The behavioral pathway model to overweight and obesity: coping strategies, eating behaviors and body mass index

Perceived Weight Discrimination and General Coping Strategies

BACKGROUND

Perceived weight discrimination is associated consistently with worse health outcomes. Coping strategies may be one mechanism of this association. The present research examined the association between perceived weight discrimination and strategies used to cope with general stress (not weight-specific) and whether these strategies accounted for part of the association with markers of health.

METHOD

Participants (N = 1882) completed a cross-sectional survey with a comprehensive measure of coping strategies and reported on their perceived experience of weight discrimination and markers of physical, mental, and social health.

RESULTS

Perceived weight discrimination was associated with greater use of disengaged coping strategies (β = .19, p < .01) and was unrelated to active and support coping strategies. Disengaged coping mediated the association between weight discrimination and worse physical, mental, and social health (proportion of mediation ranged from 14 to 47%). This pathway was independent of body mass index (BMI). Individuals in the obesity weight category (BMI ≥ 30 kg/m2) were less likely to use active (β =  - .11, p < .01) and support (β =  - .09, p < .01) coping strategies, which did not consistently mediate the association with health.

CONCLUSION

Perceived experiences of weight discrimination are associated with disengaged coping strategies to manage stressful experiences, and these strategies are one mechanism that may contribute to the worse health associated with unfair treatment due to weight.

Is problematic use of the Internet and smartphone predictor of unhealthy eating behaviors and abnormal body weight in Turkish young adults?

With technological progress, the use of the internet and smartphones has become an inseparable part of our lives and their use is increasing. The uncontrolled use of both the internet and smartphones is defined as problematic use. This study examined the effects of problematic internet and smartphone use on dietary behaviors and abnormal body weight status in young adults. Participants were 560 university students. Participants completed measures of demographics, dietary behaviors, internet and smartphone usage habits, Young's Internet Addiction Test and Smartphone Addiction Scale. Negative associations were found between dietary behaviors and problematic internet and smartphone use. Significant inverse associations were also found between these uses and recommended consumption levels of several food groups. For a healthy future generation, it is recommended that policies be developed to prevent or manage these problematic uses, especially in young adults with negative dietary behaviors and abnormal body weight.

Family cohesion and intuitive eating in Chinese college students: A serial mediation model

Improving intuitive eating can effectively prevent emotional eating, restrained eating, and overeating, and help improve people's physical and mental health. Based on the acceptance model of intuitive eating, ecological systems theory, family stress model, and transactional model of stress and coping, the present study aimed to explore the relationship between family cohesion and intuitive eating and its underlying mechanisms through a cross-sectional study design. A random sample of 702 college students from 29 provinces in China, aged from 18 to 26 years (54.56% male, M age = 21.12 years), voluntarily participated in the survey. Demographic variables, family cohesion, intuitive eating, perceived stress, and coping style were measured. The results indicated that family cohesion was significantly positively correlated with intuitive eating and the direct effect between them was significant. Meanwhile, there was a significant indirect effect of family cohesion on intuitive eating through perceived stress and positive coping styles. Moreover, perceived stress and positive coping styles, rather than negative coping styles, acted as serial mediators in the association between family cohesion and intuitive eating. The findings shed light on the prevention and intervention for disordered eating and obesity and provided a new theoretical perspective for the mental health education of college students. In addition, implications and directions for future research were also discussed.

Emotional eating among adults with healthy weight, overweight and obesity: a systematic review and meta-analysis

BACKGROUND

Emotional eating (EE) is a disordered eating behaviour which may lead to overeating. It is not clear whether EE presents to an equal degree among adults, regardless of their body mass index (BMI) status. The aim of this study was to assess whether there is a difference in degree of EE between adults with healthy weight, overweight and obesity.

METHODS

MEDLINE and APA PsycINFO databases were searched from inception up to January 2022 for studies that reported EE scores from validated questionnaires. The quality of all included studies was assessed using the AXIS tool. Meta-analysis used random effects and standardised mean difference (SMD). Heterogeneity was investigated using I2 statistics and sensitivity analyses.

RESULTS

A total of 11 studies with 7207 participants were included in the meta-analysis. Degree of EE was greater in adults with a BMI above the healthy range, compared to adults with a healthy BMI (SMD 0.31, 95% CI 0.17 to 0.45; I2  = 85%). However, subgroup analysis found that degree of EE was greater only in adults with obesity (SMD 0.61, 95% CI 0.41 to 0.81; I2  = 62%), and there was no difference in degree of EE between adults with overweight and those with a healthy BMI.

