Exploring size-inclusive health promotion: A scoping review of societal and community initiatives.

Size-inclusive health promotion initiatives aim to support health and wellbeing for people of all sizes. Greater understanding of their design and implementation at societal and community levels is needed. This review mapped existing literature on size-inclusive health promotion initiatives at societal and community levels, synthesising existing sources to improve understanding of their design, implementation, and impact. We systematically searched academic and grey literature databases for sources that recommended, described, or evaluated a size-inclusive health promotion initiative at the societal or community levels. Eligible sources were screened and extracted in Covidence, then synthesised in Excel. Of 4735 peer-reviewed and 49 non-peer reviewed sources screened, 58 met inclusion criteria. Initiatives consistently drew on frameworks such as Health at Every Size®, and guiding values of size diversity, social justice, trauma-informed practice, and intersectionality. Approaches were weight-neutral, socioecological, and systems-focused. Half (n = 29, 50%) described the implementation of an initiative, of which nine reported evaluation findings. Twenty-seven unique initiatives were synthesised. Most operated at the community level (n = 16, 59%), particularly in fitness and recreational settings (n = 8). Only nine sources reported engaging people with lived experience. Advancing size-inclusive health promotion at societal and community levels is crucial to reduce weight stigma and improve health and wellbeing for people of all sizes. This review comprehensively synthesised the existing literature, revealing common elements and implementation considerations to guide future research and practice. Future research must continue to engage people with lived experience in the design, implementation, and evaluation of initiatives to ensure they are meaningful and relevant.