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Psychology & health 2026, Vol. 41, No. 5, 603–634
Effectiveness of client-centred counselling on weight management among Black African women with overweight and obesity in high-income countries: a systematic review
Itse Olaoyea, Kyriaki Myrissaa, Eirini Kelaiditia, Fotini Tsoflioub and Nicola Browna
aFaculty of sport, allied health and Performance science, st Mary’s University, london, UK; bDepartment of Rehabilitation and sport sciences, Faculty of health and social sciences, Bournemouth University, Bournemouth, england
ABSTRACT Objective: Client-centred counselling, a collaborative approach, aims at reducing ambivalence and enhancing behavioural change for weight loss. This systematic review assessed the effectiveness of client-centred counselling for weight management in Black African women with overweight and obesity in high-income countries, identifying culturally tailored strategies and theoretical underpinnings. Methods and Measures: This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guide- lines, with nine databases searched from 1970 to June 2022. Results: Twenty-two studies were included, 91% (n = 20) of which reported positive effects on weight loss. Face-to-face and a combi- nation of in-person and telephone client-centred counselling were found effective. Although the optimal treatment duration was unclear, interventions lasting six to twelve months were most ben- eficial. Interventions were delivered by registered dietitians, physi- cians, nutritionists, and health coaches. Most interventions (n = 14) were informed by social cognitive theory, with 19 studies incorpo- rating cultural adaptations such as language considerations, socio-cultural values, constituent involvement, and leveraging tar- get group experiences. Studies using at least two cultural adapta- tion strategies were more likely to be effective. Conclusion: Client-centred counselling appears promising for weight management in Black African women with overweight or obesity. Long-term follow-up studies are needed to ensure the sus- tainability and effectiveness of these interventions in this popula- tion over time.
© 2025 Informa UK limited, trading as taylor & Francis group
CONTACT Itse olaoye [email protected], [email protected] Faculty of sport, allied health and Performance science, st Mary’s University, twickenham, london tW1 4sX, UK
https://doi.org/10.1080/08870446.2025.2475161
ARTICLE HISTORY Received 10 November 2023 Accepted 26 February 2025
KEYWORDS Black African; obesity; weight loss; behavioural change; client-centred counselling
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Introduction
Obesity has evolved from a known public health issue in rich and affluent societies to a global public health threat seen to be on the rise in the last 30–40 years (Finucane et al., 2011). Globally, the prevalence of overweight and obesity is increasing in both developing and developed countries however, obesity is more prevalent in high-income countries such as the United States, the United Kingdom, and Australia (Ng et al., 2014) and its prevalence varies greatly by ethnicity. In the United Kingdom, for example, the 2019 Health Survey for England (NHS, 2022) found obesity rates highest among Black African and Black Caribbean women (who are predominantly migrants) at 37% and 44%, respectively. Obesity contributes to a disproportionate share of chronic health conditions and noncommunicable diseases such as type 2 diabetes, cardiovascular disease, coronary heart disease, and various types of cancer (Hales et al., 2018; Puska et al., 2003).
There is variation in the prevalence and risk of obesity between and within pop- ulations which is likely to be due to genetic, ethnic differences and the extent to which local environments are considered ‘obesogenic’ (Murphy et al., 2017). Although the causes of obesity in African migrant women are multifactorial including but not limited to the “influence of migration” (Alyousif & Mathews, 2018; Osei-Kwasi et al., 2017), studies on migrant populations have shown that migration from one country to another is associated with changes in dietary behaviours and physical activity (PA) (Alyousif & Mathews, 2018; Osei-Kwasi et al., 2017; Satia, 2010). Evidence suggests that migrants from disadvantaged socio-economic backgrounds are more likely to experience obesity or be overweight than those from advantaged backgrounds (McLaren, 2007; Stamatakis et al., 2005). Most often, migrant populations tend to adopt the norms of the new host country, a phenomenon referred to as acculturation (Cunningham et al., 2008). Other factors that can explain differences in obesity in African women are the cultural perception of body image (Toselli et al., 2016; Whitaker et al., 2016) the obesogenic environment (Murphy et al., 2017) and genetic predis- position (Hennig et al., 2009; Yako et al., 2013). Parental lifestyle choices have a direct impact on children’s weight status (Shonkoff et al., 2012), therefore targeting women who are the main caregivers might be an effective strategy in reducing health inequal- ities and addressing overweight and obesity across all age groups (Leung & Stanner, 2011). Furthermore, given the dynamic nature of family structures, such as an increas- ing number of single-parent households (Leung & Stanner, 2011) and matriarchal influences in dietary and food purchasing patterns, particularly in Black/African families, interventions aimed at women could potentially benefit the entire family.
Client-centred counselling is a non-directive approach to psychotherapy that focuses on the client’s experience and needs. It is based on the idea that people are naturally motivated to achieve positive psychological functioning (Rogers, 2012). It is also used interchangeably in literature with Motivational interviewing (MI) is one approach that has been proposed to improve the efficacy of behavioural weight loss treatment. It is a collaborative style of counselling approach that uses core processes to help an individual reduce ambivalence about behaviour change: engaging with the individual, focusing on specific behaviours to change such as evoking change talk, and planning to implement change (Miller & Rollnick, 2012). It is a person-centred, non-judgmental, and directive set of skills that practitioners use to discuss changing behaviours for
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better health outcomes. There is emerging research on the efficacy of client-centred counselling in the context of obesity prevention and management. A narrative liter- ature review by DiLillo and West (DiLillo & West, 2011) evaluating the unique contri- butions of client-centred counselling incorporating motivational interviewing on weight loss elucidated the effectiveness of client-centred counselling delivered as an inde- pendent component and in addition to a behavioural weight loss program.
Systematic reviews utilising MI with adults with overweight and obesity in primary care settings (Barnes & Ivezaj, 2015) and using eHealth and telehealth as a mode of delivery of interventions (Patel et al., 2019) found about 54% of included randomised controlled trials (RCTs) reporting significant weight loss of at least 5% compared to baseline body weight among treatment groups. Armstrong et al (Armstrong et al., 2011) conducted a meta-analysis of 11 RCTs recruiting adults with overweight and obesity and found that MI had a significant, moderate effect [standardized mean difference (SMD) = 0.51] on weight loss compared to controls, such as usual treat- ments or advice. Conversely, a recent systematic review and meta-analysis by Makin et al (Makin et al., 2021) found client centred counselling incorporating MI as a non-beneficial approach among individuals with overweight and obesity. Their meta-analysis of 12 trials indicated no overall pooled effect of MI on body weight and Body Mass Index (BMI) outcomes between intervention and control groups.
While findings from previous studies are promising, the resultant effects showed modest and heterogeneity in outcomes. An additional limitation is the lack of sys- tematic reviews of intervention studies targeting Black African women, as the majority of previous studies have focused exclusively on White populations. Only a few studies included a sub-sample of African American women (DiLillo & West, 2011; Makin et al., 2021) with no examination of racial differences in intervention effectiveness. Therefore, little is known about the effectiveness of client centred counselling on weight loss in Black African women, despite their increased burden of overweight and obesity (NHS, 2022). Black Africans tend to lose less weight and at a slower rate when com- pared to whites and other racial/ethnic groups (Kumanyika, 2002; 2004). Black African women are also less likely to participate in and adhere to weight loss interventions (Anderson et al., 2015). They are often faced with multiple barriers, such as time constraints associated with low-income jobs with minimal flexibility, parenting respon- sibilities, lack of transportation, and related social stressors. These challenges have been specifically reported by Black African women and can impede their engagement in interventions that promote healthy lifestyle behaviours (Anderson et al., 2015).
The present systematic review aims to evaluate the effectiveness of client-centred counselling on weight management based on weight changes and lifestyle modi- fications, among Black African women in high-income countries. Black African refers to individuals of sub-Saharan African descent. In this review, we aimed to include women from African countries residing in high-income countries, defined as those with a Gross National Income per capita of $12,376 or more (The World Bank, 2019). This systematic review also aims to provide information about specific inter- vention components, such as skills used, culturally tailored strategies, and theoretical underpinnings, allowing the identification of intervention components that might be useful for effective weight loss and weight loss maintenance in Black African women.
606 I. OLAOYE ET AL.
Materials and methods
This systematic review was reported according to the Preferred Reporting Items for Systematic Reviews (PRISMA) guidelines (Page et al., 2021) and registered with the International Prospective Register of Systematic Reviews (PROSPERO) with registration number (CRD42022330020).
Eligibility criteria
The eligibility criteria of studies included in this review was based on study charac- teristics following the PICOS framework (Population, Intervention, Comparison, Outcome and Study design) (Amir-Behghadami & Janati, 2020) described below:
Population
Studies of women identified as Black African migrants from sub-Saharan Africa living in High Income Countries (HICs), aged ≥ 18 years and considered to be overweight or obese (BMI ≥25 kg/m2) were included. Studies among other ethnicities and in children were excluded.
