Change in self-esteem after weight-loss treatment. Alexithymia as a psychological mechanism

BACKGROUND: Self-esteem often changes during weight-loss treatment, and these fluctuations play a crucial role in shaping patients' adherence and clinical outcomes. Understanding the psychological factors that predict self-esteem trajectories during treatment-as-usual programs is therefore essential. AIM: This longitudinal study investigated whether weight change, alexithymia and its facets, psychological distress, and binge-eating disorder predicted self-esteem after a 9-month clinical weight-loss program. METHODS: A consecutive sample of 155 adults with overweight or obesity completed assessments at baseline (T0) and at 9-month follow-up (T1) during standard non-pharmacological weight-loss treatment. Baseline measures included self-esteem (RSES), alexithymia (TAS-20), perceived stress (PSS), depressive symptoms (SDS), and binge-eating symptoms (BES). Percentage of total weight loss (%TWL) was calculated at T1. Hierarchical multiple regression models examined longitudinal predictors of self-esteem at follow-up, controlling for baseline self-esteem. RESULTS: Difficulty Describing Feelings (DDF) was the only one among the three TAS-20 facets that significantly predicted self-esteem at the 9-month follow-up, showing a negative association independent of weight change and other psychological factors. Percentage of total weight loss (%TWL) and diagnosis of binge eating disorder (BED) were also associated with self-esteem, whereas psychological distress did not show independent effects. DISCUSSION: DDF emerged as the main factor shaping the changes in self-esteem during weight-loss treatment. This suggests that the ability to articulate emotional experiences plays a central role in supporting positive self-evaluations over time. Enhancing patients' ability to describe emotions could help to consolidate gains in self-esteem.