. 2022 Apr 25;8(6):691–714. doi: 10.1002/osp4.605

TABLE 1.

Data extraction

First Author setting discipline	Participants	Design and positive wellbeing outcomes	Positive wellbeing measures	Results	Comment
Acmaz, G. (2013) Turkey Medicine	N = 133 women (n = 47 control; n = 86 with polycystic ovary syndrome (PCOS) sub‐groups: n = 35 Hirsutism‐acne (HA), n = 22 infertility and, n = 26 obesity Age: Control 27.8 (SD 6.5), HA 26.1 years (SD 5.0), infertility 24.3 years (SD 5.0), obesity 26.0 years (SD 6.58) Mean BMI: Control 23.4 kg/m² (SD 3.1), HA 24.5 kg/m² (SD 2.8), infertility 24.4 kg/m²(SD 3.5), obesity 33.6 kg/m² (SD 2.6) Recruited from a polyclinic and control from unknown group	Design: Cross‐sectional survey comparing aspects of health in groups of women grouped by PCOS symptoms and women with no illness. Outcomes: Self‐esteem, vitality Attrition: N/A	Rosenberg self‐esteem scale (RSES) SF‐36: vitality	Women with PCOS and obesity rated their self‐esteem lower than other women with PCOS only and the control group (p < 0.001). All women with PCOS had lower vitality compared to the control group (p < 0.001).	Women with PCOS, regardless of their sub‐group reported lower vitality when compared with a healthy control group. Women with PCOS and obesity were more likely to rate their self‐esteem low compared to others with PCOS only or controls.
Ahmed, H. (2018) Iraq Medicine	N = 40 women Age: 25–35 years Mean BMI: 43 kg/m² (range 40–50 kg/m²) Recruited from surgical candidates having sleeve gastrectomy	Design: Prospective longitudinal with 12‐month follow‐up Outcomes: Elements of QOL Attrition: none	QOL five‐point Likert scale: Self‐esteem, happiness, time with friends	All QOL measures were improved at 12‐month follow‐up including: Self‐esteem, spending time with friends, and feeling happy (p = 0.034).	One year after sleeve gastrectomy and subsequent weight loss, women reported improved self‐esteem, feeling happy and spending time with friends.
Ahmed, H. (2019) Iraq Medicine	N = 80 women Age: 20–39 years Mean BMI: 36 kg/m² (range 31–39.9 kg/m²) Recruited from a private hospital and private clinic	Design: Non‐randomized descriptive longitudinal study with 6‐month treatment of either n = 40 Atkins diet or n = 40 gastric balloon. 12‐month follow‐up Outcomes: Elements of QOL Attrition: None	QOL five‐point Likert scale: Self‐esteem happiness, time with friends	All participants reported feeling happier, improved self‐esteem, spending time with friends. The gastric balloon group lost more weight than the Atkins diet group (p < 0.001) had greater improvements in feeling happy p = 0.005, improved self‐esteem p = 0.059 and spending more time with friends, p = 0.02.	PPWB measures including happiness, self‐esteem, and spending time with friends improved significantly in all women who lost weight with either gastric balloon insertion or Atkins. However, the gastric balloon group lost more weight than the Atkins group and had greater improvements in PPWB measurements.
Bacon, L. (2005) USA Nutrition	N = 78 women Age: 30–45 years Mean BMI: Health at Every size (HAES) group 35.9 kg/m^{2 (}SD 4.6), Mean BMI: Diet group 36.7 kg/m² (SD 4.2) Recruited from community	Design: RCT* HAES versus diet program; treatment included 24, 90‐min, weekly sessions plus 6 monthly optional sessions. 2‐year follow‐up Outcomes: Self‐esteem Attrition: HAES 10/39 Diet group 16/39	RSES	HAES group: Increased self‐esteem (p < 0.001). Diet group: Decreased self‐esteem (p = 0.028)	With no significant weight loss in either group, women in the HAES group improved self‐esteem while the diet groups self‐esteem worsened.
