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Christensen SM, Varney C, Gupta V, Wenz L, Bays HE. Stress, psychiatric disease, and obesity: An Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) 2022. OBESITY PILLARS (ONLINE) 2022; 4:100041. [PMID: 37990662 PMCID: PMC10662113 DOI: 10.1016/j.obpill.2022.100041] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 10/30/2022] [Indexed: 11/23/2023]
Abstract
Background Previous Obesity Medicine Association (OMA) Clinical Practice Statements (CPS) included topics such as behavior modification, motivational interviewing, and eating disorders, as well as the effect of concomitant medications on weight gain/reduction (i.e., including psychiatric medications). This OMA CPS provides clinicians a more focused overview of stress and psychiatric disease as they relate to obesity. Methods The scientific support for this CPS is based upon published citations, clinical perspectives of OMA authors, and peer review by the Obesity Medicine Association leadership. Results Topics in this CPS include the relationship between psychological stress and obesity, including both acute and chronic stress. Additionally, this CPS describes the neurobiological pathways regarding stress and addiction-like eating behavior and explores the relationship between psychiatric disease and obesity, with an overview of psychiatric medications and their potential effects on weight gain and weight reduction. Conclusions This Obesity Medicine Association (OMA) Clinical Practice Statement (CPS) on stress and psychiatric disease is one of a series of OMA CPSs designed to assist clinicians in the care of patients with the disease of obesity. Knowledge of stress, addiction-like eating behavior, psychiatric disease, and effects of psychiatric medications on body weight may improve the care obesity medicine clinicians provide to their patients with obesity.
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Affiliation(s)
- Sandra M. Christensen
- Integrative Medical Weight Management, 2611 NE 125th St., Suite 100B, Seattle, WA, 98125, USA
| | - Catherine Varney
- University of Virginia School of Medicine, Department of Family Medicine, University of Virginia Bariatric Surgery, PO BOX 800729, Charlottesville, VA, 22908, USA
| | - Vivek Gupta
- 510 N Prospect Suite 301, Redondo Beach, California, 90277, USA
| | - Lori Wenz
- St. Mary's Bariatric and Metabolic Surgery Clinic, 2440 N 11th St, Grand Junction, CO, 81501, USA
- Comprehensive Weight Management, Cayucos, CA, USA
| | - Harold Edward Bays
- Louisville Metabolic and Atherosclerosis Research Center, University of Louisville School of Medicine, 3288 Illinois Avenue, Louisville, KY, 40213, USA
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2
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Fogelman N, Magin Z, Hart R, Sinha R. A Longitudinal Study of Life Trauma, Chronic Stress and Body Mass Index on Weight Gain over a 2-Year Period. Behav Med 2022; 48:162-170. [PMID: 32552603 PMCID: PMC7744435 DOI: 10.1080/08964289.2020.1780192] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The United States is facing an alarming and increasing obesity epidemic. Stress is associated with obesity, but specific longitudinal effects of life trauma on weight gain have not been assessed. Here we examined if life trauma and chronic stress predicted weight gain while also measuring the impact of body mass index (BMI). Life trauma and chronic stress were assessed with the Cumulative Adversity Interview (CAI). Weight and BMI were captured repeatedly over a two-year period. Results show significant increases in weight gain over time. Individuals with obesity (IOb) reported significantly higher levels of life trauma at the onset compared to overweight (IOw) and lean individuals (Il). Greater numbers of trauma events were associated with increased weight gain for both IOb and IOw but not for Il. Increased chronic stress was not consistently associated with weight gain over time. Current findings suggest the need to address trauma coping, especially in vulnerable individuals to prevent greater weight gain and curb obesity-related health outcomes.
