The Effectiveness of Randomized-Controlled Interventions on Body Image Among Adult Women: A Systematic Review and Meta-Analysis

Background and Purpose: Adult females are commonly vulnerable to body image concerns, including body dissatisfaction, body shame, weight and shape concerns, etc., thus, plenty of interventions have been designed to improve adult women’s body image. Although several existing meta-analyses have examined the efficiency of diverse interventions on body image, none of them specifically focused on the effectiveness on adult women and contained randomized control in their inclusion criteria. Therefore, this study presented the latest pattern of randomized interventions for adult women with body image concerns and compared the effectiveness of such interventions on various body image components, in order to verify the efficiency of existing interventions in improving body image among nonclinical adult females.

Methods: This systematic review followed the Cochrane Handbook for Systematic Reviews. Seven widely used English databases (i.e., PubMed, Web of Science, EBSCO, Medline, Scopus, APA PsycArticles, and APA PsycTherapy) were searched up to 11/30/2023. The included studies must be based on psychosocial approaches, randomly controlled, high-quality according to the Newcastle-Ottawa Quality Assessment Scale (NOS), and evaluate nonclinical adult female’s body image as an outcome. Application of inclusion criteria and data extraction were conducted by three reviewers. Forty-seven studies, including 6984 participants (3537 subjects and 3447 controls) met the inclusion criteria for review. The major information was obtained from included articles, such as author, publication year, country, sample size, intervention formats, instruments, and body image outcomes. Effect sizes on various body image components were meta-analyzed, and subgroup analysis and sensitivity test were conducted to determine the source of heterogeneity among studies.

Results: Most of the 47 included studies were on body dissatisfaction (n = 34) and thin-ideal internalization (n = 34), 15 interventions were on weight and shape concerns, 14 on body satisfaction, and 10 on behavioral avoidance. The cognitive dissonance approach (n = 13) and cognitive behavioral therapy (n = 12) were popular as intervention methods. In addition, the delivery modes could be divided into four categories: therapist-led (n = 26), online self-help (n = 18), peer-led (n = 3) and trainer-led (n = 3). Diagnostic and Statistical Manual of Mental Disorders (11 studies), Body Shape Questionnaire (BSQ, 10 studies), and Eating Disorder Examination-Questionnaire (EDE-Q, 7 studies) were the three most used screening tools.

Three meta-analyses were conducted on body image components assessed in no less than 15 interventions, i.e., body dissatisfaction, weight shape concerns, and thin-ideal internalization. Existing interventions produced a small to medium reduction in body dissatisfaction (-0.42, 95% CI -0.77; -0.07), thin-ideal internalization (-0.59, 95% CI -0.77; -0.40), and a large reduction in weight shape concerns (-1.08, 95% CI -1.50; -0.67) at post-test. The long-term effects were also examined. The high heterogeneity among studies was caused by different countries, scales, intervention categories, and delivery modes.

Conclusions and Implications: This study indicates that existing interventions are effective in relieving body image concerns and promoting resilience to risk factors of body image among adult women. However, more interventions are needed to develop women’s positive body image and prolong the effectiveness after active intervention sessions.