The impact of adult behavioural weight management interventions on mental health: A systematic review and meta-analysis.
Obesity reviews : an official journal of the International Association for the Study of Obesity 2020
Jones RA, Lawlor ER, Birch JM, Patel MI, Werneck AO, Hoare E, Griffin SJ, van Sluijs EMF, Sharp SJ, Ahern AL
DOI : 10.1111/obr.13150
PubMed ID : 33103340
PMCID :
URL : https://onlinelibrary.wiley.com/doi/10.1111/obr.13150
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.
Lay Summary
What is the aim of this review?
Systematic reviews provide a high-quality summary of all existing evidence on a particular topic. The aim of this review was to find out how attending a weight loss programme affects the mental health of adults with obesity. We collected and analysed all relevant studies to answer this question and found 43 studies.
Key messages
Attending a weight loss programme may slightly improve some aspects of mental health. But we still need more high-quality studies, including studies where different types of mental health outcomes are measured and over longer durations of time.
What was studied in the review?
Weight loss programmes support people to change weight-related behaviours like diet and physical activity and are the most common form of obesity treatment.
There is good evidence that these programmes can improve physical health, for example reducing the risk of type 2 diabetes and heart disease, but we don’t know how these programmes affect mental health. By better understanding how mental health is impacted, future programmes can be developed to more effectively support both physical and mental health at the same time.
We looked to understand how the different aspects of mental health were impacted, including: anxiety, binge-eating, body image concerns, depression, distress, emotional eating, negative emotions, quality of life, satisfaction with life, stress, self-efficacy (confidence in ability to complete a task or achieve a goal), and self-esteem (overall sense of personal value and self-worth).
What were the main results of the review?
We found 43 relevant studies. All studies took place in middle to high income countries (e.g. United States of America, United Kingdom, Australia). The adults in these studies were between 18 and 82 years old and were mostly women. The weight loss programmes lasted between 8 weeks and 2 years, and they were delivered either face-to-face, online, using leaflets/pamphlets, or by a combination of these.
Adults with overweight or obesity who attended a weight loss programme were compared to adults with obesity who did not attend a weight loss programme.
At the end of a weight loss programme, we found…
• Small improvements in depression, mental health quality of life, and self-efficacy.
• Little to no difference to anxiety, overall quality of life, self-esteem, or stress.
• There was too little evidence to assess the impact on body image concerns, emotional eating, negative emotions, distress, or satisfaction with life.
12-months after starting a weight loss programme, we found…
• Small improvements in depression, mental health quality of life, and self-efficacy.
• Little to no difference to overall quality of life compared to those who do not attend a programme.
• There was too little evidence to assess the impact on anxiety, body image concerns, emotional eating, distress, negative emotions, satisfaction with life, self-esteem, or stress.
How up to date is this review?
We searched for studies that had been published up to May 2019.