Intervention
All studies evaluating the efficacy of client-centred counselling for weight management were systematically reviewed. Client-centred counselling was operationalised as both one-on-one and group-based interventions, including motivational interviewing, behavioural counselling, cognitive behavioural therapy (CBT ), and shared decision-making, either as standalone treatments or in conjunction with nutritional education and lifestyle modifications. The integration of CBT with MI is justified due to their complementary roles in facilitating behaviour change. MI addresses motiva- tional ambivalence and enhances client motivation, while CBT provides structured methodologies to tackle cognitive and behavioural barriers, supporting long-term behavioural change. Both emphasize client autonomy and empowerment, aligning with client-centred care principles. The combination of CBT and MI is commonly used, offering a strategy that addresses motivational and behavioural aspects, improving effectiveness in obesity management and promoting sustainable weight loss (Butryn et al., 2011; Cooper & Fairburn, 2002). MI has also been used alongside CBT for anxiety disorders, with four overlapping CBT elements: problem-oriented focus, case formu- lation, skills training, and behavioural activation (Randall & McNeil, 2017). Studies that did not state the mode of counselling employed were excluded.
Outcomes
To be included, a study had to report a primary weight outcome measured either as weight loss or BMI, with or without additional body composition outcomes such as waist circumference, waist-hip ratio. Lifestyle modifications such as changes in physical activity and eating behaviours were included as secondary study outcome measures where available. Where at least one of the primary study outcomes was not reported, the study was excluded.
PSYCHOLOGY & HEALTH 607
Study design
The review included all experimental study designs that were RCTs, non-randomised control trials, quasi-experimental trials and follow-up studies conducted prospectively or in retrospect. Cross-sectional studies, systematic reviews and studies of qualitative study designs were excluded.
Search strategy
Original searches took place in June 2022. The following databases were searched: MEDLINE, OVID, PubMed, PsycINFO, CINAHL and the Cochrane Library using a coverage period of 1970 to present. This period is documented as the peak of the start of Africans migrating into HICs (Zlotnik, 2004). Additional studies were searched from reference lists of articles eligible for full-text review and Google Scholar. While grey literature databases such as ProQuest and OpenGrey were searched as part of the systematic review, none of the studies retrieved from these sources met the inclusion criteria for the final analysis. As a result, all included studies were sourced from peer-reviewed journals. Language restriction to studies published in the English language was applied. To develop comprehensive strategies based on the search database of interest, searches were developed by locating key terms from published articles, controlled vocabulary, and preliminary results from scoping searches. The following keywords were combined with Boolean operators: Counselling, Client-centred, Weight management or weight loss, Black, African (see supplementary file for full example of searches). In addition, database-specific search strategies were used: Thesaurus of Psychological Index Terms for PsycINFO, Medical Subject Headings (MeSH) for PubMed and Cochrane Library.
Study selection
All articles were screened using Rayyan, a mobile and web application for systematic reviews (Ouzzani et al., 2016) using predefined inclusion and exclusion criteria which was based on the PICOS framework. Following the removal of duplicates, initial screening of all remaining articles and abstracts was done by the primary author (IO). Papers were assessed with responses of “include”, “exclude” or “maybe”. Articles assessed as “maybe” were resolved by discussion with co-authors (NB, KM, EK, FT). IO and NB independently screened full texts of eligible articles for inclusion, reaching a consensus for inclusion, similar to the strategy used by Makin et al (Makin et al., 2021).
Data extraction
Data extraction sheets were developed using the intervention description and repli- cation checklist template (TIDieR) (Hoffmann et al., 2014). This included a description of the study setting, participants’ demographics, sample size, host country, duration of residence in the host country, the content of the intervention, delivery method of intervention, frequency and duration of intervention, the theory used, main health outcomes, and intervention effects. The primary outcome measurements of body weight information were extracted as reported from baseline to the most recent point
608 I. OLAOYE ET AL.
of follow-up. In addition, secondary outcomes of lifestyle changes such as physical activity or dietary habits were extracted. Data extraction from eligible studies was first completed using a Microsoft Excel spreadsheet by the primary author (IO) and double checked for accuracy.
Risk of bias assessment
Following data extraction, papers were evaluated for risk of bias. The Cochrane Collaboration risk of bias tool (RoB 2) (Sterne et al., 2019) was used to evaluate ran- domised controlled trials. The RoB 2 focuses on five distinct domains: (1) Bias resulting from the randomization process; (2) Bias resulting from deviations from intended inter- ventions; (3) Bias resulting from missing outcome data; (4) Bias in outcome measurement; and (5) Bias in the selection of the reported result. IO and KM independently applied the tool to each of the included studies, recording the risk of bias judgements of low risk, high risk, or some concerns for each domain. Following the guidelines for using the RoB 2 tool, an overall summary risk of bias judgement (low, high, or some concerns) was derived for each study. To assess the risk of bias in non-randomized articles, the Risk of Bias in Non-randomized Studies-of Interventions tool (ROBINS-1 tool) was used (Sterne et al., 2016), which also focuses on a study’s internal validity and covers seven domains of bias: confounding, participant selection, intervention classification, deviations from intended intervention, missing data, outcome measurements, and bias in reporting selection, resulting in scores of high, low or moderate risk of bias.
Effect measures
Our study’s outcome evaluation used mean changes before and after the intervention, together with p-values presented as statistical significance measures of included studies. These results are presented in Table 1. Effect sizes were not pooled with meta-analysis due to the heterogeneity of the design of studies.
Data synthesis
In the present review, study duration and reported outcome measurements differed between studies. Included studies also differed in results presentation, reporting means and percent weight change. The studies were deemed too heterogeneous to conduct a meta-analysis (Higgins et al., 2019), therefore a narrative synthesis of study outcomes was conducted and effect sizes were provided (where possible) to evaluate interven- tion effects.
Results
Search results
Figure 1 summarises the data extraction flow diagram. The first database searches produced 7473 results from CINAHL (n = 435), OVID (n = 106), Cochrane Library
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Table 1. summary of main outcomes and intervention effects in Black african women with overweight and obesity. study Main health outcome(s) Main intervention effects
Martin et al. (2006) Body weight, BMI. Physical activity, psychosocial variables; depression, minor life stress and self-efficacy for eating behaviors.
Between baseline and 6 months, the intervention group demonstrated weight loss (mean = −2.0 kg ± 3.2) that differed significantly, p = .03 from the standard care group (mean = +0.2 kg ± 2.9). a greater percentage of intervention participants lost weight by month 6 (79%) compared with standard care participants (47%).
Bennett et al. (2013) Primary outcomes were change in weight and BMI at 12 months. Weight maintenance at 18 months
secondary measures: waist circumference, blood pressure, and fasting glucose,
triglyceride, and cholesterol levels
From baseline to 12-month follow up, weight change (kg) in treatment group was larger (−1.0 ± 0.5) relative to usual care (0.5 ± 0.5); mean difference −1.4kg, p = .04. at 18 months, weight changes were maintained. Intervention group lost 0.9 kg compared to control group, +0.8 kg, p = .03. No differences between groups in change in waist circumference, blood pressure control, glucose or lipid levels.
Befort et al. (2008) Body weight and BMI, Dietary intake, Physical activity, Psychosocial factors (motivation, diet self-efficacy, exercise self-efficacy)
Post treatment, treatment group lost weight in kg −2.6 ± 4.2 and BMI −1.0 ± 1.5. No significant change in physical activity. significant decrease in daily kcal and percent kcal from fat. significant increase in fruit and vegetables servings per day. No significant differences between treatment and control group
Weerts and amoran (2011)
Body weight, BMI, waist-to-hip ratio, caloric and nutrient intake
at month1: experimental n = 4 lost 2.85 lb body weight > control n = 5, +2.00 lb (p = .002)
at month 2: experimental n = 4 lost 1.90 lb body weigh > control n = 5, +3.68 lb (p = .022)
at month 3: experimental n = 4 lost 6.05 lb body weight > control n = 5, +3.68 lb (p = .008).
No significant reduction in calories (kcal), increased fruits and vegetable intake (cups) between treatment and control groups
herring et al. (2016) % of women with excessive gestational weight gain
Intervention group were less likely to exceed IoM guidelines compared to usual care (37% vs. 66%, p = .033). similar results were observed in analyses
adjusted for early pregnancy BMI, p = .0497). Intervention participants also gained less weight in pregnancy than controls (8.7 vs. 12.3 kg, respectively, p = .046). No group differences found for neonatal and obstetric outcomes
cahill et al. (2018) Primary outcome: % exceeding IoM gWg for overweight and obesity.
secondary outcomes: weekly gWg and changes from week 15 to 35; body fat and fat-free masses; glycemic control; plasma lipid profile; systolic and diastolic blood pressures
Pat+ group gained less weekly (0.4 kg vs 0.5 kg/ wk, p = .04) and total weight (8.0 kg vs 9.6 kg, p = .02).
