S2337 Illness Perception and Weight Loss Adherence in MASLD: A Retrospective Cohort Study With Psychological Profiling

Introduction: MASLD (Metabolic dysfunction-associated steatotic liver disease) is the most common chronic liver condition globally, yet adherence to lifestyle changes remains low despite strong evidence that sustained weight loss improves outcomes. While clinical factors are routinely considered in management, psychological drivers, such as illness perception, health-related anxiety, and behavioral self-efficacy, are underexplored. This study aimed to evaluate whether these psychological factors are associated with successful weight loss adherence in patients with MASLD. Methods: We conducted a retrospective cohort study of adults with radiologically or biopsy-confirmed MASLD seen at the outpatient departments of Bahrain government hospitals between January and December 2024. Inclusion criteria were BMI ≥30 and completion of standardized psychological assessments: the Brief Illness Perception Questionnaire (B-IPQ), Generalized Anxiety Disorder-7 scale (GAD-7), and Weight Efficacy Lifestyle Questionnaire (WEL). Patients on weight loss medications, including GLP-1 receptor agonists, were excluded. Patients were stratified into adherent (≥5% weight loss) and non-adherent (<5%) groups. Multivariate logistic regression identified independent psychological predictors of adherence, adjusting for age, sex, diabetes, and alanine aminotransferase. Results: A total of 268 patients met the inclusion criteria. The cohort had a mean age of 46.7 ± 10.9 years; 53% were woman and 64% had type 2 diabetes. At 12 months, 29.1% (n = 78) achieved ≥5% weight loss. Higher illness perception scores (B-IPQ ≥6) were independently associated with adherence (aOR 2.41; P < 0.001), as were higher self-efficacy scores (WEL, aOR 1.92; P = 0.01). A U-shaped relationship emerged between anxiety and adherence: moderate GAD-7 scores (5–9) showed highest adherence (42%), while both low (<5) and high (≥15) scores were associated with lower adherence (25% and 18%). Patients perceiving MASLD as non-serious were less likely to lose weight, while those concerned about liver progression were more engaged in lifestyle changes. Conclusion: Psychological factors, especially illness perception and moderate health-related anxiety, significantly influence adherence to weight loss in MASLD. Routine assessment of patient beliefs and behavioral readiness may help tailor interventions and improve outcomes in this increasingly prevalent disease.