Ball, K. (2004) Australia Exercise and Nutrition	N = 7865 women (n = 519 with obesity) who completed 1996 survey. Age: 18–23 years BMI: ≥ 30 kg/m² Recruited from urban and rural communities	Design: Cross‐sectional survey from the Women's health Australia longitudinal study. 1996 survey data. Outcomes: Life satisfaction Attrition: N/A	Life satisfaction survey: Achievements in work/career/study; family relationships; partner/close relationships; friendships; social activities.	Women with obesity reported less satisfaction in work/career/study (Odds Ratio (OR) = 0.79, confidence interval (CI) 0.66‐0.94), family relationships (OR = 0.82, CI 0.68‐0.98), partner relationships (OR = 0.55, CI 0.46‐0.65), and social activities (OR = 0.69, CI 0.58‐0.83), relative to women in the healthy weight group. There was no difference in satisfaction with friendships (OR = 1.0, CI 0.83‐1.19).	Women with obesity reported lower life satisfaction scores in work/career/study, family and partner relationships, and social activities when compared to women in healthy weight category. Friendships did not differ.
Berman, M. (2016) USA Psychiatric medicine	N = 21 women, with major depressive disorder Age: 23–66 years Mean BMI: 37 kg/m² (range 31–50 kg/m²) Recruited from community	Design: Longitudinal study with a pre‐ post‐treatment and 3‐month follow‐up; 11 weekly 2‐h group sessions of self‐acceptance‐based treatment (participants broken up into 2 groups, n = 11 and n = 10). Outcomes: Well‐being, body image acceptance Attrition: 3/21	Obesity related well‐being (ORWELL‐97), body image acceptance and Action questionnaire (BIAAQ)	Self‐acceptance intervention improved: Obesity‐related well‐being (p < 0.001) and body image acceptance (p < 0.001) post‐treatment. Improvements were maintained at 3‐month follow‐up.	A self‐acceptance‐based treatment, accept Yourself, improved well‐being in women with obesity and major depressive disorder.
Böckerman P. (2014) Finland Economics/Applied science and mental health	N = 2245 (women = 1134 with obesity = unknown) Age: 30–54 years BMI ≥30 kg/m² Recruited from health 2000 survey of Finish people	Design: Cross‐sectional survey of subjective well‐being (SWB) with full time working people outcomes: SWB Attrition: N/A	Single SWB question with a 11‐point Likert sale: “All things considered how satisfied have you been with your life as a whole during the past 30 days?”	Obesity was associated with a decrease in subjective well‐being (p < 0.05) and this association disappeared when health status and functional capacity were added to the model.	Lower SWB was associated with obesity yet when health and functional capacity were considered this association disappeared.
Bookwala, J. (2008) USA Psychology	N = 3251 (women = 1588 with obesity = 373) Age: 25‐74 BMI: ≥30 kg/m² Recruited from the national survey of Midlife development in the USA (MIDUS I)	Design: Cross‐sectional survey of sex differences BMI and PWB Outcomes: Measured six domains of well‐being and combined them for a single composite measure Attrition: N/A	Ryff's scale. (Positive relations with others, self‐acceptance, autonomy, personal growth, mastery, and purpose in life)	Having a higher BMI was associated with lower psychological well‐being in women (p < 0.001) but not men p = 0.906.	Women classified as obese had lower psychological well‐being when compared to women in the normal weight category. Men psychological well‐being did not differ significantly between BMI groups.
Borkoles, E. (2016) England Psychology/Exercise Physiology	N = 62 women (non‐dieting lifestyle intervention n = 31, waitlist control n = 31) Age: 24–55 years BMI: >35.0 kg/m² Recruited from community	Design: RCT* examining 12‐week non‐dieting lifestyle intervention followed by 40‐week maintenance phase versus waitlist control; 1‐year follow‐up Outcomes: General well‐being, self‐perception, self‐esteem Attrition: 15/31 intervention, 15/31 wait‐list control	General well‐being Schedule (GWB), self‐perception profile (SPP) measure of self‐esteem	Significant improvement in well‐being (29.9%, p < 0.001), and self‐perceptions (no data).	A non‐dieting lifestyle intervention improved well‐being and self‐perceptions from baseline to end of treatment, and over the 40‐week follow‐up
Brown, W.J. (2000) Australia Human Movement/Gender and Health/Psychology/Population Health	N = 14,762 women (n = 742 with obesity who completed 1996 surveys) Age: 18–23 years BMI: >30 kg/m² Recruited from urban and rural communities	Design: Cross‐sectional survey from the Womens health Australia longitudinal study. 1996 survey data Outcomes: Mental wellbeing. Attrition: N/A	SF‐36: vitality	Women classified as overweight and obesity reported lower vitality when compared to women classified as normal or underweight. (p < 0.05).	Young Australian women with obesity reported lower vitality than peers classified as normal or underweight.