Pat+ group had lesser excessive gWg (36.1% vs 45.9%) but not statistically significant, p = .11.
haire-Joshu et al. (2019)
Primary outcome: body weight change from baseline to 12 months postpartum
secondary outcome: % of women returning to baseline weight, % of women with gWg (baseline to 36weeks)>IoM weight guidelines
Pat+lifestyle group gained less weight than standard Pat (2.5 kg vs 5.7 kg, p = .01) and were more likely to return to baseline weight (38.0% vs 21.5%, p = .001)
(Continued)
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study Main health outcome(s) Main intervention effects
Martin et al. (2008) BMI, Physical activity, Dietary intake, Psychosocial variables (depression, major life stress, life experience, minor life stress, self efficacy for eating behaviors)
From baseline to 6-month follow up, treatment lost 1.4 kg > ct (p < .05).
treatment group more successful in weight maintenance from baseline:
at 9 months, treatment lost more weight than control (−1.53 ± 3.72 kg vs +0.61 ± 3.37 kg, p = .01)
at 12 months, −1.38 ± 3.69 kg vs −0.16 ± 3.63 kg, p = .10
at 18 months, −0.49 ± 3.33 kg vs+ 0.07 ± 3.75 kg, p = .39
liu et al. (2015) gWg, Postpaturm weight retention, Physcial activity, Dietary intake
compared to contemporary controls, study participants gained less total weight on average (mean gWg 24.9 ± 13.3 vs 26.2 ± 17.6, p = .23) and were less likely to exceed gWg recommendations (56.3% vs 63.2%).
at 12 weeks postpartum, intervention participants retained 2.6 lbs from their pre-pregnancy weight.
No significant change in Pa during pregnancy. Increased Pa postpartum, p = .06. significant increase in total daily energy
expenditure at 32 weeks from baseline (p = .03) and postpartum (p = .008)
total caloric intake declined across time. chung et al. (2016) Body weight change, BMI, Mindful
eating scores From baseline to 6 months, weight and BMI
significantly decreased over time, p = .015 and p = .014, respectively.
significant increase in MeQ scores overtime, p = .001.
West et al. (2019) Body weight change calculated in kg and %.
% of individuals achieving >5% and >10% weight loss.
Physical activity
In treatment group (Black african-american women, n = 303), weight loss trajectories followed a similar pattern in percent weight change and weight change in kg from baseline- highest weight losses at year 1: −6.7 kg ± 0.3 and −6.8 (%) ± 0.3. at year 4 some regain was observed (−4.4 kg ± 0.5 and −4.3% ± 0.5) however, approximately half of respondents sustained weight loss at year- 8 (−6.5kg ± 0.6 and −6.3% ± 0.6).
sheppard et al. (2016)
Body weight, waist/hip ratio, BMI, dietary intake, Physical activity, cardiovascular fitness (Vo2max)
the intervention group only lost 0.8% of their total bodyweight, less than expected 5% weight loss goal.
tendency for lower bodyweight, body mass index, and lower waist/hip ratio in the intervention group (mean change = −1.7, −0.3, −0.03, respectively).
change was greatest for vigorous activity in the intervention group compared to lower levels of activity. total physical activity levels increased in the intervention group 3.6-fold when compared to the control group (+3501.1 Met min/week vs. +965.3 Met min/week, respectively).
Reduced energy intake, fat intake and % energy from fat in intervention group
lutes et al. (2017) Primary outcomes were hba1c secondary outcomes: weight, and BP,
psychosocial outcome measures (self-reported empowerment and medication adherence)
Participants in the small changes group had modest
but significantly greater weight loss (21.3566.22 vs. 20.3964.57 kg; P50.046) compared to the
mail-based education group across 12 months.
Table 1. continued.
(Continued)
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study Main health outcome(s) Main intervention effects
stolley et al (2009) Body weight, BMI, Food intake, Physical activity, social support and quality of life
Post-intervention there were: sig reductions in weight (-5.57lb) and BMI
(-1.00kg/m2) post intervention., p = .001 sig increase in veg consumption (1.6 servings per
day) and fibe (3.8g per 1000 kcal), p = .001 sig reduction in total daily fat (23.6 g) No change in teI, sodium consumptions or
servings fruit per day. stolley et al. (2017) Weight (kg), Waist circumference,
Physical activity, Dietary intake Between groups, MFg demonstrated significantly
greater improvements than sg for weight and percentage of weight loss (23.49 kg v 21.27 kg;
p < 0.001; 3.6% v 1.4%, respectively), waist circumference (23.31 cm v 21.37 cm; p = .028) at 6 months. and for weight (22.70 kg v 21.57 kg; p <.05) at 12months. In terms of clinically meaningful weight losses, 68.2% of MFg
participants lost ~3% compared with 44.4% of sg; 44.3% of MFg and 19% of sg lost ~5% (p <.05).
West et al (2007) Body weight, BMI, glycemic control significant weight loss at 6 months (p <.0007) and 12 months (p = .008). Weight regained by 18 months,
yanek et al. (2001) Body weight, BMI, Blood Pressure and heart rate, Blood lipids and glucose levels, Dietary intake, Physical activity
From baseline to 12-month follow up, weight change (lb) in treatment groups was larger (−1.1 ± 0.42) compared to control group (0.83 ± 0.52), p = .0008. similar for BMI in treatment group (−0.17 ± 0.07) vs 0.14 ± 0.09, p = .0012. significant differences between groups in energy intake −117 kcal, p = .0038, waist circumference −0.66 inches, p =.0047
Fitzgibbon et al. (2005)
Body weight change (kg), BMI, Dietary fat, Physical activity
the intervention group showed significant weight loss (2.6 kg) and BMI reduction (1.0) from baseline to 12 weeks (p < .005), but no significant differences compared to the control. significant increase in total energy expenditure and energy expended. No significant difference in fat consumption.
McNabb et al. (1997) Body weight, BMI, Waist circumference, Weight loss behaviour index
significant difference in weight loss between the intervention group (5% loss, −10 lb) and control group (1% gain, +1.9 lb) (p < .0001). BMI decreased by 1.4 in the intervention group and increased by 0.6 in controls (p < .0001). high-fat food intake decreased in the intervention group and increased in controls (p < .05). No differences in physical activity were observed.
ard et al. (2017) Body weight, BMI, Waist circumference, Blood Pressure, Dietary intake
57.1% of Weight loss only participants and 60.4% of Weight loss Plus participants experienced weight loss, with no significant difference between groups. at the 5% weight loss target, 23% of the total sample met this goal, with no differences by treatment assignment.
hollis et al. (2008) Weight change (kg), BMI change, Physical activity, Fruit and vegetable servings/day
the mean differences in weight change post intervention were −4.1 kg (sD 2.9), BMI change was −1.5 (sD 1.2), and fruit and vegetable servings per day increased by 2.1 (sD 2.3).
Wilbur et al. (2016) Physical activity, Body weight, BMI, Waist circumference
No significant changes in Weight and body composition between groups, p > .05
Table 1. continued.
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(n = 1970), PsycINFO (n = 752), PubMed which includes Medline (n = 4192), ProQuest dissertation and abstract (n = 10) and Open Grey (n = 8). Following the removal of duplicate articles (n = 584), the initial screening consisted of a review of the study title and abstract. Following a review of the titles and abstracts, 43 full texts were chosen for full text screening. The most common reasons for exclusion were irrelevant studies (n = 6847), incorrect study population (n = 23), and a non-client-centred coun- selling approach (n = 18). The final review included twenty-two articles (Ard et al., 2017; Befort et al., 2008; Bennett et al., 2013; Cahill et al., 2018; Chung et al., 2016; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Herring et al., 2016; Hollis et al., 2008; Liu et al., 2015; Lutes et al., 2017; Martin et al., 2006; 2008; McNabb et al., 1997; Sheppard et al., 2016; Stolley et al., 2009; 2017; Weerts & Amoran, 2011; West et al.,
Figure 1. PRIsMa data extraction flow diagram (Page et al., 2021).
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2007; 2019; Wilbur et al., 2016; Yanek et al., 2001) that were deemed appropriate for inclusion.
Characteristics of included studies
All included studies were conducted in the United States of America and were pub- lished in peer reviewed health journals between 1997 and 2019. Participants were recruited mainly from hospital settings (n = 8) (Bennett et al., 2013; Hollis et al., 2008; Lutes et al., 2017; Martin et al., 2006; 2008; Sheppard et al., 2016; West et al., 2019; Wilbur et al., 2016), and the community (n = 14) (Ard et al., 2017; Befort et al., 2008; Cahill et al., 2018; Chung et al., 2016; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Herring et al., 2016; Liu et al., 2015; McNabb et al., 1997; Stolley et al., 2009; 2017; Weerts & Amoran, 2011; West et al., 2007; Yanek et al., 2001). Study designs utilised were RCTs (n = 19) (Ard et al., 2017; Befort et al., 2008; Bennett et al., 2013; Cahill et al., 2018; Chung et al., 2016; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Herring et al., 2016; Hollis et al., 2008; Lutes et al., 2017; Martin et al., 2006; 2008; McNabb et al., 1997; Sheppard et al., 2016; Stolley et al., 2017; Weerts & Amoran, 2011; West et al., 2007; 2019; Wilbur et al., 2016; Yanek et al., 2001), and intervention studies with longitudinal follow-up (n = 3) (Chung et al., 2016; Liu et al., 2015; Stolley et al., 2009). In RCTs, comparators to intervention were “treatment as usual or standard” (Herring et al., 2016; Lutes et al., 2017; West et al., 2019), traditional health education (Cahill et al., 2018; Haire-Joshu et al., 2019; West et al., 2007), non-MI content of intervention (Befort et al., 2008; Weerts & Amoran, 2011), or traditional advice or handouts (Bennett et al., 2013; Martin et al., 2006; 2008; McNabb et al., 1997; Stolley et al., 2017; Yanek et al., 2001) and waitlists (McNabb et al., 1997; Sheppard et al., 2016). Of the three intervention studies with longitudinal follow-up, only one used a control group (Liu et al., 2015). Weight loss outcomes were reported as body weight change in kilograms (n = 10) (Bennett et al., 2013; Cahill et al., 2018; Haire-Joshu et al., 2019; Herring et al., 2016; Liu et al., 2015; Lutes et al., 2017; Martin et al., 2006; 2008; Stolley et al., 2017; West et al., 2019), pounds (n = 2) (McNabb et al., 1997; Weerts & Amoran, 2011), percent weight loss (%) (n = 2) (Ard et al., 2017; Sheppard et al., 2016), change in BMI (n = 1) (Chung et al., 2016), and a combination of both body weight kg and BMI (n = 7) (Befort et al., 2008; Haire-Joshu et al., 2019; Hollis et al., 2008; McNabb et al., 1997; West et al., 2007; Yanek et al., 2001).