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Affiliation(s)
- Nia Fogelman
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Zachary Magin
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rachel Hart
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Rajita Sinha
- Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut, USA
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Delker E, AlYami B, Gallo LC, Ruiz JM, Szklo M, Allison MA. Chronic Stress Burden, Visceral Adipose Tissue, and Adiposity-Related Inflammation: The Multi-Ethnic Study of Atherosclerosis. Psychosom Med 2021; 83:834-842. [PMID: 34292207 PMCID: PMC8490301 DOI: 10.1097/psy.0000000000000983] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We investigated the role of chronic stress burden on adiposity and adiposity-related inflammation with two hypotheses: a) greater chronic stress is associated with higher central adiposity and selective accumulation of visceral adipose tissue (VAT) compared with subcutaneous adipose tissue (SAT), and b) associations between VAT and inflammatory biomarkers are exacerbated when chronic stress is high. METHODS Data come from 1809 participants included in a Multi-Ethnic Study of Atherosclerosis ancillary study of body composition and adiposity-related inflammation. Chronic psychosocial stress was measured with a five-item version of the Chronic Stress Burden Scale. First, we tested associations between chronic stress (three-level categorical variable) and VAT, SAT, and VAT/SAT ratio. Second, we tested whether associations between VAT and inflammatory biomarkers varied by level of chronic stress. RESULTS Participants were approximately 65 years, 50% female, and 40.5% White, 25.6% Hispanic, 21.2% African American, and 12.8% Chinese American. About half of the sample reported little to no stress, and a quarter and a fifth of the sample reported medium and high levels of stress. Higher levels of chronic stress were associated with greater VAT and SAT, but not VAT/SAT ratio. Greater levels of VAT were associated with increased levels of adiposity-related inflammation in a graded pattern. These associations did not vary by stress level. CONCLUSIONS Greater chronic stress burden is associated with both central and subcutaneous adiposity. We found no evidence that the associations between VAT and inflammatory biomarkers are exacerbated by chronic stress. Findings contribute to ongoing literature untangling pathways in which psychosocial stress contributes to adiposity-related inflammation.
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Affiliation(s)
- Erin Delker
- From the Joint Doctoral Program in Epidemiology, San Diego State University and University of California San Diego (Delker), San Diego; School of Medicine (AlYami), University of California San Diego; Department of Psychology (Gallo), San Diego State University, San Diego, California; Department of Psychology (Ruiz), University of Arizona, Tucson, Arizona; Department of Epidemiology (Szklo), Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; and Family Medicine and Public Health (Allison), University of California San Diego, San Diego, California
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Çatli G, Acar S, Cingöz G, Rasulova K, Yarim AK, Uzun H, Küme T, Kızıldağ S, Dündar BN, Abacı A. Oxytocin receptor gene polymorphism and low serum oxytocin level are associated with hyperphagia and obesity in adolescents. Int J Obes (Lond) 2021; 45:2064-2073. [PMID: 34091593 DOI: 10.1038/s41366-021-00876-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 05/12/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND/OBJECTIVES In recent years, oxytocin (OXT) and polymorphisms in the oxytocin receptor (OXTR) gene have been reported to play roles in obesity pathogenesis. However, there was no study evaluating OXTR gene variants in childhood obesity. The aim of the study was to investigate the relation of OXTR gene polymorphisms and serum OXT levels with metabolic and anthropometric parameters in obese and healthy adolescents. SUBJECTS/METHODS The study was a multi-centered case-control study, which was conducted on obese and healthy adolescents aged between 12 and 17 years. Serum OXT and leptin levels were measured, and OXTR gene variants were studied by qPCR (rs53576) and RFLP (rs2254298) methods. RESULTS A total of 250 obese and 250 healthy adolescents were included in this study. In the obese group, serum OXT level was lower and leptin level was higher than the control group. In the obese group, frequencies of homozygous mutant (G/G) and heterozygous (A/G) genotypes for rs53576 polymorphism were higher than the control group. Homozygous mutant(G/G) and heterozygous (A/G) genotypes for rs53576 polymorphism were found to increase the risk of obesity compared to the wild type (A/A) genotype [OR = 6.05 and OR = 3.06; p < 0.001, respectively]. In patients with homozygous mutant (G/G) and heterozygous (A/G) genotype for rs53576 polymorphism, serum OXT levels were lower than the wild type (A/A) genotype. In the obese group, hyperphagia score was higher than the control group and correlated negatively with serum OXT level. CONCLUSIONS This study revealed that low serum OXT level, which is associated with hyperphagia may be an underlying cause for obesity in adolescents. For rs53576 polymorphism of the OXTR gene, obesity risk is higher in patients with homozygous mutant(G/G) and heterozygous(A/G)genotypes.