Burns, D. (2021) USA Nursing	N = 87 women with obesity Age: 30–44 years BMI: ≥30 kg/m² Recruited from Facebook groups targeted 30–44‐year‐old Latino women	Design: Cross‐sectional survey examining associations between self‐esteem, body dissatisfaction and the effect on internalized weight stigma (IWS). Outcomes: Self‐esteem Attrition: N/A	RSES	When self‐esteem decreased by one unit (4‐point scale), body dissatisfaction increased by 0.270 (7‐point scale) (p < 0.001).Both self‐esteem (p < 0.001) and body dissatisfaction (p < 0.008) predicted IWS.	Lower self‐esteem is associated with a higher body dissatisfaction in Latino women with obesity. Self‐esteem and body dissatisfaction were predictors of IWS.
Crerand, C. (2007) USA Medicine/Psychology	N = 123 women (diet intervention n = 84, non‐dieting program n = 39) Mean age: 44.3 years diet intervention, 43.9 years non‐dieting program Mean BMI: 36.2 kg/m² diet intervention, 35.5 kg/m² non‐dieting group Recruited from community	Design: RCT* Meal replacement or balanced deficit diet (LEARN program for weight control), versus non‐dieting program (Self‐Esteem Comes in all Sizes), with weekly meetings for the first 20 weeks lead by psychologist and RD) and biweekly for the following 20 weeks. Outcomes: Self‐esteem Attrition: Not reported	RSES	There was an improvement in all participants' self‐esteem (p < 0.001) with no significant differences between groups at either the 20‐ or 40‐week follow‐up.	There was overall improvement in self‐esteem. Group assignment did not influence improvement.
Godoy‐Izquierdo, D. (2020) Spain Psychology	N = 100 (60 women, with 69 classified as overweight and 31 with obesity) Age: 19–57 years Mean BMI: Overweight 26.6 kg/m² obese 33.5 kg/m² Recruited from two primary care medical setting.	Design: Cross‐sectional survey Outcomes: Positivity and SWB (reported with happiness scale) Attrition: N/A	8‐Item positivity scale Single happiness question with a 11‐point Likert scale: “How happy are you at the present?”	No differences in positivity scores between overweight or obese participants. Obese individuals had significantly lower happiness scores (p = 0.014). BMI did not predict happiness after body satisfaction (p = 0.12 and positivity (p = 0.000) were considered. Self‐stigma explained variance in happiness (p < 0.001) but not when positivity included in model.	Women and men with obesity had significantly lower happiness scores compared to people who were overweigh. However, individuals with obesity who had higher positivity traits and higher body satisfaction were more likely to be happy. Authors suggest that positivity may supress the effects of self stigma.
Groh, C. (2015) USA Nursing	N = 106 African American women Age: 19–64 years Mean BMI: 41.2 kg/m² (8.3) Recruited from a nurse managed center for underinsured and primary care clinic for uninsured in large urban center	Design: Longitudinal study. Repeat measures intervention (24‐week) 12 weeks of exercise, educational sessions, scripture reading followed by 12 weeks with no intervention. 12 & 24‐week follow‐up Outcomes: Subscales of SF‐36: Vitality Attrition: 51/106	SF‐36v2: vitality	Improvements from base line to 24 weeks were found in vitality (p < 0.001) after interventions.	Improvement in vitality after the 12‐week program. Gains declined 12 weeks post‐intervention, yet improvements remained significant.
Hill, A.J. (1998) England Psychiatry	N = 179 women Age: 18–75 years BMI: >30.0 kg/m² Recruited from subscribers to a magazine for women size 16+	Design: Cross‐sectional survey with women divided into three obesity categories assessing predictors of psychological distress Outcomes: Self‐esteem Attrition: N/A	RSES with added questions on social life	Self‐ esteem decreased as weight increased (p < 0.001). Lower self‐esteem (p < 0.001) and peer relationships (p < 0.01) scores predicted lower mental health inventory scores regardless of weight category.	Self‐esteem decreased as weight increased. Yet, BMI alone did not predict mental health scores; low self‐esteem and social relationships predicted lower mental health scores.