CONCLUSIONS

Degree of EE is greater among adults living with obesity, compared to adults with a healthy BMI, indicating a need for behavioural support to support EE among people living with obesity seeking weight management. Future research should examine the long-term effectiveness of interventions for EE.

Effects of Metabolic Syndrome and Sex on Stress Coping Strategies in Individuals with Depressive Disorder

Metabolic syndrome (MetS) is related to depression and contributes to reduced life expectancy in individuals with mental disorders. Stress coping strategies are important factors in the development and maintenance of depressive disorders and have been related to metabolic disturbances. The aim of this study was to determine whether there is a difference in the use of positive (re- and devaluation, distraction, and control) and negative stress coping strategies in relation to patients' MetS. A sample of 363 individuals (n female = 204, n male = 159) with a diagnosis of depression was measured with the Stress Coping Style Questionnaire and the Beck Depression Inventory. In addition, we collected data on MetS (waist circumference, triglycerides, high-density lipoprotein, fasting glucose/diabetes, blood pressure/hypertonia) according to the International Diabetes Federation. A 2 × 2 design including Mets (with vs. without) and sex (female vs. male) was performed to test for differences in stress coping strategies. Individuals with depression and MetS scored higher on distraction strategies than depressed individuals without MetS (p < 0.01, corrected with false discovery rate). In addition, we found sex differences in stress coping strategies indicating that women with depression scored higher on distraction strategies (p < 0.001, FDR corrected), as well as negative strategies (p < 0.001, FDR corrected), than men. No significant interaction between MetS and sex was found regarding the higher value of stress coping strategies. Findings suggest that individuals with depression and MetS used distraction strategies to a higher amount to cope with stress, which could be stress eating in some cases, than those without MetS. Women with depressive disorders had higher values than men on other coping strategies in our sample of individuals with depression. A better understanding of MetS and sex-specific differences in stress coping strategies might help to plan more effective preventive strategies and personalized treatment options for depression.

The Association of Emotional Eating with Overweight/Obesity, Depression, Anxiety/Stress, and Dietary Patterns: A Review of the Current Clinical Evidence

(1) Background: Emotional eating is considered as the propensity to eat in response to emotions. It is considered as a critical risk factor for recurrent weight gain. Such overeating is able to affect general health due to excess energy intake and mental health. So far, there is still considerable controversy on the effect of the emotional eating concept. The objective of this study is to summarize and evaluate the interconnections among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns; (2) Methods: This is a thorough review of the reported associations among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns. We compressively searched the most precise scientific online databases, e.g., PubMed, Scopus, Web of Science and Google Scholar to obtain the most up-to-date data from clinical studies in humans from the last ten years (2013-2023) using critical and representative keywords. Several inclusion and exclusion criteria were applied for scrutinizing only longitudinal, cross-sectional, descriptive, and prospective clinical studies in Caucasian populations; (3) Results: The currently available findings suggest that overeating/obesity and unhealthy eating behaviors (e.g., fast food consumption) are associated with emotional eating. Moreover, the increase in depressive symptoms seems to be related with more emotional eating. Psychological distress is also related with a greater risk for emotional eating. However, the most common limitations are the small sample size and their lack of diversity. In addition, a cross-sectional study was performed in the majority of them; (4) Conclusions: Finding coping mechanisms for the negative emotions and nutrition education can prevent the prevalence of emotional eating. Future studies should further explain the underlying mechanisms of the interconnections among emotional eating and overweight/obesity, depression, anxiety/stress, and dietary patterns.

The relationship between food and cooking skills, and eating behaviors in people with overweight or obesity

BACKGROUND

In the present study, the authors aimed to determine food skills and cooking skills, and eating behaviors, and to evaluate the relationship between food skills and cooking skills, and eating behaviors in people with overweight or obesity.

METHODS

This cross-sectional study was conducted with 185 people with overweight or obesity. The researchers collected the study data using the face-to-face interview method through a questionnaire including the Descriptive Information Form, Cooking Skills and Food Skills Scale, and Three-Factor Eating Questionnaire-R21. Numbers, percentages, arithmetic mean, standard deviation, Student's t-test, Pearson Chi-Square test, and multiple linear regression analysis were used in the analysis of the data.

