Psychosocial versus surgical weight loss interventions and their effect on body image: a systematic review

Abstract

Background: Patients undergoing bariatric surgery lose around 25% of their body weight in the first year (Karlsson, 2007), significantly greater than 10% for those taking part in psychosocial interventions (Wadden-Thomas, 2005). Body image dissatisfaction is reported to play a significant role in people seeking weight loss treatment (Sarwer et al, 2005). It would be logical to assume that as weight is lost, body image improves, yet this remains unclear. The aim of this systematic review was to investigate the effect that psychosocial or surgical weight loss interventions have upon body image and the role of weight loss. Method: In August 2015 electronic databases were searched for studies that delivered a psychosocial or surgical weight loss intervention and provided pre-post treatment data on body image and weight loss. Following multiple stages of the review, 21 studies were eligible for in depth evaluation and quality assessment (Surgical: 10, Psychosocial: 11). Findings: There were differences in the relationship between weight loss and improvements in body image across studies in this review. Some studies reported weight loss improving body image (or vice versa), whilst some reported improvements in body image despite no actual weight loss. Calculation of Hedges g effect sizes representing the magnitude of pre-post intervention body image improvement for surgical (d=0.66-12.82) and psychosocial interventions (d=0.19-1.70) did not clarify this. Discussion: Further research is needed, (particularly RCTs) to fully understand the relationship between weight loss and body image and to establish whether body image improvements are an outcome or mediator of weight loss.