Jorm, A. (2003) Australia Medicine/Psychology	N = 6919 (n = 574 women and n = 492 men with obesity) Age: Groups: 20–24 years n = 2280, 40–44 years n = 2334, 60–64 years n = 2305 BMI: >30.0 kg/m² Recruitment from a random sample of participants from a longitudinal community study (PATH through life Project).	Design: Cross‐sectional survey of three age groups and four weight categories (under weight, acceptable, overweight, & obese). Outcomes: positive affect measures. Attrition: N/A	PANAS	Women with obesity had lower positive affect (p < 0.001). However, when physical health, vigorous activity, negative support from family, years of education, and financial problems were controlled the association was not significant.	Women with obesity had lower positive affect than women classified as acceptable weight. This association was gone after controlling for negative physical and social factors.
Laferrere, B. (2002) USA Medicine	N = 145 women Mean age: 46.3 ± 11.1 years Mean BMI: 35.2 ± 4.2 kg/m² Recruited from middle class urban community	Design: Cross‐sectional survey of pre and post menopausal African american (AA) n = 80 and white women (W) n = 65. Outcomes: Medical outcomes study Short (MOS‐SF‐36): Survey includes life satisfaction, self‐esteem, vitality, social activity. Attrition: N/A	SWLS RSES SF‐36:Vitality	No difference between AA and W women self‐esteem or life satisfaction. Yet there were differences between pre and post menopausal women pre‐menopause women had less vitality (p = 0.001), life satisfaction (p < 0.01).	No difference in life satisfaction and self‐esteem were found between African american and white women with obesity. Post‐menopausal AA women had more vitality and life satisfaction compared to pre‐menopausal AA women.
Latif, E. (2014) Economics Canada	N = 28,952 (n = 6006 women, n = 5837 with obesity) Mean age: women 46.7 years, men 44 years BMI: Obesity ≥30.0 kg/m² obesity Recruited from the Canadian national Public survey 1994‐2006	Design: Cross‐sectional survey Outcomes: Happiness Attrition: N/A	Single happiness question with 5 ordered choices: So unhappy in life, very unhappy, somewhat unhappy, somewhat happy, and happy in life	Obesity is associated with a reduction in happiness in women between the ages of 25‐54 (p = 0.04). Obesity was not associated with happiness in men. Statistical model controlled for age, marital statis, education, income, urban location, own home, and provinces.	Obesity is associated with reduced happiness in women between the ages of 25‐54. Obesity is not associated with happiness in men.
Mensinger, J. (2016) USA Psychology/Population health	N = 80 women Age: 30–45 years BMI: 30–45 kg/m² Recruited from community	Design: RCT* comparing 6‐month group‐based weight ‐neutral (HUGS program) or weight‐loss interventions with 2‐year follow‐up Outcome: Self‐esteem Attrition: Weight‐loss: 6‐month 7/40 24‐ month 19/40, weight‐neutral: 6‐month 1/40 24‐month 21/40	RSES	Both groups increased self‐esteem (p < 0.001)	Women in both interventions significantly increased their self‐esteem.
Pasco, J. (2013) Australia Medicine/Psychiatry	N = 273 women (n = 68 with obesity) Age: 29‐84 BMI: ≥30 kg/m² Recruited from the Geelong Osteoporosis study from general population	Design: Cross‐sectional survey Outcomes: positive and negative affect Attrition: N/A	PANAS	No association between BMI category and positive affect. Obesity was associated with high negative affect (OR 1.95 CI 0.57‐1.69) and physical illness explained this association.	Women's positive affect was not associated with their BMI category.
Polat, H. (2020) Turkey Nursing	N = 90 women Mean age: 32.98 ± 7.74 years Mean BMI: 40.10 ± 5.14 kg/m² Recruited from a University hospital dietitian department	Design: Cross‐sectional Outcome: Self‐esteem Attrition: N/A	RSEM	Women with obesity had moderate levels of self‐esteem. Self‐esteem was higher in those who were physically active (p < 0.05). Positive association between self‐esteem and sexual quality of life (p < 0.01).	Obese women had moderate levels of self‐esteem. Exercise enhanced self‐esteem. High self esteem was associated with improved sexual quality of life in women with obesity.