Participants
Table 2 provides details about the study participants. Sample sizes ranged from 16 (Liu et al., 2015) to 540 (Hollis et al., 2008) with a total of 4073 participants recruited across all 22 studies. The age of participants ranged from 18 years to 76 years. All 22 studies were conducted among Black African women, however no study delineated the countries of origin of study participants. Similarly, no information was reported on the participants duration of residence in the host country. All studies included women who were overweight or obese with a BMI of ≥25 kg/m2. Four studies were conducted among pregnant women (Cahill et al., 2018; Haire-Joshu et al., 2019; Herring
614 I. OLAOYE ET AL.
Table 2. characteristics of included studies (n = 22)a.
study Program setting age (years) Baseline BMI
(kg m−2)
sample size and participant
characteristics control group
Martin et al. (2006)
hospital 18 to 65 ≥25 144 obese and overweight african american women
yes
Bennett et al. (2013)
hospital 25 to 44 25–34.9 194 premenopausal black female primary care patients
yes
Befort et al. (2008)
community ≥18 30–50 44 obese african american women
yes
Weerts and amoran (2011)
community 18 to 44 ≥25 21 overweight african american women
yes
herring et al. (2016)
community/ technology based
≥18 25–45 66 pregnant women with overweight or obesity
yes
cahill et al. (2018)
home/community 18 to 45 25 to 45 267 socioeconomically disadvantaged african american women with overweight or obesity
yes
haire-Joshu et al. (2019)
home/community 18 to 45 25–45 267 pregnant women yes
Martin et al. (2008)
hospital 18 to 65 ≥25 144 african-american women
yes
liu et al. (2015)
home/community 25–40 16 pregnant overweight and obese african-american women recruited from prenatal clinics, <18 weeks of gestation
yes (contemporary control)
chung et al. (2016)
community ≥25 26 african american breast cancer patients
No
West et al. (2019)
hospital/home 45 to 76 ≥25 5145 african-american, hispanic and Non-hispanic White women with obesity and type2 diabetes (303 african american)
yes
sheppard et al. (2016)
hospital/ technology based
≥ 25–≤40 31 african american Breast cancer survivors
yes
lutes et al. (2017)
hospital/ community based
19 to 75 ≥25 200 rural obese african american women
yes
stolley et al. (2009)
community ≥18 ≥25 23 black/african american women, Breast cancer survivors
No
stolley et al. (2017)
community ≥18 ≥25 246 black/african american women. Breast cancer survivors
yes
West et al. (2007)
community ≥18 27–50 217 (38% african-american women with type 2 diabetes)
yes
yanek et al. (2001)
community /church based
≥40 >30 529 african american women
yes
Fitzgibbon et al. (2005)
hospital/faith based
≥21 ≥25 59 african american women
No
(Continued)
PSYCHOLOGY & HEALTH 615
et al., 2016; Liu et al., 2015), one study among breast cancer patients (Chung et al., 2016), three among breast cancer survivors (Sheppard et al., 2016; Stolley et al., 2009; 2017) and two among type 2 diabetes patients (West et al., 2007; 2019). Only five studies (Bennett et al., 2013; Cahill et al., 2018; Haire-Joshu et al., 2019; Lutes et al., 2017; Weerts & Amoran, 2011) published information regarding the socioeconomic status (SES) of study participants describing participants as low income or socioeco- nomically disadvantaged.
Client centred counselling intervention
Modes of delivery Client-centred counselling, which included behavioural strategies, was provided in an individual format in half of the studies (n = 11) (Befort et al., 2008; Bennett et al., 2013; Cahill et al., 2018; Haire-Joshu et al., 2019; Herring et al., 2016; Liu et al., 2015; Lutes et al., 2017; Martin et al., 2006; 2008; Weerts & Amoran, 2011; West et al., 2019), while nine studies were conducted in group formats (Ard et al., 2017; Fitzgibbon et al., 2005; Hollis et al., 2008; Lutes et al., 2017; McNabb et al., 1997; Stolley et al., 2009; 2017; West et al., 2007; Wilbur et al., 2016; Yanek et al., 2001), and two studies used a mix of both formats (Chung et al., 2016; Sheppard et al., 2016). Studies used various modes of delivery: face-to-face in 11 studies (Cahill et al., 2018; Chung et al., 2016; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Martin et al., 2006; 2008; McNabb et al., 1997; Stolley et al., 2009; Weerts & Amoran, 2011; West et al., 2007; Yanek et al., 2001), telephone in two studies (Bennett et al., 2013; Herring et al., 2016), and a combination of face-to-face and telephone in nine studies (Ard et al., 2017; Befort et al., 2008; Hollis et al., 2008; Liu et al., 2015; Lutes et al., 2017; Sheppard et al., 2016; Stolley et al., 2017; West et al., 2019; Wilbur et al., 2016). Of note, significant intervention effects were more frequently observed in studies that provided face-to- face sessions, either alone or in combination with telephone follow-ups. While the impact of delivery mode on weight loss is not directly compared, this trend was noted across studies reporting significant outcomes.
Duration of interventions also varied, ranging from 90 min over three months (Weerts & Amoran, 2011) to 37 h over 24 months (West et al., 2019) for in-person formats. Telephone sessions ranged from 60 min over two weeks (Befort et al., 2008) to 240 min
study Program setting age (years) Baseline BMI
(kg m−2)
sample size and participant
characteristics control group
McNabb et al. (1997)
community/ church based
≥18 30–45 39 african american women
yes
ard et al. (2017)
community 30 to 70 ≥25 409 african american women
No
hollis et al. (2008)
hospital ≥ 25 25–45 1685 (540 african american women)
No
Wilbur et al. (2016)
hospital 40-65 >30 288 african american women
No
aall studies were based in the Usa, provided no information on duration of residency in the country and did not specify ethnicity (country of origin).
Table 2. continued.
616 I. OLAOYE ET AL.
over three months (Herring et al., 2016). The majority of studies (n = 14) had a follow-up of one year or less (Ard et al., 2017; Chung et al., 2016; Fitzgibbon et al., 2005; Hollis et al., 2008; Lutes et al., 2017; Martin et al., 2006; McNabb et al., 1997; Sheppard et al., 2016; Stolley et al., 2009; 2017; Weerts & Amoran, 2011; Wilbur et al., 2016; Yanek et al., 2001), with two studies having an 18-month follow-up (4,445,156), and one study having a 13.5-year follow-up (West et al., 2019). Interestingly, intervention duration appeared to play a role: shorter interventions (less than six months) seemed to achieve significant weight loss more frequently compared to longer interventions.
Reported interventionist backgrounds included registered dieticians (Bennett et al., 2013; Chung et al., 2016; Liu et al., 2015), physicians (Martin et al., 2006; 2008), nutri- tionists (Hollis et al., 2008; Sheppard et al., 2016; Stolley et al., 2017), health coaches (Ard et al., 2017; Cahill et al., 2018; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Herring et al., 2016; Lutes et al., 2017; McNabb et al., 1997; Weerts & Amoran, 2011; Yanek et al., 2001), lifestyle counsellors (Weerts & Amoran, 2011), registered nurses (Wilbur et al., 2016) and psychologists (Befort et al., 2008; West et al., 2007). Four studies (Chung et al., 2016; Herring et al., 2016; Martin et al., 2006; Weerts & Amoran, 2011) gave no information on the duration of interventionists training but of those that did, this ranged from nine hours (Martin et al., 2006; 2008) to two days (Befort et al., 2008; Bennett et al., 2013; West et al., 2019; Wilbur et al., 2016).
Treatment fidelity Fidelity of intervention delivery was reported in 13 studies (Ard et al., 2017; Befort et al., 2008; Bennett et al., 2013; Cahill et al., 2018; Haire-Joshu et al., 2019; Herring et al., 2016; Hollis et al., 2008; Martin et al., 2006; 2008; McNabb et al., 1997; Sheppard et al., 2016; Wilbur et al., 2016). In one study (Befort et al., 2008), a motivational Interviewing Skills Code checklist was utilised to assess the degree to which counsellors conformed to the principles of MI (Stolley et al., 2017). Another study used an annual certification of site interviewers (West et al., 2019). Eight studies reported supervision of trainers to assure satisfactory completion of session contents (Ard et al., 2017; Bennett et al., 2013; Cahill et al., 2018; Haire-Joshu et al., 2019; Hollis et al., 2008; Martin et al., 2006; 2008; McNabb et al., 1997). Four studies referred to the review of audio recordings or calls (Befort et al., 2008; Cahill et al., 2018; Haire-Joshu et al., 2019; Herring et al., 2016; Sheppard et al., 2016). Others used retraining of interventionist (Bennett et al., 2013), role play retraining (Herring et al., 2016) and the Breitenstein fidelity checklist (Wilbur et al., 2016).