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Affiliation(s)
- Gönül Çatli
- Department of Pediatric Endocrinology, Izmir KatipÇelebi University, Faculty of Medicine, İzmir, Turkey.
| | - Sezer Acar
- Department of Pediatric Endocrinology, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Gülten Cingöz
- Department of Pediatrics, Sağlik Bilimleri University, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Khayala Rasulova
- Department of Medical Biology and Genetics, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Ayça Kanat Yarim
- Department of Medical Biology and Genetics, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Hamide Uzun
- Department of Nutrition and Dietetics, Sağlik Bilimleri University, Tepecik Training and Research Hospital, İzmir, Turkey
| | - Tuncay Küme
- Department of Biochemistry, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Sefa Kızıldağ
- Department of Medical Biology and Genetics, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
| | - Bumin Nuri Dündar
- Department of Pediatric Endocrinology, Izmir KatipÇelebi University, Faculty of Medicine, İzmir, Turkey
| | - Ayhan Abacı
- Department of Pediatric Endocrinology, Dokuz Eylül University, Faculty of Medicine, İzmir, Turkey
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Tsegaye A, Bjørne J, Winther A, Kökönyei G, Cserjési R, Logemann HA. Attentional bias and disengagement as a function of Body Mass Index in conditions that differ in anticipated reward. J Behav Addict 2020; 9:818-825. [PMID: 33006956 PMCID: PMC8943657 DOI: 10.1556/2006.2020.00073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/03/2020] [Accepted: 09/17/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIMS Previous studies suggest that attentional bias and disengagement may vary as a function of Body Mass Index (BMI), most notably in a palatable food related context. Though this could indeed represent a food context specific effect, it could also represent a general reward related context effect. In addition, though mindfulness and stress have both been reported to affect attention, it is not yet clear whether these moderate the relationship between BMI and attention as a function of reward context. In the current study we addressed these questions. It was hypothesized that BMI would be positively associated with bias in a food context and money context relative to a neutral context. The inverse was expected for disengagement. It was expected that mindfulness would decrease these relationships and for stress the inverse was expected. METHODS In the current online study, eighty-seven participants (24 males and 63 females; age: M = 30.1, SD = 8.3; BMI: M = 24.2, SD = 4.67), filled out questionnaires and completed a visuospatial cueing task measuring attention and disengagement of attention in a neutral, food-related, and money-related condition. RESULTS There was no association between BMI and attentional bias. Higher BMI was associated with faster responses to money pictures presented opposite to a cued location as compared to money pictures that did not follow a predictive cue. Our results do not support a clear moderating role of mindfulness and stress. DISCUSSION AND CONCLUSION Our results imply faster processing and associated quicker responding to unanticipated reward-related stimuli in individuals with overweight or obesity.
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Affiliation(s)
- Afework Tsegaye
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | | | - Anita Winther
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Gyöngyi Kökönyei
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,SE-NAP2 Genetic Brain Imaging Migraine Research Group, Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary,Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - Renáta Cserjési
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - H.N. Alexander Logemann
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary,Corresponding author. E-mail:
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Sanchis-Soler G, Tortosa-Martínez J, Manchado-Lopez C, Cortell-Tormo JM. The effects of stress on cardiovascular disease and Alzheimer's disease: Physical exercise as a counteract measure. INTERNATIONAL REVIEW OF NEUROBIOLOGY 2020; 152:157-193. [PMID: 32450995 DOI: 10.1016/bs.irn.2020.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
AD is a complicated multi-systemic neurological disorder that involves different biological pathways. Several risk factors have been identified, including chronic stress. Chronic stress produces an alteration in the activity of the hypothalamic pituitary adrenal (HPA) system, and the autonomic nervous system (ANS), which over time increase the risk of AD and also the incidence of cardiovascular disease (CVD) and risk factors, such as hypertension, obesity and type 2 diabetes, associated with cognitive impairment and AD. Considering the multi-factorial etiology of AD, understanding the complex interrelationships between different risk factors is of potential interest for designing adequate strategies for preventing, delaying the onset or slowing down the progression of this devastating disease. Thus, in this review we will explore the general mechanisms and evidence linking stress, cardiovascular disease and AD, and discuss the potential benefits of physical activity for AD by counteracting the negative effects of chronic stress, CVD and risk factors.
