A Timely Update: An Umbrella Review and Meta-Meta-Analysis of Psychotherapy for Non-Underweight Eating Disorders

This umbrella review and meta-analysis synthesized recent evidence on the efficacy of psychotherapy for adults with non-underweight eating disorders (EDs).

PsycINFO, Scopus, PubMed, and ProQuest Dissertations and Theses Global were searched for meta-analyses of randomized controlled trials comparing psychotherapy to treatment as usual (TAU) or control conditions in non-underweight adults with EDs (published January 2020-September 2025). Standardized mean differences (SMDs) for ED psychopathology and objective binge episode (OBE) frequency were pooled using second-order random-effects models. Subgroup analyses examined specific diagnoses and delivery format. Quality was assessed with the A MeaSurement Tool to Assess systematic Review (AMSTAR 2). Data were synthesized with Covidence and analyzed using R.

Ten meta-analyses (71 RCTs) were included. Most participants were female, White, and diagnosed with bulimia nervosa or binge eating disorder. Psychotherapy yielded significant medium-to-large improvements in ED psychopathology (SMD = 0.74, 95% CI: 0.67-0.82, Q _p  = 0.79, I ² = 0.0% [95% CI: 0.0%- 56.6%]) and OBE frequency (SMD = 0.64, 95% CI: 0.52-0.77, Q _p  = 0.40, I ² = 4.5% [95% CI: 0.0%- 66.4%]) relative to TAU/control, with low heterogeneity. Effects were comparable across sub-group analyses. Nine of 10 meta-analyses were rated as critically low regarding confidence in results, as per the AMSTAR 2.

Psychotherapy is efficacious for non-underweight adults with eating disorders, including when delivered using program-led focused interventions. The use of the AMSTAR-2 tool is encouraged to guide high-quality, transparent reporting of future meta-analyses in our field.