The association between anhedonia and obesity: A systematic review

Anhedonia, conceptualized here as a multidimensional transdiagnostic construct encompassing deficits in both hedonic experience (''liking'') and motivational reward processing (''wanting''), is frequently reported in individuals with obesity; however, the nature of this relationship remains incompletely characterized. This systematic review synthesizes clinical evidence on the association between anhedonia and obesity, with an emphasis on behavioral, metabolic, and genetic mechanisms.

Following PRISMA guidelines, we systematically searched PubMed, Ovid (MEDLINE and APA PsycInfo), Web of Science and ProQuest from inception to April 22, 2025. Studies were eligible if they included adults over the age of 18 with overweight or obesity and reported associations between anhedonia and obesity-related parameters. Risk of bias was assessed using ROBINS-E for observational studies, RoB-2 for randomized trials, and STROBE-MR principles for Mendelian randomization (MR) analyses. Anhedonia measures included validated multidimensional scales, clinician-administered interviews, behavioral reward paradigms, and genetic proxies reflecting reduced interest or pleasure.

Eight studies met inclusion criteria. Across observational studies, elevated anhedonia was associated with higher BMI, emotional eating, reduced motivation, and poorer adherence to lifestyle interventions in longitudinal cohorts, independent of depressive symptoms. One randomized trial found that individuals with anhedonia exhibited more disordered eating patterns and attenuated weight-loss outcomes over 12 months. Genetic evidence supported shared biological pathways: MR analyses supported a potential directional effect of higher genetically proxied BMI on anhedonia, and FTO polymorphisms were associated with hedonic impairments.

The evidence base was small and heterogeneous, and most studies were observational, limiting causal inference and generalizability. In addition, studies that measured both anhedonia and obesity-related variables but did not explicitly report their association were excluded based on te prespecified eligibility criteria, which may have narrowed the evidence base.

Anhedonia is a significant correlate of obesity and may contribute to maladaptive eating, reduced treatment adherence, and metabolic dysfunction. Incorporating anhedonia screening into obesity interventions and targeting reward-processing deficits may improve clinical outcomes.