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Simos DS, Kokkinos A, Tentolouris N, Dimosthenopoulos C, Mantzou E, Artemiadis A, Bacopoulou F, Nicolaides NC, Kosta O, Chrousos GP, Darviri C. Pythagorean self-awareness intervention: A novel cognitive stress management technique for body weight control. Eur J Clin Invest 2019; 49:e13164. [PMID: 31421060 DOI: 10.1111/eci.13164] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/11/2019] [Accepted: 08/15/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Over the past decades, the prevalence of obesity has markedly increased worldwide. Stress is recognized as a substantial contributor to increased body weight; therefore, stress management interventions, especially cognitive behavioural, are becoming increasingly popular. The impact of stress management on stress- and obesity-related biomarkers (eg blood lipid profile, HBA1c, inflammatory biomarkers, such as CRP) has been scarcely studied. The aim of this study was to assess the effect of a novel cognitive behavioural stress management intervention, called 'Pythagorean Self-Awareness Intervention' (PSAI), in overweight/obese adults. MATERIALS AND METHODS This was a two-armed 1:1 randomized, nonblind controlled study including overweight/obese individuals. The control group followed a personalized Mediterranean low-calorie diet, and the intervention group followed the same diet in addition to the PSAI intervention for 8 weeks. Measurements included demographic, anthropometric (ie BMI, waist-to-hip ratio), stress (ie perceived stress, salivary cortisol), dietary behaviour (ie emotional eating) and metabolic parameters (ie blood lipid profile, HBA1c, CRP, body composition in fat and water). Outcome per-protocol analysis was performed using mixed linear models adjusted for age and gender. RESULTS A total of 49 of 62 eligible adults were analysed in the study (there were three dropouts in the intervention group and 10 dropouts in the control group); 28 were assigned to the intervention group (mean age 54.7 ± 11.9 years) and 21 to the control group (mean age 51.8 ± 11.9 years). The intervention group showed a statistically significant decrease in perceived stress, cortisol concentrations 30 minutes after awakening, cortisol's area under the curve, BMI, waist-to-hip ratio, restrained, emotional and external eating behaviour, fasting glucose, LDL, triglycerides, HbA1c and body and trunk fat, compared with the control group. Based on the observed effect sizes, clinically meaningful changes may be more evident in stress perception, restrained and external eating behaviour, Hb1ac and trunk fat. The compliance to the PSAI intervention reached 100%, and there were no adverse effects. CONCLUSIONS The PSAI technique may be an effective stress management method for overweight/obese adults. Future and larger randomized controlled studies are needed to allow generalization of these findings.