Ripsch, J. (2002) USA Social work PhD Thesis	N = 13 women Age: 32–53 years Mean BMI: 37 kg/m² Recruitment from a snowball sampling from a University and community.	Design: Grounded theory Women with obesity who reported positive sense of self on the Orientation to life questionnaire) were interviewed. Outcomes: Theory development on how women maintained a positive sense of self Attrition: none	Orientation to life questionnaire	Participants chose to have a positive sense of self irrespective of their weight. They shared supportive relationships with friends, family and/or mentors, developed skills and competencies, cared for others, and engaged in positive self talk.	Women with obesity attributed their positive sense of self to interpersonal connections, positive self‐talk as well as their skills and abilities.
Rodino, I. (2016) Australia Psychology	N = 403 women (n = 73 with obesity) Age: 34.5 years (SD = 4.8) BMI: >30 kg/m² Recruited from an infertility clinic	Design: Cross‐sectional survey examining wellbeing of women with and without polycystic ovary syndrome Outcomes: positive affect and self‐esteem Attrition: 445/1000 participants returned survey	PANAS RSES	Women with obesity exhibited lower levels of self‐esteem as compared to their normal weight and overweight counterparts (p < 0.001). Higher self‐esteem was associated with a higher positive affect (p < 0.001).	Women with obesity scored lower in self‐esteem. Higher self‐esteem was associated with a higher level of positive affect.
Sarwer, D (2013) USA Medicine/Psychiatry	N = 390 women (n = 311) Mean age: 51.5 (SD = 11.5) BMI: 30.0–50.0 kg/m² Recruited from six primary care practices	Design: RCT* with three arms: usual care, brief lifestyle counseling (BLC) or enhanced LC (ELC). Women were followed for 2 years. Outcomes: Self‐esteem Attrition: 20/130 usual care, 19/130 B LC, 15/129 ELC	Impact of weight on quality of life‐Lite (IWQOL)	A mean population weight loss of 3.7 kg ± 0.4% at 12 months and 3.0 ± 0.4% at 24 months was associated with improved self‐esteem (p < 0.001) in women.	Women's self‐esteem measures improved significantly with modest weight reduction regardless of treatment stream,
Sato, K. (2020) Japan Political science	N = 6359 women and men in China/USA (n = 1380/4979). Number of women with obesity not reported. Mean age: China/USA women 46.1/50.5 years, men 45.5/49.0 years BMI: ≥30 kg/m² Recruited between 2009 and 2013	Design: Cross‐sectional survey subjective well‐being (happiness) Outcome: Happiness Attrition: N/A```	Single happiness question with 11‐point Likert scale: “ overall, how happy would you say you are currently?”	No significant association between obesity and happiness in women overall. Obese men in China were happier (p < 0.001) than obese men in USA.	There was no association with obesity and happiness in women from China and USA.
Smith (2014) USA Nursing	N = 68 women Age: 18–24 years Mean BMI: 35.6 (5.1) kg/m² Recruited from a community healthcare center	Design: Cross‐sectional survey of young women with obesity Outcomes: Self‐esteem Attrition: N/A	RSES	Self‐esteem had a strong inverse association with stress (r = − 0.6, p < 0.001), and loneliness (r = −0.69, p < 0.001). Women who rated their health poor/fair had lower self‐esteem (p = 0.001) compared to those who rated their health good/very good.	Poor self‐esteem was associated with stress, and loneliness in women with obesity. Poor self‐esteem was also associated with personal assessment of poor/fair health.
Toft B. (2020) Denmark Lifestyle Rehabilitation/Nursing	N = 10 (n = 5 women, n = 5 men) Age: 30–69 years BMI: 40–48 kg/m² Recruited from a lifestyle intervention hospital program	Design: Qualitative Hermeneutic. Interviews were conducted 18 months after a 12‐month health promotion intervention by an interdisciplinary team Outcome: Barriers and facilitators of well‐being Attrition: one woman	Well‐being defined by womens descriptions of elevated mood and vitality	Women participants appreciated how the process of vitality gave them the desire and courage to stay committed to healthy living. Vitality came from reducing self‐blame, strengthening confidence and a strong sense of self.	Women found increasing their pride, confidence and self‐acceptance improved their mood and vitality which enabled them to engage in an active everyday life.
