Virtual body image exercises for people with obesity – results on eating behavior and body perception of the ViTraS pilot study

Background: A negative body image can have an impact on developing and maintaining obesity. Using virtual reality (VR) to conduct cognitive behavioral therapy (CBT) is an innovative approach to treat people with obesity. This multicenter non-randomized pilot study examined the feasibility and the effect on eating behavior and body perception of a newly developed VR system to conduct body image exercises. Methods: Participants with a body mass index (BMI) ≥ 30.0 kg/m² without severe mental diseases attended three study visits in an interval of one to four weeks to receive virtual (VR intervention) or traditional (non-VR intervention) body image exercises. Data on anthropometrics, eating behavior (Dutch Eating Behavior Questionnaire, DEBQ), body perception (Body Shape Questionnaire, BSQ; Multidimensional Assessment of Interoceptive Awareness, MAIA), and satisfaction (standardized interview and questionnaire) were collected. Results: In total, 66 participants (VR intervention: 31, non-VR intervention: 35) were included. The majority was female (52/66, 78.8 %), the mean age was 45.0 ± 12.8 years, and the mean BMI was 36.8 ± 4.3 kg/m². Both intervention groups showed non-significant body weight reduction (VR intervention: 1.7 ± 3.3 %, non-VR intervention: 0.9 ± 3.0 %) and showed no statistically significant difference between the groups (p = 0.35). Scores of DEBQ, BSQ, and MAIA showed over time no statistically significant changes neither between the two groups nor within the groups (all p ≥ 0.05). The overall satisfaction of the VR group with the two virtual body image exercises was high (4.1 ± 0.8 on a 5-point Likert scale). Conclusions: The intervention with the developed VR system was feasible and the virtual and traditional body image exercises resulted in statistically non-significant weight loss. It seems that single focus on body image is not successful in improving eating behavior and body perception in people with obesity. Long-term human intervention studies with larger sample sizes are necessary to examine the efficacy of integrating this kind of VR system into standard obesity therapy. Trial registration: This study was registered in the German Clinical Trials Register (Registration number: DRKS00027906, Date of registration: 8^th February 2022).