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Affiliation(s)
- Dimitrios S Simos
- Postgraduate Course Stress Management and Health Promotion, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandros Kokkinos
- First Department of Propaedeutic Internal Medicine, Medical School, Diabetes Center, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Tentolouris
- First Department of Propaedeutic Internal Medicine, Medical School, Diabetes Center, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Emily Mantzou
- Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Artemios Artemiadis
- Postgraduate Course Stress Management and Health Promotion, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Medical School, University of Cyprus, Nicosia, Cyprus
| | - Flora Bacopoulou
- First Department of Pediatrics, Medical School, Center for Adolescent Medicine and UNESCO Chair on Adolescent Health Care, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nicolas C Nicolaides
- Postgraduate Course Stress Management and Health Promotion, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Division of Endocrinology and Metabolism, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Ourania Kosta
- First Department of Propaedeutic Internal Medicine, Medical School, Diabetes Center, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George P Chrousos
- Postgraduate Course Stress Management and Health Promotion, Medical School, National and Kapodistrian University of Athens, Athens, Greece.,Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, Medical School, Aghia Sophia Children's Hospital, National and Kapodistrian University of Athens, Athens, Greece.,Division of Endocrinology and Metabolism, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Christina Darviri
- Postgraduate Course Stress Management and Health Promotion, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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Steward T, Juaneda-Seguí A, Mestre-Bach G, Martínez-Zalacaín I, Vilarrasa N, Jiménez-Murcia S, Fernández-Formoso JA, Veciana de Las Heras M, Custal N, Virgili N, Lopez-Urdiales R, García-Ruiz-de-Gordejuela A, Menchón JM, Soriano-Mas C, Fernandez-Aranda F. What Difference Does it Make? Risk-Taking Behavior in Obesity after a Loss is Associated with Decreased Ventromedial Prefrontal Cortex Activity. J Clin Med 2019; 8:jcm8101551. [PMID: 31569607 PMCID: PMC6832276 DOI: 10.3390/jcm8101551] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 12/11/2022] Open
Abstract
Altered activity in decision-making neural circuitry may underlie the maladaptive food choices found in obesity. Here, we aimed to identify the brain regions purportedly underpinning risk-taking behavior in individuals with obesity. Twenty-three adult women with obesity and twenty-three healthy weight controls completed the Risky Gains Task during functional magnetic resonance imaging (fMRI). This task allows participants to choose between a safe option for a small, guaranteed monetary reward and risky options with larger rewards. fMRI analyses comparing losing trials to winning trials found that participants with obesity presented decreased activity in the left anterior insula in comparison to controls (p < 0.05, AlphaSim corrected). Moreover, left insula activation during losses vs. wins was negatively correlated with UPPS-P questionnaire sensation seeking scores. During safe vs. risky trials following a loss, the control group exhibited increased activation in the ventromedial prefrontal cortex (vmPFC) (p < 0.05, AlphaSim corrected) in comparison to the OB group. Moreover, vmPFC response in the obesity group during post-loss trials was negatively correlated with risky choices on the task overall. As a whole, our findings support that diminished tuning of the insula towards interoceptive signals may lead to a lack of input to the vmPFC when weighing the costs and benefits of risky choices.
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Affiliation(s)
- Trevor Steward
- School of Psychological Sciences, University of Melbourne, Parkville, Victoria 3010, Australia.
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Asier Juaneda-Seguí
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
- Ciber Salud Mental (CIBERSAM), Instituto Salud Carlos III, Feixa Llarga s/n, 08907 Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Gemma Mestre-Bach
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Feixa Llarga s/n, 08907 Barcelona, Spain.
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Ignacio Martínez-Zalacaín
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Nuria Vilarrasa
- Department of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Susana Jiménez-Murcia
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Feixa Llarga s/n, 08907 Barcelona, Spain.
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Jose A Fernández-Formoso
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Feixa Llarga s/n, 08907 Barcelona, Spain.
| | | | - Nuria Custal
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Nuria Virgili
- Department of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
- CIBERDEM-CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Instituto de Salud Carlos III, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Rafael Lopez-Urdiales
- Department of Endocrinology and Nutrition, University Hospital of Bellvitge-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Amador García-Ruiz-de-Gordejuela
- Bariatric and Metabolic Surgery Unit, Service of General and Gastrointestinal Surgery, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - José M Menchón
- School of Psychological Sciences, University of Melbourne, Parkville, Victoria 3010, Australia.
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
- Ciber Salud Mental (CIBERSAM), Instituto Salud Carlos III, Feixa Llarga s/n, 08907 Barcelona, Spain.
| | - Carles Soriano-Mas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
- Ciber Salud Mental (CIBERSAM), Instituto Salud Carlos III, Feixa Llarga s/n, 08907 Barcelona, Spain.
- Departament of Psychobiology and Methodology in Health Sciences. Universitat Autònoma de Barcelona, 08193 Barcelona, Spain.
| | - Fernando Fernandez-Aranda
- Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto Salud Carlos III, Feixa Llarga s/n, 08907 Barcelona, Spain.
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
- Department of Clinical Sciences, School of Medicine, University of Barcelona, C/Feixa Llarga s/n, 08907 Barcelona, Spain.
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