Behavioural change techniques Five studies (Befort et al., 2008; Chung et al., 2016; McNabb et al., 1997; Weerts & Amoran, 2011; West et al., 2019) did not mention any theories of behaviour change used in the development of the intervention. Of studies that reported theoretical underpinnings, the most common was the Social Cognitive Theory (SCT) (n = 14) (Ard et al., 2017; Bennett et al., 2013; Cahill et al., 2018; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Herring et al., 2016; Hollis et al., 2008; Liu et al., 2015; Martin et al., 2006; 2008; Stolley et al., 2009; West et al., 2007; Wilbur et al., 2016; Yanek et al., 2001). Others included the Transtheoretical Model of Behavioural change (TTM) (Hollis et al., 2008; Martin et al., 2006; 2008), the Theory of Planned Behaviour (TPB) (Sheppard
PSYCHOLOGY & HEALTH 617
et al., 2016) and the Social Ecological Model (SEM) (Herring et al., 2016; Stolley et al., 2017). A variety of behavioural change techniques were present in all interventions. Data revealed the use of 10 unique BCTs across a total of 12 studies with an average of approximately 5 BCTs incorporated in each study. The majority of studies utilized goal setting (Ard et al., 2017; Befort et al., 2008; Bennett et al., 2013; Cahill et al., 2018; Haire-Joshu et al., 2019; Herring et al., 2016; Hollis et al., 2008; Liu et al., 2015; Martin et al., 2006; 2008; McNabb et al., 1997; West et al., 2007; Wilbur et al., 2016; Yanek et al., 2001), self-efficacy (Befort et al., 2008; Bennett et al., 2013; Chung et al., 2016; Herring et al., 2016; Liu et al., 2015; Lutes et al., 2017; Martin et al., 2006; 2008; Sheppard et al., 2016; Stolley et al., 2017; West et al., 2019; Yanek et al., 2001) and social support (Ard et al., 2017; Befort et al., 2008; Bennett et al., 2013; Fitzgibbon et al., 2005; Herring et al., 2016; Hollis et al., 2008; Liu et al., 2015; Lutes et al., 2017; Martin et al., 2006; 2008; Stolley et al., 2017; West et al., 2019). Others included self-motivation (readiness to change) (Befort et al., 2008; Bennett et al., 2013; Herring et al., 2016; Martin et al., 2006; 2008; Sheppard et al., 2016), self-monitoring of behaviours (Ard et al., 2017; Befort et al., 2008; Bennett et al., 2013; Cahill et al., 2018; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Hollis et al., 2008; Liu et al., 2015; Lutes et al., 2017; West et al., 2007; 2019), problem solving (Ard et al., 2017; Bennett et al., 2013; Hollis et al., 2008; Liu et al., 2015; McNabb et al., 1997; Stolley et al., 2009; West et al., 2007; 2019; Wilbur et al., 2016), considerations of high-risk situations or barriers to change (Ard et al., 2017; Befort et al., 2008; Bennett et al., 2013; Cahill et al., 2018; Chung et al., 2016; Haire-Joshu et al., 2019; Liu et al., 2015; Lutes et al., 2017; Sheppard et al., 2016; Stolley et al., 2009; 2017; Weerts & Amoran, 2011), con- siderations of ‘pros and cons’ (Befort et al., 2008; Liu et al., 2015; West et al., 2019), reinforcement (Cahill et al., 2018; Haire-Joshu et al., 2019; Liu et al., 2015; Martin et al., 2006; 2008) and role modelling (Sheppard et al., 2016). It was observed that interventions utilising a combination of more than three BCTs were more frequently associated with weight loss (Befort et al., 2008; Bennett et al., 2013; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Hollis et al., 2008; Liu et al., 2015; Lutes et al., 2017; McNabb et al., 1997; West et al., 2007; 2019).
Cultural adaptations An analysis of cultural adaptation strategies across the interventions identified about nine distinct strategies utilised in 11 studies. On average, each study incorporated approximately 3 distinct cultural adaptation strategies. These included constituent involvement (Fitzgibbon et al., 2005; Liu et al., 2015; Lutes et al., 2017; McNabb et al., 1997; Stolley et al., 2017; Wilbur et al., 2016), in-depth interviews with participants to learn about barriers and enablers of healthy eating and physical activity as well as preferred intervention channels and components (Liu et al., 2015), engagement of community leaders as peer mentors (Befort et al., 2008), use of multi-ethnic personnel at intervention sites (Lutes et al., 2017; West et al., 2019), use of themes and contents relevant to participants and social contexts (Ard et al., 2017; Fitzgibbon et al., 2005; Herring et al., 2016; Hollis et al., 2008; Sheppard et al., 2016; Stolley et al., 2017). Addressing cultural and dietary preferences were utilised in seven studies (Weerts & Amoran, 2011; Sheppard et al., 2016; Martin et al., 2008; Martin et al., 2006; Chung
618 I. OLAOYE ET AL.
et al., 2016; Befort et al., 2008; Stolley et al., 2009; Fitzgibbon et al., 2005; McNabb et al., 1997; Ard et al., 2017; Hollis et al., 2008), others included values placed on faith and religion (Sheppard et al., 2016; Stolley et al., 2009), socioeconomic factors (Befort et al., 2008; Cahill et al., 2018; Haire-Joshu et al., 2019; Martin et al., 2006; 2008; Weerts & Amoran, 2011; Wilbur et al., 2016), and perception of body images (Befort et al., 2008; McNabb et al., 1997; Sheppard et al., 2016). Two studies (Bennett et al., 2013; Yanek et al., 2001) did not provide any information about the cultural tailoring of intervention. Nine studies used a combination of at least two cultural strategies (Ard et al., 2017; Befort et al., 2008; Fitzgibbon et al., 2005; Hollis et al., 2008; Lutes et al., 2017; Martin et al., 2006; McNabb et al., 1997; Sheppard et al., 2016; Stolley et al., 2017).
Treatment adherence In the studies that reported adherence, treatment adherence was defined as the extent to which participants followed the prescribed intervention protocols, which could include attending scheduled sessions and following behavioural guidelines. Treatment acceptance encompassed participants’ willingness to engage with the intervention and their overall satisfaction with the counselling process. To promote treatment adherence, six studies reported the use of financial incentives (Herring et al., 2016; Liu et al., 2015; Martin et al., 2006; 2008; Weerts & Amoran, 2011; Wilbur et al., 2016), ranging from $25 to $45. Additionally, the provision of vouchers for fresh fruits and vegetables (Weerts & Amoran, 2011) was shown to encourage healthy eating habits. The treatment adherence rates varied among the nine studies that reported on it. Among nine studies that reported treatment adherence rates, two (Befort et al., 2008; Wilbur et al., 2016) reported <50% adherence, seven (Ard et al., 2017; Bennett et al., 2013; Herring et al., 2016; Sheppard et al., 2016; West et al., 2007; 2019; Yanek et al., 2001) reported adherence >60%. Intervention acceptability rates, reported in four studies (Befort et al., 2008; Herring et al., 2016; Liu et al., 2015; Sheppard et al., 2016) were >70%. Factors that influenced adherence to and accep- tance of treatment included the level of social support provided (Befort et al., 2008), cultural sensitivity of interventions (Befort et al., 2008; Herring et al., 2016), intensity as well as individual participant characteristics (Liu et al., 2015; Sheppard et al., 2016). Studies that utilized more intensive interventions such as frequent counselling sessions, personalised feedback or social support typically resulted in higher adherence rates (Ard et al., 2017; Bennett et al., 2013; Herring et al., 2016; Sheppard et al., 2016; West et al., 2007; 2019; Yanek et al., 2001). See Table 3 for a summary of study interventions.
Outcome measurements
Effect of client-centred counselling on primary outcomes
Included papers reported post-intervention bodyweight outcomes as change in kilo- grams (kg) (Bennett et al., 2013; Cahill et al., 2018; Haire-Joshu et al., 2019; Herring et al., 2016; Liu et al., 2015; Lutes et al., 2017; Martin et al., 2006; 2008; Stolley et al., 2017; West et al., 2019), change in pounds (lb) (McNabb et al., 1997; Weerts & Amoran,
PSYCHOLOGY & HEALTH 619
Table 3. summary of client-centred counselling interventions design in Black african women with overweight and obesity.
study study design/intervention theory baseda Duration of intervention
(counseling) length of
follow up
Martin et al. (2006)
Rct control: Usual physician obesity
management during regular medical care (n = 73)
treatment: culturally tailored, physician-directed recommendations based on participants’ current eating practices and physical activity levels (n = 71)
sct, ttM 15-min individual sessions over 6 months.