RESULTS

The mean scores of the individuals obtained from the overall Cooking Skills and Food Skills Scale, and cooking skills, food skills, uncontrolled eating, cognitive restraint, and emotional eating sub-dimensions were 148.17 ± 52.20, 70.45 ± 27.48, 77.84 ± 28.90, 43.90 ± 22.74, 36.95 ± 23.93, and 38.94 ± 29.17 respectively. Multiple linear regression was fitted to determine the association between food skills and cooking skills and eating behaviors while adjusting for sociodemographic and health-related characteristics. Food skills and cooking skills were positively associated with uncontrolled eating (β = 0.213, p = 0.030), cognitive restraint (β = 0.245, p = 0.009), and emotional eating behaviors (β = 0.338, p = 0.001).

CONCLUSION

In people with overweight or obesity, cognitive restraint and emotional eating behaviors improve as their food preparation and cooking skills improve. Therefore, education and public health practices on eating awareness, food skills, and cooking skills can play an important role in bringing healthy behavior change into practice in society.

Coping and resilience levels of bariatric surgery candidates and affecting factors

PURPOSE

This study aimed to evaluate coping and resilience levels and affecting factors in candidates for bariatric surgery.

DESIGN AND METHODS

This was a descriptive study. Data were collected with Personal Information Form, Connor-Davidson Resilience Scale, and Ways of Coping Inventory.

FINDINGS

This study was completed with 138 bariatric surgery candidates with a mean age of 35.70 ± 10.76. Candidates used problem-focused coping, and their resilience level was moderate.

PRACTICE IMPLICATIONS

Psychiatric nurses can develop training and counseling programs for the bariatric surgery candidates to enhance problem-focused coping and psychological resilience. These programs can apply routinely throughout the preoperative period and the postoperative period.

Infertility-related stress and quality of life among infertile women with polycystic ovary syndrome: Does body mass index matter?

OBJECTIVE

Infertility and obesity are common among women with Polycystic ovary syndrome (PCOS) and related to poor quality of life (QoL). Obesity may confer an elevated adverse effect of infertility-related stress given its relationship with increased susceptibility to stress. This study aimed to investigate the association of infertility-related stress with QoL among infertile women with PCOS, and to evaluate whether body mass index (BMI) modifies this association.

METHODS

A cross-sectional study was conducted with 306 participants recruited from the infertility outpatient clinic. A self-administered, structured questionnaire including COMPI Fertility Problem Stress Scale (COMPI-FPSS) and the modified PCOS health-related QoL questionnaire (MPCOSQ) was conducted in this study. The moderation model was conducted by the PROCESS macro using SPSS.

RESULTS

The mean score of QoL was 142.67 (SD = 20.11), ranged from 93 to 183 (theoretical range = 30-210). QoL was negatively associated with infertility-related stress (r = -0.373, P < 0.001). Moderation analysis indicated that the interaction term between infertility-related stress and BMI significantly predicted QoL (β = -0.154, P = 0.005, f² = 0.03) as well as emotional disturbance (β = -0.170, P = 0.002, f² = 0.04). Specifically, higher BMI significantly exacerbated the effect of infertility-related stress on QoL and emotional disturbance.

CONCLUSION

Infertile women with PCOS experienced poor QoL. The moderation role of BMI provides a better understanding of individual difference in relationship between infertility-related stress and QoL. Interventions aiming to improve QoL among infertile women with PCOS should focus on alleviating infertility-related stress, especially among women with high BMI.

Correlation between Eating Behavior and Use of Social Media with Energy-Dense Food Intake Based on Gender among Students in Semarang, Indonesia

