Behavioral weight loss management programs may not contribute to a significant increase in eating disorders, according to the results of a study published in Obesity Reviews.

Investigators conducted a systematic literature review of randomized controlled trials of behavioral weight management interventions published between 1994 and 2022. Participants in the studies were 18 years or older with overweight or obesity, defined as a BMI 25 kg/m2 or higher. Studies indicating any interventions, defined as information or advice on weight management, such as bariatric surgery, pharmacotherapy, nutrition, physical movement, or underlying conditions contributing to high BMI, were excluded. The control group consisted of participants with no treatment or support related to weight management.

The investigators assessed trial outcomes, including measures of eating disorder risk, symptoms, or behaviors taken at study baseline and following the intervention.  Of the 12,023 screened studies from the United States, the United Kingdom, Australia, the Netherlands, Italy, New Zealand, Canada, Finland, Brazil, and Greece, 49 met inclusion criteria (n=6337; mean age range 22.1 to 59.9; 20.4% women).

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The investigators employed multiple analytic techniques to assess the data, including a narrative synthesis of results according to the Synthesis Without Meta-analysis (SWIM) guidelines, meta-analyses of global eating disorders, and binge eating scores.

In a meta-analysis of 9 relevant trials with 20 total intervention arms and 929 total participants, the investigators reported a reduced risk for global eating disorders between baseline and following the intervention (Hedges’ g = -0.27; 95% CI, -0.36 to -0.17; I2 = 67.1%; 95% PI, -0.62 to 0.08; τ2 = 0.029), with reductions maintained at latest follow-up. Similarly, in a meta-analysis of 23 trials with 49 total intervention arms and 1986 total participants, there was a demonstrated reduction in binge eating behaviors between baseline and following the intervention (Hedges’ g = -0.66; 95% CI, -0.76 to -0.55; I2 = 83.2%; 95% PI, -1.28 to -0.03; τ2 = 0.0984), with reductions maintained at latest follow-up.

Additionally, the investigators noted reductions in global eating disorder risk, binge eating severity, and binge eating episodes across the intervention arms of all the included trials.

Study limitations for this meta-analysis include a lack of data to discern details about smaller subgroups, measures of global eating disorder risk reducing the available data pool, and geographic location of included studies, which limits the generalizability of the data to populations in less developed regions.

The investigators concluded, “For most adults, behavioral weight management interventions do not appear to increase eating disorder risk or binge eating. Indeed, a reduction in global eating disorder and binge eating scores is seen following interventions of 4 weeks to 18 months duration, and at follow-up of up to 36 months from post-intervention.” However, they noted that future research is needed to inform which patient groups are at highest risk for developing eating disorders as a result of weight management programs, and to identify the risk factors that led to them.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.


Jebeile H, Libesman S, Melville H, et al. Eating disorder risk during behavioral weight management in adults with overweight or obesity: a systematic review with meta-analysisObes Rev. Published online March 15, 2023. doi:10.1111/obr.13561

This article originally appeared on Endocrinology Advisor