Cognitive-Psychological Characteristics Influencing Weight Loss in Severe Obesity

Background/Objectives: Cognitive and psychological factors, such as eating disorder psychopathology, irrational food beliefs, and internalized weight stigma, have not been sufficiently explored in the context of obesity treatment. This study evaluated the role of these variables as predictors of weight loss in patients with severe obesity following a brief intensive cognitive-behavioral therapy for obesity (CBT-OB) program. Methods: A total of 400 patients (mean BMI: 41.9 kg/m²; mean age: 55.9 years) participated in a 21-day residential CBT-OB intervention, followed by a 12-month follow-up assessment. The Eating Disorder Examination Questionnaire, Weight Bias Internalization Scale, and Irrational Food Beliefs Scale were administered at admission and discharge. Body weight was also assessed at the 12-month follow-up. Results: Of the participants, 371 patients (92.2%) completed the intensive CBT-OB program, and 310 (81.1%) attended the follow-up. On average, completers achieved 9% weight loss at follow-up, accompanied by a significant reduction in binge-eating episodes. Cognitive factors, including lower baseline eating concern, higher baseline weight concern, and greater improvement in irrational beliefs (specifically self-deception about eating and weight control), significantly predicted weight loss at 12 months. However, internalized weight stigma did not predict weight loss in this cohort. Conclusions: This study underscores the importance of targeting specific cognitive factors in obesity treatment to enhance long-term outcomes. Addressing irrational food beliefs and promoting flexible dietary restraint may improve weight loss and maintenance in individuals with severe obesity. Further research is warranted to refine cognitive-behavioral interventions for personalized obesity management strategies.