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Using virtual reality (VR) to conduct cognitive behavioral therapy (CBT) is an innovative approach to treat people with obesity. This multicenter non-randomized pilot study examined the feasibility and the effect on eating behavior and body perception of a newly developed VR system to conduct body image exercises.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Participants with a body mass index (BMI)\u2009\u2265\u200930.0\u00a0kg\/m<jats:sup>2<\/jats:sup> without severe mental diseases attended three study visits in an interval of one to four weeks to receive virtual (VR intervention) or traditional (non-VR intervention) body image exercises. Data on anthropometrics, eating behavior (Dutch Eating Behavior Questionnaire, DEBQ), body perception (Body Shape Questionnaire, BSQ; Multidimensional Assessment of Interoceptive Awareness, MAIA), and satisfaction (standardized interview and questionnaire) were collected.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>In total, 66 participants (VR intervention: 31, non-VR intervention: 35) were included. The majority was female (52\/66, 78.8 %), the mean age was 45.0\u2009\u00b1\u200912.8\u00a0years, and the mean BMI was 36.8\u2009\u00b1\u20094.3\u00a0kg\/m<jats:sup>2<\/jats:sup>. Both intervention groups showed non-significant body weight reduction (VR intervention: 1.7\u2009\u00b1\u20093.3 %, non-VR intervention: 0.9\u2009\u00b1\u20093.0 %) and showed no statistically significant difference between the groups (<jats:italic>p<\/jats:italic>\u2009=\u20090.35). Scores of DEBQ, BSQ, and MAIA showed over time no statistically significant changes neither between the two groups nor within the groups (all <jats:italic>p<\/jats:italic>\u2009\u2265\u20090.05). The overall satisfaction of the VR group with the two virtual body image exercises was high (4.1\u2009\u00b1\u20090.8 on a 5-point Likert scale).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>The intervention with the developed VR system was feasible and the virtual and traditional body image exercises resulted in statistically non-significant weight loss. It seems that single focus on body image is not successful in improving eating behavior and body perception in people with obesity. Long-term human intervention studies with larger sample sizes are necessary to examine the efficacy of integrating this kind of VR system into standard obesity therapy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Trial registration<\/jats:title>\n            <jats:p>This study was registered in the German Clinical Trials Register (Registration number: DRKS00027906, Date of registration: 8<jats:sup>th<\/jats:sup> February 2022).<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12911-025-02993-x","type":"journal-article","created":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T10:26:52Z","timestamp":1745576812000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Virtual body image exercises for people with obesity \u2013 results on eating behavior and body perception of the ViTraS pilot study"],"prefix":"10.1186","volume":"25","author":[{"given":"Kathrin","family":"Gemesi","sequence":"first","affiliation":[]},{"given":"Nina","family":"D\u00f6llinger","sequence":"additional","affiliation":[]},{"given":"Natascha-Alexandra","family":"Weinberger","sequence":"additional","affiliation":[]},{"given":"Erik","family":"Wolf","sequence":"additional","affiliation":[]},{"given":"David","family":"Mal","sequence":"additional","affiliation":[]},{"given":"Sebastian","family":"Keppler","sequence":"additional","affiliation":[]},{"given":"Stephan","family":"Wenninger","sequence":"additional","affiliation":[]},{"given":"Emily","family":"Bader","sequence":"additional","affiliation":[]},{"given":"Carolin","family":"Wienrich","sequence":"additional","affiliation":[]},{"given":"Claudia","family":"Luck-Sikorski","sequence":"additional","affiliation":[]},{"given":"Marc Erich","family":"Latoschik","sequence":"additional","affiliation":[]},{"given":"Johann Habakuk","family":"Israel","sequence":"additional","affiliation":[]},{"given":"Mario","family":"Botsch","sequence":"additional","affiliation":[]},{"given":"Christina","family":"Holzapfel","sequence":"additional","affiliation":[]}],"member":"297","published-online":{"date-parts":[[2025,4,25]]},"reference":[{"key":"2993_CR1","unstructured":"Kluge HHP. 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[PMID: 38578667]. https:\/\/doi.org\/10.2196\/51558.","journal-title":"J Med Internet Res."}],"container-title":["BMC Medical Informatics and Decision Making"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-025-02993-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12911-025-02993-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12911-025-02993-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,25]],"date-time":"2025-04-25T10:26:57Z","timestamp":1745576817000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmedinformdecismak.biomedcentral.com\/articles\/10.1186\/s12911-025-02993-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,25]]},"references-count":45,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["2993"],"URL":"https:\/\/doi.org\/10.1186\/s12911-025-02993-x","relation":{},"ISSN":["1472-6947"],"issn-type":[{"value":"1472-6947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,25]]},"assertion":[{"value":"15 March 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 April 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study protocol has been approved by the ethics committee of the Institute for Human-Computer-Media of the Faculty of Human Sciences at the University of W\u00fcrzburg (8th November 2021), of the University Hospital in Jena (2021-2484-BO), and of the School of Medicine and Health at the Technical University of Munich (90\/22 S). The study is registered in the German Register of Clinical Studies (Registration number: DRKS00027906). All study participants gave written informed consent prior to participation.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"KG, ND, NAW, EW, DM, SK, SW, EB, CW, CLS, MEL, JHI, and MB declare that they have no conflict of interest. CH is a member of the scientific advisory board of the 4sigma GmbH (Oberhaching, Germany) and received speaker\u00b4s honorary from Novo Nordisk Pharma GmbH.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"176"}}