Stroke remains a major public health problem with substantial disability and long-term care needs. Elevated body mass index is a recognised risk factor for primary stroke, and contemporary guidelines recommend weight and lifestyle management as part of secondary prevention. The association between BMI and post-stroke outcomes is complex; while some literature has described an ‘obesity paradox’, guideline bodies continue to emphasise weight-management strategies for cardiovascular risk reduction. The post-acute rehabilitation phase commonly sees weight gain among stroke survivors, driven by sensorimotor, cognitive and biopsychosocial factors, which may impair engagement with weight-management programmes and worsen rehabilitation outcomes across functioning, quality of life and mood.
Nutrition in neurorehabilitation has traditionally focused on preventing undernutrition and addressing dysphagia. By contrast, interventions aimed at reducing overweight and obesity in post-acute stroke rehabilitation often extend beyond nutritional counselling to include broader lifestyle, behavioural and physical-activity components. Despite guideline recommendations for weight management, practical, rehabilitation-focused guidance on how to implement obesity-management interventions for people with stroke is limited.
The scoping review aimed to identify and map the literature on professional dietary and lifestyle interventions targeting the management of overweight and obesity among adults with stroke during post-acute rehabilitation. The review addressed two questions:
The review followed Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR reporting checklist, and adhered to a previously published protocol. Several pragmatic refinements were made during the review to broaden the scope from nutrition-alone interventions to include dietary components embedded within multicomponent lifestyle approaches, and to frame the concept as management of overweight and obesity (both reduction and preventing further gain). Review articles were identified but excluded from the main synthesis to avoid duplication; only primary studies and clinical guidelines were included in the main mapping.
The review included adults (≥18 years) undergoing post-acute stroke rehabilitation who were living with overweight (BMI ≥25 kg/m²) or obesity (BMI ≥30 kg/m²). Materials needed to report professional dietary and lifestyle interventions delivered by qualified healthcare providers (for example, dietitians, nurses or allied health professionals) and to be applicable to the post-acute rehabilitation context, which spans inpatient, outpatient, community and home-based rehabilitation programmes. Publications in English and Scandinavian languages from January 2010 onwards were eligible.
A three-step, librarian-assisted search was performed in MEDLINE, Embase, CINAHL and Web of Science, supplemented by targeted grey-literature searches and screening of reference lists. Identified citations (3,254 records) were collated and screened in Covidence; duplicates were removed and two reviewers independently screened titles/abstracts and full texts with consensus processes for disagreements. The final synthesis included 14 studies meeting the predefined criteria.
The 14 included studies varied substantially in design, settings and reported intervention details. Settings encompassed inpatient, community and home-based post-acute rehabilitation contexts. Intervention durations ranged from 3 weeks to 2 years, with reported session frequencies between 6 and 22 sessions. Most studies described multicomponent interventions combining dietary counselling with behavioural techniques, physical-activity elements and self-monitoring tools.
Intervention content commonly included dietary counselling, group education, behaviour change techniques and app-based or digital self-monitoring systems. Duration and intensity varied widely across studies (3 weeks to 2 years; 6–22 sessions reported), reflecting heterogeneity in programme design. Digital interventions and technology-supported self-monitoring were prominent features in several studies.
Interventions were delivered by a range of health professionals, including dietitians, nurses, psychologists, physiotherapists and interprofessional teams. Delivery predominantly occurred in community or home-based settings, though inpatient and outpatient contexts were also represented. Roles and responsibilities of professionals differed by study and setting; where studies included mixed populations, stroke-specific data were extracted when available.
The review mapped the breadth of available professional interventions but found the evidence base to be heterogeneous and descriptive. Notable findings include the prominence of multicomponent programmes, frequent use of digital tools, and the variety of professionals involved. Important gaps identified were limited attention to cognitive impairment tailoring, scarce reporting on caregiver involvement and environmental adaptations (only three studies explicitly addressed caregiver roles and environmental barriers), and an absence of detailed guidance on integrating obesity management into routine rehabilitation pathways.
Strengths of the review include adherence to a published protocol, use of JBI methodology, reporting according to PRISMA-ScR, and a comprehensive librarian-assisted search strategy. Inclusion criteria based on the PCC framework and independent dual screening and extraction strengthened rigour. Consistent with scoping review methodology, a formal quality appraisal of included studies was not performed. A limitation is language restriction to English and Scandinavian publications, which may have omitted relevant evidence published in other languages.
This scoping review provides a descriptive map of professional dietary and lifestyle interventions targeting overweight and obesity in the post-acute stroke rehabilitation population. The evidence is varied and primarily comprises multicomponent interventions delivered in community and home settings, often with digital elements and interprofessional involvement. Key gaps remain in tailoring interventions for cognitive and functional impairments, involving caregivers and adapting environments. The authors recommend further research to inform development, implementation and evaluation of targeted weight-management strategies within post-acute stroke rehabilitation. Data supporting the review are available on reasonable request and supplementary materials are provided with the publication.