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. 2025 Jan 31:80:103049.
doi: 10.1016/j.eclinm.2024.103049. eCollection 2025 Feb.

The impact of weight loss interventions on disordered eating symptoms in people with overweight and obesity: a systematic review & meta-analysis

Elena Tsompanaki  1 , Dimitrios A Koutoukidis  1 , Gina Wren  1 , Heather Tong  1 , Annika Theodoulou  1 , Danni Wang  1 , Rebecca J Park  2 , Susan A Jebb  1 , Paul Aveyard  1
Affiliations

The impact of weight loss interventions on disordered eating symptoms in people with overweight and obesity: a systematic review & meta-analysis

Elena Tsompanaki et al. EClinicalMedicine. .

Abstract

Background: It is unclear whether weight loss interventions worsen disordered eating in people living with overweight/obesity. We aimed to systematically evaluate the association between weight loss interventions and disordered eating.

Methods: Six databases were searched from inception until September 2024. Trials of weight loss interventions in people with overweight/obesity were included if they reported a validated score for disordered eating on either the Eating Disorder Examination Interview or the Eating Disorder Examination Questionnaire pre- and post-intervention. Interventions included behavioural weight loss programmes (BWL) and pharmacotherapy licenced for weight loss, with or without concurrent psychological support, provided for at least 4 weeks. Pooled standardised mean differences (SMD) in scores of disordered eating were calculated using random effects meta-analyses. Risk of bias (RoB) was assessed using the Cochrane RoB 2 tool and the Newcastle-Ottawa scale for randomised and single-arm trials, respectively (PROSPERO ID: CRD42023404792).

Findings: Thirty-eight studies with 66 eligible arms (61 interventions: 29 BWL, 11 BWL + pharmacotherapy, 20 BWL + psychological intervention, 1 pharmacotherapy + psychological intervention) and 3364 participants in total were included. The mean weight change was -4.7 kg (95% CI: -5.7, -3.7). Compared with baseline, disordered eating scores improved by -1.47 SMD units (95% CI: -1.67, -1.27, p < 0.001, I2 = 94%) at intervention completion (median of 4 months). Seven randomised trials that directly compared a weight loss intervention to no/minimal intervention reported an improvement of -0.49 SMD units (95% CI, -0.93, -0.04, p = 0.0035, I2 = 73%). Sub-group analyses showed: (a) disordered eating scores improved more in people with an eating disorder at baseline compared with people without high scores, (b) no clear evidence that the association depended upon intervention type, and (c) disordered eating scores improved more in trials rated at low overall RoB.

Interpretation: Despite heterogeneity in effect size, weight loss interventions consistently improved disordered eating scores. These findings provide reassurance that weight loss interventions might not worsen disordered eating and may improve it.

Funding: Novo Nordisk UK Research Foundation Doctoral Fellowship in Clinical Diabetes.

Keywords: Disordered eating; Overweight/obesity; Weight loss programmes.

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Conflict of interest statement

DAK, SAJ, and PA are investigators in two investigator-led publicly funded (NIHR) trials where the weight loss intervention was donated by Nestle Health Science and Oviva to the University of Oxford outside the submitted work. Second Nature is the commercial partner on GMW's MRC industrial collaborative awards in science and engineering (iCASE) studentship, but had no involvement in this review. None of these associations led to payments to these authors. DW received funding from the China Scholarship Council (CSC) for a visiting scholar position at the University of Oxford. This funding is unrelated to the content of the present manuscript. PA is an NIHR Senior Investigator and PA and SAJ are supported by the NIHR Oxford Biomedical WResearch Centre, the NIHR Oxford Health Biomedical Research Centre, and the NIHR Oxford and Thames Valley Applied Research Collaboration. DAK is supported by an NIHR Advanced Fellowship (NIHR302549). The funders had no role in the design and conduct of this work; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. The views expressed are those of the author(s) and not necessarily those of the NIHR, or the Novo Nordisk UK Research Foundation.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram.
Fig. 2
Fig. 2
Association between weight loss interventions and disordered eating at the end of the intervention, pre-post analysis of single arms.
Fig. 3
Fig. 3
Association between weight loss interventions and disordered eating in the end of the intervention, analysis of randomised control trials.
Fig. 4
Fig. 4
Subgroup analysis by type of intervention, pre-post analysis of singe arms.
Fig. 5
Fig. 5
Subgroup analysis by baseline disordered eating status, pre-post analysis of single arms.
See this image and copyright information in PMC

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