Virtual reality interventions in obesity and eating disorders: a systematic review of biomarker, clinical, and behavioral outcomes

Obesity and eating disorders (EDs) are major public health challenges associated with high morbidity and mortality. This systematic review evaluated the effects of immersive virtual reality (VR) interventions on clinical outcomes and biomarker-domain outcomes in obesity and EDs. Following PRISMA 2020 guidelines, PubMed, Web of Science, and PsycINFO were searched through to April 2025. Eligible studies included immersive VR interventions targeting obesity or EDs and reporting at least one biomarker-domain outcome (anthropometric, physiological/autonomic, endocrine/metabolic, or neurocognitive/eye-tracking). Risk of bias was assessed using Joanna Briggs Institute tools. When at least three RCTs reported comparable outcomes, random-effects meta-analyses were performed. Twenty-three studies met the inclusion criteria (11 obesity, 12 EDs). ED studies included anorexia nervosa, bulimia nervosa, and binge-eating disorder. In obesity, VR-enhanced cognitive-behavioral therapy (VR-CBT) was associated with weight-loss maintenance, while VR-based exercise interventions were associated with short-term reductions in BMI and body weight. A meta-analysis of four RCTs showed a significant pooled effect of VR compared with control on anthropometric outcomes (Hedges' g = - 0.35, 95% CI [-0.61, - 0.09], p = .009; I² = 0%), with a numerically larger effect for VR-CBT. In EDs, VR-CBT was associated with reductions in body image disturbance and fear of weight gain, while VR cue-exposure therapy was linked to decreases in binge and purge frequency. Eye-tracking measures indicated attentional biases toward disorder-relevant cues, and autonomic and endocrine markers suggested VR's ability to elicit measurable psychophysiological responses. Overall, immersive VR interventions show promising but still preliminary effects across anthropometric, neurocognitive, and selected psychophysiological outcomes in obesity and EDs. Conclusions are constrained by small samples, heterogeneity within the interventions and outcome definitions, and a limited randomized evidence base (particularly in EDs). Larger biomarker-integrated trials with standardized measurement protocols and longer follow-up are needed to confirm efficacy and clarify mechanisms.