Effect of obesity treatments on eating behavior: Psychosocial interventions versus surgical interventions. A systematic review

Objective(1) To use available research data to estimate the amount of change in eating behavior following obesity treatment; (2) To examine how this change relates to the amount of change in weight loss after treatment and at follow up. A meta-analysis was conducted in September 2009.MethodsStudies were identified through a computer search of articles in the PubMed and PsychInfo databases. Key terms entered were obesity, treatment, and eating behavior. Effect sizes (Glass d) were calculated according to published procedures.ResultsEighteen studies met the inclusion and exclusion criteria, grouped into two categories: psychosocial interventions and surgical interventions. For psychosocial interventions, we found a medium effect size on eating behavior (d = .73, CI = (.66, .90)), and a low effect size on weight (d = .32, CI = (.28, .36)) at posttreatment and a low effect size for both outcomes at follow-up (for eating behavior d = .47, CI = (.45, .49), for weight d = .37, (CI = .18, .56)). For surgical interventions we found large effect sizes on both outcomes (for eating behavior d = 1.84, CI = (1.26, 2.42); for weight d = 1.40, CI = (1.25, 1.65)).ConclusionsSurgical interventions have superior results to psychosocial interventions, on both weight loss and eating behavior. Implications for treatment of obesity are discussed.

Research highlights
► Psychosocial treatments have a medium effect size on eating behavior and a small one on weight.
► Surgical treatments have a large effect size on both weight and eating behavior.
► Surgery leads to a larger effect size in both eating behavior and weight.
► Dysfunctional eating behavior might be not a cause of obesity, but a symptom.