The impact of adult behavioural weight management interventions on mental health: A systematic review and meta-analysis

Abstract

There is good evidence that behavioural weight management interventions improve physical health; however, the impact on mental health remains unclear. We evaluated the impact of behavioural weight management interventions on mental health-related outcomes in adults with overweight or obesity at intervention-end and 12 months from baseline. Eligible studies were randomized controlled trials (RCTs) or cluster RCTs of adult behavioural weight loss interventions reporting affect, anxiety, binge eating, body image, depression, emotional eating, quality of life, self-esteem and stress. We searched seven databases from inception to 7 May 2019 and included 43 articles reporting 42 RCTs. Eighteen studies were deemed to be at high risk of bias. We conducted random-effects meta-analyses, stratified analyses and meta-regression using Stata. Interventions generated greater improvements than comparators for depression, mental health-related quality of life and self-efficacy at intervention-end and 12 months from baseline. There was no difference between groups for anxiety, overall quality of life, self-esteem or stress at intervention-end. There was insufficient evidence to assess the impact on anxiety, binge eating, body image, emotional eating, affect, life satisfaction, self-esteem or stress at intervention-end and/or 12 months from baseline. Although evidence suggests that interventions benefit some aspects of mental health, high-quality, transparently reported RCTs measuring a range of mental health outcomes over longer durations are required to strengthen the evidence base.

Keywords: interventions; mental health; obesity; weight management.

Figure 1

PRISMA Flow Diagram for the inclusion of studies.

Figure 2

Changes in negatively scaled mental health outcomes at intervention-end comparing adult behavioural weight management interventions with inactive, minimal or usual care comparator using random-effects pairwise meta-analysis. [Abbreviations: TTT: Ten Top Tips; DSD: Do Something Different; BWLP: Behavioural Weight Loss Programme; PG: Pamphlet Group; FB: Facebook Group; SS: Structured Support; SSP: Structured Support and Physical Activity; HADS: Hospital Anxiety and Depression Scale: BSI: Brief Symptom Inventory; DASS: Depression Anxiety Stress Scales; BSQ: Body Shape Questionnaire; CES-D: Center for Epidemiologic Studies Depression Scale; BDI: Beck Depression Inventory: PHQ: Patient Health Questionnaire; TFEQ: Three Factor Eating Questionnaire; DEBQ: Dutch Eating Behaviour Questionnaire; PANAS/PNAS: Positive and Negative Affect Schedule; ATQ: Automatic Thoughts Questionnaire; ORWELL-R: Obesity Related Wellbeing Questionnaire; IWOQOL: Impact of Weight on Quality of. Life; PSS: Perceived Stress Scale; HPLP II: Health Promoting Lifestyle Profile.]

Figure 3

Changes in posivitely scaled mental health outcomes at intervention-end comparing adult behavioural weight management interventions with inactive, minimal or usual care comparator using random-effects pairwise meta-analysis. [Abbreviations: TTT: Ten Top Tips; DSD: Do Something Different; BWLP: Behavioural Weight Loss Programme; PG: Pamphlet Group; FB: Facebook Group; SS: Structured Support; SSP: Structured Support and Physical Activity; SHED-IT: Self-Help, Exercise, and Diet using Information Technology; IDT: Individualised dietetic treatment; FBI: Fat Boosters Incorporated; WHOQOL: World Health Organization Quality of Life; QWS: Quality of Well-being Scale; SF: Short Form; OWL-QOL: Obesity and Weight-Loss Quality of Life; SWL: Satisfaction with Life; WEL: Weight Efficacy Lifestyle Questionnaire; ESES: Exercise Self-Efficacy Scale; SOCQ: Stages of Change questionnaire; WMEQ: Weight Management Efficacy Questionnaire; SERPA: Self-Efficacy for Regulating Physical Activity; SEEB: Self-Efficacy for Exercise Behaviours; GSES: General Self-Efficacy Scale.]

Figure 4

Changes in [positively scaled] self-esteem at intervention-end comparing adult behavioural weight management interventions with inactive, minimal or usual care comparator using random-effects pairwise meta-analysis. [Abbreviations: SS: Structured Support; SSP: Structured Support and Physical Activity; RSES: Rosenberg self-esteem scale.]