6 months
Bennett et al. (2013)
Rct (2-arm). treatment, n = 97: interactive obesity treatment approach (iota) and mutually reinforcing components: tailored behaviour change goals, weekly self-monitoring via interactive voice response, 12 counseling calls, tailored skills training materials and a 12-month yMca membership. control n = 97, usual care
sct-self efficacy 20-min counseling calls monthly over 12 months, by registered dieticians
18 months
Befort et al. (2008)
Rct control: health education on
non-weight loss topics (n = 23) treatment: culturally-targeted
behavioral weight loss program with motivational interviewing (MI) sessions (n = 21)
No information Four 30-min MI sessions over 16 weeks (weeks 0, 3, 8, and 13) delivered by a doctoral clinical psychology student.
16 weeks
Weerts and amoran (2011)
Mixed (quantitative and qualitative) methods pilot Rct.
treatment: personalised nutritional counseling at four appointments plus $40 gift card to purchase fruits and vegetables (n = 10)
control: received $40 gift card to purchase groceries (n = 11)
No information 15 min monthly individual sessions over 3 months by a well-known african american woman
3 months
herring et al. (2016)
Rct (2-arm). treatment: technology-based behavioural intervention (n = 33); control: usual obstetrical care (n = 33).
sct, seM 15–20 minute counselling calls for the treatment group: weekly for the first 2 weeks, then twice monthly thereafter.
until delivery
cahill et al. (2018)
Rct (2-arm) treatment group (Pat+): n = 133,
received standard Parents as teachers (Pat) education plus lifestyle weight management counseling focused on diet and physical activity. this included goal setting for appropriate gestational weight gain (gWg), self-assessments, and positive reinforcement.
control group: n = 134, received the standard Pat curriculum emphasizing development-centered parenting support.
sct 10 biweekly home visits during pregnancy, with 1-hour sessions led by parent educators.
until delivery
(Continued)
620 I. OLAOYE ET AL.
(Continued)
study study design/intervention theory baseda Duration of intervention
(counseling) length of
follow up
haire-Joshu et al. (2019)
Rct (2-arm) treatment: Pat+ lifestyle, n = 133;
included standard Pat education plus lifestyle counseling on diet and physical activity (goal setting, reinforcement of positive behaviors).
control: standard Pat curriculum, n = 134; focused on development-centered parenting support and education.
sct home visits every other week during pregnancy and monthly for 12 months postpartum.
12 months after paturition
Martin et al. (2008)
Rct (2-arm) treatment: culturally tailored
weight loss and weight maintenance intervention. Physician-patient counselling with incentives, n = 68.
control: Usual care, n = 69; regular medical care with no weight loss instructions.
sct Five sessions of 15 minutes each monthly for 5 months, plus 1 weight maintenance session at month 6, totalling 90 min of physician-patient contact.
6 months for weight loss and 18 months for weight maintenance
liu et al. (2015)
Pilot culturally tailored lifestyle intervention (based on formative research) on nutrition and physical activity
Mixed individual and group counseling sessions and with telephone counseling
sct treatment in pregnancy, n = 16: individual counselling session followed by 8 90-min group sessions with telephone counseling contacts by registered dieticians
treatment postpartum at 6–8 weeks: individual home visits and 3 counseling telephone calls through to week 12 postpartum.
32 weeks 12 weeks
postpartum
chung et al. (2016)
a single group longitudinal pilot study.
treatment: mixed Individual and group dietary counseling incorporating mindful eating and reinforcement of healthy eating, n = 26
No information 12 weeks, with bi-weekly sessions.
6 months
West et al. (2019)
3-phased lifestyle intervention modeled after the diabetes prevention program (DPP).
treatment: look aheaD (action for health in Diabetes), n = 303
No information Phase 1: Months 1–6: weekly
on-site visits; 3 group and 1 individual session
Months 7–12: 3 per month on-site visits; 2 group, 1 individual session
Phase 2: years 2–4: minimum of 1
per month on-site visit; 1 individual with minimum of 1 additional contact by phone or mail
Phase 3: years 5+: monthly on-site
visits; individual sessions
13.5 years
Table 3. continued.
PSYCHOLOGY & HEALTH 621
study study design/intervention theory baseda Duration of intervention
(counseling) length of
follow up
sheppard et al. (2016)
Rct (2-arm) treatment: stepping stone
intervention, n = 15; control (usual care), n = 16
tPB, sct every two weeks of 90-min group sessions (30 min of supervised physical activity and 60 min of education) and 6 individual phone sessions of motivational interviewing (15 min each) every other week by an exercise physiologist and a nutritionist.
12 weeks
lutes et al. (2017)
Rct treatment: behaviourally-centred
and culturally-relevant lifestyle coaching intervention, (n = 100) control group (n = 100) received standard care.
small changes model of behavior change
12 months with 16 individual contacts: first two sessions face-to-face, followed by 14 sessions either face-to-face or via telephone (20–30 min each) delivered by trained african american chWs.
12 months
stolley et al (2009)
Pre-post interventional study. a culturally relevant intervention incorporating weekly Focus group Discussions on food, family, music, social roles and relationships, and spirituality/ religion. treatment n = 23
sct, health belief model
6 months of weekly sessions
6 months
stolley et al. (2017)
Rct culturally sensitive intervention.
treatment group (n = 125) participated in the 6-month Moving Forward Interventionist-guided program (MFg); control group (n = 121) received the Moving Forward self-guided program (sg).
seM MFg included twice-weekly in-person classes (90 min and 60 min) and twice-weekly text messaging.
12 months
West et al (2007)
Rct. treatment group (n = 109)
received individual sessions of motivational interviewing as an adjunct to a group-based behavioral weight control program; attention control group (n = 108) received individual health education.
sct 42-session weight management program: weekly for 6 months, biweekly for 6 months, and monthly for 6 months. emphasis on weight loss in the first 6 months and weight maintenance in the following 12 months. Five individual motivational interviewing sessions (approximately 45 min each) were delivered by licensed clinical psychologists.
18 months
Table 3. continued.
(Continued)
622 I. OLAOYE ET AL.
study study design/intervention theory baseda Duration of intervention
(counseling) length of
follow up
yanek et al. (2001)
Rct. treatment: standard behavioral intervention- held weekly sessions on nutrition and physical in churches, n = 188. spiritual intervention- standard intervention plus spiritual components, n = 267. control: self-help intervention: materials from the american heart association on healthy eating and physical activity, n = 74
sct-self efficacy Weekly 30–45 min in-person sessions held over 20 weeks
12 months
Fitzgibbon et al. (2005)
Rct treatment: Faith on the Move.
Faith-Based Weight loss Intervention: culturally tailored Weight loss Intervention with addition of scriptures, n = 30. vs culturally tailored Weight loss Intervention, n = 29
sct twice weekly for 12 weeks. First weekly meetings lasted 90 minutes (45 min for didactic and 45 min for exercise); second weekly meetings consisted of a 45-min exercise session.
12 weeks
McNabb et al. (1997)
Rct. treatment: culturally tailored PathWays program, n = 19. control: waitlist, n = 20
No information small group sessions were held weekly for
14 weeks in churches for 1.5 h.
14 weeks
ard et al. (2017)
Rct. treatment: culturally tailored behavioral weight loss program augmented with community strategies, n = 255. vs weight loss only, n = 154
sct Weekly group sessions of 1.5 h each were delivered consecutively for 6 months, followed by a 6-month follow-up period (3 months bi-monthly sessions followed by 3 months of monthly sessions). Follow-up phone calls of 10–20 min monthly.
6 months
hollis et al. (2008)
Rct. treatment: culturally tailored weight loss maintenance trial, n = 1685 (540 african american women)
sct, techniques of
behavioral self- management, ttM
20 weekly group weight-loss sessions
over 6 months. 90–120 min long with about 18–25 participants per group. occasional phone contacts
6 months
Wilbur et al. (2016)
Rct. the Women’s lifestyle Physical activity Program plus MI. group discussion only, n = 95, group discussion + Personal Motivational telephone calls, n = 96, group discussion + automated Motivational telephone calls, n = 97
sct six 2-hour group meetings delivered over 48 weeks with either 11 personal motivational calls, 11 automated motivational messages, or no calls between meetings.
48 weeks
asct: social cognitive theory; ttM: transtheoretical model of behavioural change; seM: socioecological model; tPB: theory of planned behaviour.
Table 3. continued.
2011; Yanek et al., 2001), percent weight loss (%) (Ard et al., 2017; Sheppard et al., 2016) or change in BMI (Chung et al., 2016).
