Objectives

Obesity and overweight pose a global health and economic burden. Lifestyle interventions are recommended as first-line treatment. Given their individual complexity, personalized lifestyle interventions may be more effective than one-size-fits-all approaches. This review assessed the methodology, findings and reporting quality of cost-effectiveness analyses evaluating personalized lifestyle interventions in adults with overweight or obesity.

Methods

MEDLINE, Embase, Web of Science, and Scopus were searched in March 2025, with backward reference tracking. Full economic evaluations were included without date restrictions. Studies were categorized by highest applicable personalization level: behavioral (Level 1), phenotype-based (Level 2), or omics-based (Level 3). Reporting quality was assessed using the CHEERS 2022 Checklist.

Results

From 15,385 records screened, 18 studies were included. Fourteen evaluated Level 1 interventions and two each evaluated Levels 2 and 3. Thirteen were cost-utility analyses: seven reported cost-effective or dominant findings, four reported not cost-effective findings, and two reported unclear or mixed results. Ten studies reported cost-effectiveness using clinical outcomes: eight showed favorable findings for at least one outcome, and two reported unclear findings. Heterogeneity in intervention design and methods between studies precluded robust conclusions. Findings for level 1 were mixed, evidence for levels 2 and 3 was limited, with favorable and inconsistent findings, respectively. 

Conclusions

Evidence on the cost-effectiveness of personalized lifestyle interventions was mixed and predominantly behavioral personalization. The scarcity of economic evaluations evaluating more advanced personalized lifestyle interventions remains a key evidence gap. Future research should evaluate their added value to inform resource allocation in obesity management.