities and system-level barriers. PBS-listed pharmacotherapies for obesity (e.g., semaglutide under recent PBS listings) are increasingly relevant but may be inaccessible or inappropriate without tailored behavioural support for these populations. State-based healthy weight programmes (e.g., NSW Get Healthy, Victorian HWCS) would benefit from the evidence this review will generate to improve inclusivity. Adults (and potentially adolescents) living with mobility-limiting conditions (including physical disabilities, spinal cord injury, severe arthritis, neurological conditions), intellectual disabilities (mild to severe), or severe mental illness (schizophrenia spectrum disorders, bipolar disorder, severe recurrent depression). Findings will also be relevant to carers, support workers, and healthcare professionals involved in weight management for these groups.
Abstract
This is a protocol for a Cochrane Review (qualitative). The objectives are as follows: This qualitative evidence synthesis (QES) aims to address the question: What is known from qualitative evidence about behavioural weight management for people living with mobility-limiting conditions, intellectual disabilities, or severe mental illness? The five review objectives are as follows. To explore individuals' experiences with weight and behavioural weight-management programmes. This includes understanding how individuals living with mobility-limiting conditions, intellectual disabilities, severe mental illness and their carers experience managing their weight and how they perceive and engage with behavioural weight-management programmes, including how accessible, supportive, and relevant they find the programme elements. To identify barriers to and facilitators of managing a healthy weight and accessing behavioural weight-management programmes. Focusing on the unique obstacles encountered by each population group, we will examine issues such as physical accessibility, communication challenges, financial constraints, and gaps in tailored support that may prevent equitable participation. We will also include people's perspectives on structural and system-level barriers, as well as the influence of intersectional factors (e.g. gender and ethnicity), on the challenges of maintaining weight and accessing and benefiting from support. To understand the impact of stigma and discrimination on programme engagement and outcomes. This objective seeks to uncover how stigma related to weight, disability, or mental health influences individuals' willingness to participate, their inclusion and sense of belonging with others within the programmes, and overall programme satisfaction. It also examines the role of stigma as a potential barrier to success. To capture the perspectives of programme providers and healthcare practitioners. Gathering insights from healthcare providers and programme facilitators, this objective assesses which programme elements are considered successful and which present ongoing challenges. This includes evaluating aspects like accessibility, engagement strategies, and support mechanisms that may require improvement. To produce an inclusive piece of research through incorporating the insight of people with lived experience and professional expertise in interpreting and considering the implications of the evidence. By synthesising this qualitative evidence, the review aims to provide a comprehensive understanding of how to design and implement behavioural weight-management programmes that are more inclusive, effective, and responsive to the needs of these populations.
References
- 1.Sutcliffe, K., Kneale, D., Dimitrova, V., Mathew, S., Stansfield, C., Schucan Bird, K., Rivas, C., Hunter, R., & O'Mara-Eves, A. (2026). Views and experiences of weight management for people living with mobility-limiting conditions, intellectual disabilities or severe mental illness: a qualitative evidence synthesis. Cochrane Database of Systematic Reviews. https://doi.org/10.1186/s13012-017-0689-2
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