PSYCHOLOGY & HEALTH 623
Between 1 and 6 months post-intervention follow-up, 10 studies (Ard et al., 2017; Befort et al., 2008; Chung et al., 2016; Fitzgibbon et al., 2005; Hollis et al., 2008; Martin et al., 2006; 2008; McNabb et al., 1997; Sheppard et al., 2016; Stolley et al., 2009; Weerts & Amoran, 2011) reported effects on weight loss, with statistically significant effects. Ten studies (Bennett et al., 2013; Cahill et al., 2018; Herring et al., 2016; Liu et al., 2015; Lutes et al., 2017; Stolley et al., 2017; West et al., 2007; 2019; Wilbur et al., 2016; Yanek et al., 2001) reported intervention effects between 8 and 12 months of follow-up after the intervention period, also demonstrating statistically significant effects. Overall, Ninety-one percent (n = 20) of the studies revealed within-group effects on weight loss (p < .05), whereas 93% (n = 14) of the 15 studies with control groups showed statistically significant between-group intervention effects (Bennett et al., 2013; Cahill et al., 2018; Haire-Joshu et al., 2019; Herring et al., 2016; Liu et al., 2015; Lutes et al., 2017; Martin et al., 2006; 2008; McNabb et al., 1997; Sheppard et al., 2016; Stolley et al., 2017; Weerts & Amoran, 2011; West et al., 2019; Yanek et al., 2001)
Client-centred counselling was only found to be effective in two out of five studies (Bennett et al., 2013; Haire-Joshu et al., 2019) (both of which used individual-based formats) in promoting weight maintenance over 12-months of post-intervention follow-up.
Effect of client-centred counselling on secondary outcomes
In addition to investigating body weight outcomes, lifestyle modifications, including physical activity and dietary intake, were also examined. Dietary intake was evaluated in terms of participants’ total energy intake, fat and salt intake, as well as fruit and vegetable intake. Physical activity was measured using self-reported questionnaires in seven studies (Ard et al., 2017; Befort et al., 2008; Fitzgibbon et al., 2005; Martin et al., 2006; 2008; Sheppard et al., 2016; West et al., 2019) and accelerometry in three studies (Hollis et al., 2008; Liu et al., 2015; Wilbur et al., 2016). Of these, six studies (60%) (Ard et al., 2017; Fitzgibbon et al., 2005; Martin et al., 2006; 2008; Sheppard et al., 2016; Wilbur et al., 2016) reported significant improvements in physical activity outcomes within the intervention groups. Regarding dietary intake, eight out of ten studies (80%) (Befort et al., 2008; Hollis et al., 2008; Liu et al., 2015; Martin et al., 2008; McNabb et al., 1997; Sheppard et al., 2016; Stolley et al., 2009; Yanek et al., 2001) showed improvements in dietary habits within the intervention groups. Table 1 reports the findings of lifestyle outcomes.
Risk of bias
A summary of quality appraisal for RCTs is provided in Table 4. In terms of overall ratings, there was variability in the risk of bias across studies. Of the 19 RCTs (Ard et al., 2017; Befort et al., 2008; Bennett et al., 2013; Cahill et al., 2018; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Herring et al., 2016; Hollis et al., 2008; Lutes et al., 2017; Martin et al., 2006; 2008; McNabb et al., 1997; Sheppard et al., 2016; Stolley et al., 2017; Weerts & Amoran, 2011; West et al., 2007; 2019; Wilbur et al., 2016; Yanek et al., 2001) evaluated using the RoB 2 tool, 15 (Ard et al., 2017; Cahill et al., 2018; Fitzgibbon et al., 2005; Haire-Joshu et al., 2019; Herring et al., 2016; Hollis
624 I. OLAOYE ET AL.
et al., 2008; Lutes et al., 2017; Martin et al., 2006; 2008; McNabb et al., 1997; Stolley et al., 2017; West et al., 2007; 2019; Wilbur et al., 2016; Yanek et al., 2001) had low risk of bias, two some concerns (Befort et al., 2008; Bennett et al., 2013; Cahill et al., 2018; Chung et al., 2016; Haire-Joshu et al., 2019; Herring et al., 2016; Liu et al., 2015; Martin et al., 2006; 2008; Sheppard et al., 2016) and two had high risk of bias (Bennett et al., 2013; Weerts & Amoran, 2011). All three non-RCTs (Chung et al., 2016; Martin et al., 2006; Stolley et al., 2009) evaluated using the ROBINS-1 tool had a low risk of bias (Table 5). In RCTs with a high risk of bias, the source of bias differed across
Table 4. RoB 2 for Rct studies (n = 19).
author
Domain 1: Risk of bias arising from
the randomization
process
Domain 2: Risk of bias due to
deviations from the intended interventions
(effect of assignment to intervention)
Domain 3: Risk of bias
due to missing
outcome data
Domain 4: Risk of bias in
measurement of the outcome
Domain 5: Risk of bias in selection
of the reported
result
overall risk of bias
judgement
Befort et al. (2008)
some concerns low risk low risk low risk low risk some concerns
Weerts and amoran (2011)
some concerns some concerns low risk low risk low risk high risk
herring et al. (2016)
low risk low risk low risk low risk low risk low risk
haire-Joshu et al. (2019)
low risk low risk low risk low risk low risk low risk
cahill et al. (2018)
low risk low risk low risk low risk low risk low risk
Martin et al. (2008)
low risk low risk low risk low risk low risk low risk
Martin et al. (2006)
low risk low risk low risk low risk low risk low risk
Bennett et al. (2013)
high risk low risk low risk low risk low risk high risk
sheppard et al. (2016)
some concerns low risk low risk low risk low risk some concerns
West et al. (2019)
low risk low risk low risk low risk low risk low risk
lutes et al. (2017)
low risk low risk low risk low risk low risk low risk
stolley et al. (2017)
low risk low risk low risk low risk low risk low risk
West et al (2007)
low risk low risk low risk low risk low risk low risk
yanek et al. (2001)
low risk low risk low risk low risk low risk low risk
Fitzgibbon et al. (2005)
low risk low risk low risk low risk low risk low risk
McNabb et al. (1997)
low risk low risk low risk low risk low risk low risk
ard et al. (2017)
low risk low risk low risk low risk low risk low risk
hollis et al. (2008)
low risk low risk low risk low risk low risk low risk
Wilbur et al. (2016)
low risk low risk low risk low risk low risk low risk
PSYCHOLOGY & HEALTH 625
domains: bias resulting from randomization and bias resulting from deviations from intended interventions (Bennett et al., 2013; Weerts & Amoran, 2011).
Discussion
The findings from this systematic review, one of the first to evaluate the effectiveness of client-centred counselling for weight management among Black African women with overweight and obesity in high-income countries, provide valuable insights into the efficacy of such interventions. The evidence demonstrates that client-centred counselling, particularly when culturally tailored and grounded in BCTs, results in meaningful weight loss.
The positive outcomes in weight loss seen across 93% of the studies reviewed highlight the potential for client-centred counselling to address obesity in Black African women—a population where health disparities are often pronounced (NHS, 2022). The 5% weight loss achieved by participants as a result of treatment in 75% of the studies is especially noteworthy, as it represents the threshold for clinically meaningful weight reduction according to established obesity guidelines (Blackburn, 1995; Williamson et al., 2015). This result mirrors findings from studies on African American populations, where behavioural interventions have also led to notable weight loss (Fitzgibbon et al., 2012; Tussing-Humphreys et al., 2013). In the systematic review by Fitzgibbon et al., (2012), larger, multi-site trials involving medically at-risk African American women achieved greater weight loss compared to smaller, single-site, or non-randomised trials, which often lacked the power or intensity to detect significant changes. Likewise, the present study’s findings are comparable to those found by previous systematic reviews and meta-analysis (Armstrong et al., 2011; Barnes & Ivezaj, 2015) that looked at client-centred intervention effects on weight loss among adults of different ethnicities with overweight and obesity, with approximately one-third and 6%–35.7% of participants achieving a clinically significant threshold of at least 5% weight loss. So too, the systematic review (Patel et al., 2019) which evaluated the efficacy of MI delivered via eHealth and telehealth strategies among adults with overweight and obesity also reported evidence on the effectiveness of client-centred counselling in achieving weight loss in ~55% of included studies.
One critical aspect emerging from this review is the importance of cultural rele- vance in intervention design. The integration of cultural elements such as dietary
Table 5. RoBINs-1 for non-Rct studies (n = 3).
author Bias due to
confounding
Bias in selection of participants
into the study
Bias in classification
of interventions
Bias due to deviations
from intended
interventions
Bias due to missing
data
Bias in measurement of outcomes
Bias in selection
of the reported
result
overall risk of Bias judgement
chung et al. (2016)
low low low low low low low low
liu et al. (2015)
low low low low low low low low
stolley et al. (2009)
low low low low low low low low
626 I. OLAOYE ET AL.
preferences, religious considerations, and community involvement was a common feature of successful interventions, aligning with previous research that emphasises the importance of culturally tailored interventions in promoting behaviour change among ethnic minorities (Kumanyika, 2019; Lancaster et al., 2014). However, beyond confirming the effectiveness of these adaptations, the findings raise questions about how best to incorporate these cultural elements without reinforcing stereotypes or limiting the flexibility of the intervention. For instance, the inclusion of community-based components may foster social support but may not fully address individual barriers related to socioeconomic status or access to healthcare services. As such this under- scores the complexity of developing interventions that are not only culturally sensitive but also adaptable to diverse individual needs (LeBlanc et al., 2018; Resnicow et al., 1999).
