Body image and risk of exercise addiction in adults: A systematic review and meta-analysis.

Background and aims: Exercise addiction in adults is increasingly recognized as a public health concern, carrying potentially harmful physical, psychological, and social consequences. Body image-encompassing cognitive, behavioral, affective, and perceptual elements-may be a key factor in this risk, yet comprehensive evidence remains scarce. This systematic review and meta-analysis aimed to (1) evaluate the overall relationship between multidimensional body image and the risk of exercise addiction in adults, and (2) identify key moderators (e.g., different elements of body image, gender, region).

Methods: A systematic search was conducted in PsycINFO, Medline, SPORT Discus, Web of Science, and Embase up to October 22, 2024. A three-level meta-analysis model was employed, and univariate and multivariate meta-regressions were used to explore potential moderating factors.

Results: A total of 38 eligible studies were identified, contributing 65 effect sizes. The meta-analysis revealed a moderate correlation (r = 0.26) between body image and risk of exercise addiction in adults. Moreover, the cognitive component of body image and the use of compulsive exercise measures in addiction assessments emerged as unique moderators, each further strengthening the observed relationship.

Discussion and conclusions: These findings underscore the central role of body image-particularly its cognitive dimension-in shaping the risk of exercise addiction in adults, especially when assessed via compulsive exercise measures. Incorporating these insights into research and practice may guide more effective interventions and improve public health strategies aimed at mitigating harmful exercise behaviors.