Ul‐Haq, Z. (2014) UK Public health	N = 163,066 (54.5% women) n = 39,941 classified obese Age: 30–72 years BMI: > 30.0 kg/m² Recruited form biobank participants	Design: Cross‐sectional Outcomes: Happiness Attrition: N/A	Single happiness question with a 6‐chocies: “In general, how happy are you?”	Women with obesity had greater odds of being unhappy when compared to normal weight women (OR: Obesity Class l ‐ 1.27 (CI 1.16‐1.40 p < 0.001), Class ll‐ 1.41 (CI 1.23‐1.61, p < 0.001), Class lll‐ 2.11 (1.79‐2.49, p < 0.001). There was no association between happiness and obesity when self‐reported health (SRH) was included in the model	Women with obesity reported more unhappiness compared to those of normal weight. When adjusted for self‐reported health, the association between women with obesity and lower ratings of happiness disappeared. Author suggested self‐reported health may be a mediator of happiness.
Unlu, S. (2019) Turkey Nutrition and Dietetics	N = 250 women (80 in each category normal, overweight, and obese) Age: 18–64 years BMI: Obese group ≥30 kg/m² Recruited from a family healthcare center	Design: Cross‐sectional Outcomes: Self‐esteem Attrition: N/A	Self‐esteem Inventory	Women with obesity were 12.19 times more likely to have lower low self‐esteem (p < 0.001). and 91.22 times more likely to have body dissatisfaction (p < 0.001) compared to the normal weight group.	Obesity negatively effects self‐esteem and body satisfaction.
Wadsworth, T. (2014) USA Sociology	N = 1,319,340, n = 82,116 women (33% with obesity), n = 498,224 men (32% with obesity) Mean age: Female 46.78 years, men 44.67 years BMI: Obese class I 30–34.9 kg/m², class II 35–39.9 kg/m², Class III >40 kg/m² Corrected self‐reported weight Recruited from telephone survey across communities in the USA	Design: Cross‐sectional Behavior risk factor Surveillance System (BRFSS) survey data 2005‐2008 Outcome: Life satisfaction Attrition: N/A	Single life satisfaction question with 3 choices: “In general, how satisfied are you with your life?”	Women with class I obesity or class II or III report lower levels of life satisfaction compared to non obese women (OR 0.78, 0.57, p < 0.001). Although men with obesity also report lower levels of satisfaction, women were statistically lower (p = 0.001). Good health, being employed, white, married, and having higher education improve life satisfaction scores for women.	People with obesity report lower life satisfaction and this association is stronger for women than men.
Wee, C. (2014) USA Medicine	N = 337 (women/men with BMI ≥35 n = 230/107) Mean age 48.1 years BMI: ≥35 kg/m² Recruited from four primary care practices in greater Boston	Design: Cross‐sectional interview/survey. Examined how specific QOL domains explained health Utility (overall well‐being) in African american, Caucasian, and Hispanic population. Outcomes: Self‐esteem Attrition: N/A	Impact of weight on quality of life‐lite (IWQOL‐lite)‐subscale self‐esteem	Self‐esteem did not explain diminished well‐being in women with obesity. Social stigma(public distress) and impaired sexual function were associated with lower well‐being (p < 0.05)	Self‐esteem was not associated with well‐being in African american, Caucasian, or Hispanic women with obesity.
van Zutven, K. (2015) Australia Psychology	N = 2734 (women/men classified non‐obese n = 1220/769, obese n = 276/169) Age 20–44 years BMI: Obese ≥30 kg/m² Non‐obese 20–29.9 kg/m² Recruited from 2006 Australian community survey (Food, Drink, lifestyle and wellbeing survey)	Design: Cross‐sectional survey Outcomes: Satisfaction with life Attrition: N/A	SWLS	Women with obesity had lower satisfaction with life scores than non‐obese women (<0.001). This relationship was not significant after considering health, weight and shape concerns and binge eating (p = 0.23).	Women with obesity had lower satisfaction with life than non‐obese participants. However, this association dissipated after considering health, weight/shape concerns, and binge eating.