Theories such as Social Cognitive Theory (Bandura, 1986) and the Transtheoretical Model of Behavioural Change (Sutton, 1997) underpin many of the client-centred interventions reviewed. These theories focus on enhancing self-efficacy, motivation, and personal accountability, and appear particularly effective in promoting weight loss, especially when combined with practical strategies like goal setting and self-monitoring. Theories of behaviour change suggest that sustained weight loss is more likely when individuals feel empowered to make autonomous decisions, sup- ported by counsellors who adopt a non-directive, empathetic approach (Hardcastle et al., 2017; Lancaster et al., 2014). This is consistent with our review’s finding that interventions delivered using one-to-one formats appeared more effective than group interventions, though both formats showed benefits. The question of whether indi- vidual or group interventions are more appropriate for different stages of behaviour change is one that further research could address, as the current findings suggest there may be context-specific advantages to each format (Fitzgibbon et al., 2012; Michie et al., 2014).
The issue of intervention duration also warrants careful consideration. Interestingly, interventions lasting less than six months appeared more likely to achieve significant weight loss outcomes compared to those of longer duration. This pattern may reflect the phenomenon of "diminishing returns," where initial motivation and engagement are high, but participants experience a plateau in weight loss over time (Wing & Phelan, 2005). This is further corroborated by other studies (Armstrong et al., 2011; Barnes & Ivezaj, 2015) that found better weight loss outcomes within six months, whereas longer-term interventions did not seem to offer weight loss benefits. Moreover, obesity treatment guidelines for lifestyle interventions recommend a minimum of six months of treatment and with at least 14 contacts with clinicians (Jensen et al., 2014). From a behavioural perspective, shorter, more intensive inter- ventions could be more effective for initiating weight loss, while longer-term strat- egies are needed to sustain it. However, this present review also highlights a gap in the literature regarding long-term follow-up, with only 40% of studies including assessments beyond 12 months. This is consistent with findings from Tussing-Humphreys and colleagues (Tussing-Humphreys et al., 2013), who noted limited long-term suc- cess in maintaining weight loss. In their study, African American women lost less weight during the intensive weight loss phase and maintained a lower percent of their weight loss compared to Caucasian women in the behavioural lifestyle
PSYCHOLOGY & HEALTH 627
interventions reviewed, underscoring the need for ongoing support or periodic "booster" sessions.
In terms of delivery methods, face-to-face counselling, whether conducted alone or in combination with telephone follow-ups, emerged as a particularly effective mode of intervention. While digital and remote health strategies are increasingly popular, especially in the wake of the COVID-19 pandemic (Golinelli et al., 2020; Wosik et al., 2020), the present review suggests that in-person interactions may foster stronger relationships between participants and counsellors, improving adherence (Fitzgibbon et al., 2012). This observation is supported by existing literature on therapeutic alli- ances, which shows that face-to-face interactions can strengthen motivation and trust, key factors in achieving behaviour change (Ardito & Rabellino, 2011; Horvath & Luborsky, 1993). However, given the logistical and financial barriers to frequent in-person counselling, hybrid models that combine digital tools with periodic face-to- face sessions may strike an optimal balance between accessibility and effectiveness.
A critical dimension of the interventions was the incorporation of multiple BCTs. Interventions that employed at least three BCTs, such as self-monitoring, social support and goal-setting, appeared more likely to achieve significant weight loss. This is sup- ported by recommendations by Olateju et al., (2021) on the use of multiple BCTs to enhance compliance and adherence to study interventions. Moreover, the use of multiple BCTs aligns with established behavioural theories, such as the Theory of Planned Behaviour (Ajzen, 1991), which highlights the importance of perceived behavioural control, social influences, and intention formation in driving behaviour change. The effectiveness of using multiple BCTs points to the need for interventions that are not only comprehensive but also dynamic, capable of adapting to the evolv- ing needs of participants throughout the intervention period. However, our study also reveals a gap in the literature concerning the comparative effectiveness of dif- ferent BCTs (Lancaster et al., 2014). Future research should explore which specific techniques or combinations of techniques are most effective for this population, as this would allow for the development of more targeted, cost-effective interventions.
The present review also highlights the importance of intervention fidelity and practitioner expertise in determining outcomes. Studies that reported high fidelity, often through the use of trained professionals such as registered dieticians or lifestyle counsellors, were more likely to report positive outcomes. This raises important ques- tions about the scalability of such interventions. While it is clear that expertise and training improve effectiveness (DiLillo & West, 2011), the feasibility of widespread implementation using highly trained specialists may be limited in resource-constrained settings. This highlights the need for future research to explore how non-specialist health workers can be effectively trained to deliver client-centred counselling with high fidelity, particularly in underserved communities (Tussing-Humphreys et al., 2013). There is growing evidence that non-specialists, when properly trained and supported, can achieve outcomes comparable to those of specialists (Oyedeji et al., 2022) making this an important area for future investigation.
Finally, the present review sheds light on the importance of addressing the broader social determinants of health in weight management interventions. Many of the interventions reviewed adopted a socio-ecological approach, recognising that
628 I. OLAOYE ET AL.
individual behaviour change is influenced by factors such as access to healthy foods, transportation, childcare, and safe environments for physical activity (Burton et al., 2017). This is particularly relevant for Black African women in HICs, who may face intersecting barriers related to race, gender, and socioeconomic status (Burton et al., 2017). While many of the interventions successfully integrated strategies to overcome these barriers—such as providing vouchers for healthy food or addressing childcare needs—the persistence of health disparities suggests that broader structural changes are necessary. Interventions that merely focus on individual behaviour change without addressing the systemic issues that contribute to obesity are unlikely to produce sustainable, population-wide effects (Burton et al., 2017). Future research should therefore explore how client-centered counseling can be integrated into broader public health strategies that address the root causes of obesity in marginalised communities.
There are study limitations to consider. Firstly, although the search was rigorous including nine databases, it is possible that the inclusion of other search engines may have populated additional studies. We also acknowledge that additional papers may have been published since the article was submitted for review. Secondly, searches were restricted to studies available in English, which may have excluded relevant papers and resulted in location bias. Thirdly, all included studies failed to delineate information about participants’ countries of origin, migration status, and length of stay in host countries which would have allowed for a more robust eval- uation and interpretation of study outcomes in the context of Black African women migrants which was the intended target population in the present systematic review. Given the aforementioned limitations, we recommend that our study findings be interpreted cautiously. Nonetheless, this present systematic review has several key strengths. This study is a novel attempt to fill a gap in the literature on the use of client-centred counselling on weight management specifically among Black African minority women with overweight and obesity; to the best of the authors knowledge, this is one of the first studies to be conducted among this ethnic group. Thus, the findings of this study can be used to inform the planning and programming of obesity interventions in different settings–primary care, community and through the use of technologies. So too, our findings may be used to inform educational policy and practice in adult settings, as well as to improve the rigour and planning of future research on weight management in overweight and obese Black African women.
There are additional areas of future research that will benefit the field. Quantitative analysis was not performed in this study due to the heterogeneity of study outcomes. It is therefore impossible to draw conclusions based on pooled effect size estimates. In the future, a meta-analysis of intervention effects should be investigated. Given the relatively small number of studies (n = 22) conducted over the last five decades (1970 to June 2022), it is clear that more interventions using client-centred counselling as a weight loss strategy are required in this population. As previously stated, all studies failed to report participants’ countries of origin, ethnicities, migration status, and length of stay in host countries. Future studies should report ethnic breakdowns (and countries of origin) as well as breakdown information of study participants’ migratory status. Furthermore, all studies were based in the United States, which
PSYCHOLOGY & HEALTH 629
could have resulted in location bias. Therefore, more studies from other high-income countries are needed to allow for more robust comparisons of weight loss outcomes. Finally, while efforts to develop more scalable and accessible obesity treatment inter- ventions for Black African women living in HICs are critical, these should be accom- panied by further research focusing on long-term outcomes, including the acceptability, feasibility, and adherence to these interventions. Long-term follow-up studies are particularly needed to ensure that such interventions are sustainable and effective in this population over time.
Conclusions
This review underscores the potential of client-centred counselling as an effective intervention for weight management among Black African women in HICs. However, it also highlights several gaps in the current evidence base, particularly regarding long-term outcomes, the comparative effectiveness of different BCTs, and the scalability of interventions. While the findings are promising, particularly in terms of short-term weight loss and the cultural relevance of interventions, future research must focus on sustaining these outcomes over time and addressing the broader socioecological factors that influence health behaviours. By doing so, client-centred counselling can become a more effective tool in the fight against obesity and related health disparities in this vulnerable population.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Funding
Authors declare no funding sources.
Data availability statement
Datasets generated during the present study may be considered by the corresponding author on reasonable request.
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- Effectiveness of client-centred counselling on weight management among Black African women with overweight and obesity in high-income countries: a systematic review
- ABSTRACT
- Introduction
- Materials and methods
- Eligibility criteria
- Population
- Intervention
- Outcomes
- Study design
- Search strategy
- Study selection
- Data extraction
- Risk of bias assessment
- Effect measures
- Data synthesis
- Results
- Search results
- Characteristics of included studies
- Participants
- Client centred counselling intervention
- Modes of delivery
- Treatment fidelity
- Behavioural change techniques
- Cultural adaptations
- Treatment adherence
- Outcome measurements
- Effect of client-centred counselling on primary outcomes
- Effect of client-centred counselling on secondary outcomes
- Risk of bias
- Discussion
- Conclusions
- Disclosure statement
- Funding
- Data availability statement
- References
