June 2015, Vol 3, No 6 - Inside Health & Wellness

Obesity is a significant health problem in the United States, leading to conditions including diabetes and cardiovascular disease, and contributing to significant healthcare costs.

Hai-Lun Chao of the Department of Health Care Administration, Chung-Hwa University of Medical Technology, Tainan, Taiwan, conducted a systematic review and meta-analysis of studies examining the effect of weight-loss interventions on body image in obese and overweight individuals using MEDLINE, Current Contents, and the Cochrane Database.

The search focused on comparative studies and clinical trials, including prospective and retrospective studies involving obese and overweight adults enrolled in weight-loss interventions where body image was quantitatively assessed. Studies that included participants with any coexisting chronic diseases, or that did not quantitatively assess body image, were excluded from the analysis. Changes in body shape concern, body size dissatisfaction, and body satisfaction were the outcomes measured. Data extraction and quality assessment were conducted by 2 independent reviewers, and a third reviewer was consulted for disagreement resolution.

Overall, 149 publications were identified during the initial search; 124 of these studies did not include relevant body image outcomes and were excluded. Of the remaining 25 articles that were reviewed, 7 were included in the systematic review (N = 931); 4 of these studies were included in the meta-analysis. Patient characteristics of the studies in the analysis included mostly women, with only 1 study evaluating both men and women. In addition, Dr Chao found that the type of weight-loss intervention varied between studies. However, all of the participants in these studies were overweight or obese (body mass index, 25-45). The number of patients included in the studies ranged from 31 to 144 in the intervention group, and 17 to 88 in the control group. Tools used to measure body image also varied between studies, including the Body Shape Questionnaire, which was used to assess body shape concern; the Body Image Assessment to assess body size dissatisfaction. Several studies reported other methods to measure body satisfaction and body image avoidance, as well as attractiveness/self-confidence, accentuation of appearance, insecurity/concern, and physical/sexual misperception.

Significantly pronounced differences in body image were seen in 4 studies; no significant difference in body image outcomes was seen in 3 studies. The meta-analysis demonstrated improvements in body shape concerns (95% confidence interval [CI], –1.04 to 0.00), body size dissatisfaction (95% CI, –0.88 to –0.45), and body satisfaction (95% CI, 0.09 to 1.38), which significantly favored the intervention group compared with the control group (P <.05).

“The findings of our systematic review and meta-analysis support the notion that weight loss interventions may improve body image in obese/overweight adults,” the author reported in PLoS One. “This is important given that body image is an important mediator of psychological well-being and the capacity for an individual to maintain weight loss.”

The effects of body image on psychological well-being and maintenance of weight loss have been evaluated, the study authors noted citing previously published studies. Researchers have also found that improvements in the investment dimension of body image may be more important than evaluative dimensions in improving self-eating regulation. In addition, researchers have observed that the investment dimension of body image is more significantly impacted by physical activity than the evaluative dimension.

Further research is warranted in the form of large-scale randomized controlled trials to assess whether certain weight-loss interventions facilitate optimal outcomes in terms of improving body image, as well as facilitating and maintaining weight loss.

Chao HL. Body image change in obese and overweight persons enrolled in weight loss intervention programs: a systematic review and meta-analysis. PLoS One. 2015;10:e0124036.

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