BACKGROUND: Eating behavior and the use of social media are believed to affect the intake of energy-dense foods. This study aimed to determine the relationship between eating behavior and use of social media with energy-dense food intake in students by gender. METHODS: This study used a cross-sectional method. The subjects were 123 peoples from one of university in Semarang, Indonesia aged 18-24 years, taken using the consecutive sampling method. Energy-dense food intake was taken using the Semi-Quantitative Food Frequency Questionnaire, eating behavior was using the Dutch Eating Behavior Questionnaire and social media use was using the Scale of Effects of Social Media on Eating Behavior and self-identity questionnaire. Data were analyzed using Pearson's test, Spearman's rank test, and multiple linear regression. RESULTS: The intake of energy-dense foods was higher in men than women. This study showed that there was a relationship between emotional eating (p = 0.001; r = 0.408), external eating (p = 0.008; r = 0.338), and eating behavior due to social media (p = 0.001; r = 0.415) and energy-dense food intake. in women, and duration of social media use (p = 0.003; r = 0.377) with energy-dense food intake in men. Gender and eating behavior due to social media had an effect of 24.9% on energy-dense food intake. CONCLUSION: In women, emotional eating, external eating, and eating behavior due to social media were related to the intake of energy-dense foods. In men, the duration of social media use was related to the intake of energy-dense foods. Gender and eating behavior due to social media were the most influential variables on energy-dense food intake.

eNAMPT actions through nucleus accumbens NAD+/SIRT1 link increased adiposity with sociability deficits programmed by peripuberty stress

Obesity is frequently associated with impairments in the social domain, and stress at puberty can lead to long-lasting changes in visceral fat deposition and in social behaviors. However, whether stress-induced changes in adipose tissue can affect fat-to-brain signaling, thereby orchestrating behavioral changes, remains unknown. We found that peripubertally stressed male-but not female-mice exhibit concomitant increased adiposity and sociability deficits. We show that reduced levels of the adipokine nicotinamide phosphoribosyltransferase (NAMPT) in fat and its extracellular form eNAMPT in blood contribute to lifelong reductions in sociability induced by peripubertal stress. By using a series of adipose tissue and brain region-specific loss- and gain-of-function approaches, we implicate impaired nicotinamide adenine dinucleotide (NAD+)/SIRT1 pathway in the nucleus accumbens. Impairments in sociability and accumbal neuronal excitability are prevented by normalization of eNAMPT levels or treatment with nicotinamide mononucleotide (NMN), a NAD+-boosting compound. We propose NAD+ boosters to treat social deficits of early life stress origin.

Investigating the Association between Unhealthy Dietary Habits and Obesity among Libyan Adults

BACKGROUND

Although an increasing number of studies have reported on nutrition transition and unhealthy eating habits (UEHs) worldwide, there is a paucity of studies on UEHs in the Arab region, particularly in Libya. Aim: This study investigated the associations between obesity among Libyan adults and UEHs. Methods: A cross-sectional survey was conducted at the five major districts in Benghazi, Libya. A multistage cluster sampling strategy was implemented to choose and recruit Libyan adults. Anthropometric measurements were gathered by highly qualified nurses, using the Segmental Body Composition Monitor and a portable Stadiometer. The study used and adapted the two Self-administered questionnaires: the WHO STEPS Instrument and eating behaviors linked with obesity questionnaire. Results: Among a total of 401 participants who were successfully recruited in this study, 253 (63%) were female (aged 20-65 years), the response rate achieved was 78%. The prevalence of obesity amongst Libyan adults was estimated to be 42.4%. The results revealed the presence of a significant association between obesity (BMI ≥ 30 kg/m2) and five UEHs for Libyan men and six UEHs for Libyan women. For Libyan men, an association was found between obesity and the following five explanatory factors: fast food intake in a day and a week, which were (OR: 2.52, 95% CI: 4.04-12.32) and (OR: 4.65, 95% CI: 1.04-9.46), respectively; large food portion sizes consumed at one sitting (OR: 19.54, 95% CI: 1.41-27.74); a high frequency of skipping breakfast either in a typical day or a week, which were (OR: 0.02, 95% CI: 0.01-0.77) and (OR: 0.03, 95% CI: 0.01-0.24), respectively. For Libyan women, a significant association was found between obesity and the following six explanatory factors: fast food intake in a day and a week, which were (OR: 2.14, 95% CI: 3.32-11.12) and (OR: 5.5, 95% CI: 1.88-16.11), respectively; intake of sugar-sweetened beverages in a typical week (OR: 4.02, 95% CI: 1.35-11.99); and large food portion sizes consumed at one sitting at one sitting (OR: 3.40, 95% CI: 1.18-9.84); and a high frequency of skipping breakfast either in a typical day or a week, which were (OR: 0.11, 95% CI: 0.03-0.43) and (OR: 0.12, 95% CI: 0.08-0.63), respectively. Conclusions: The findings of the study reveal areas of action for Libyan researchers, clinicians, policymakers, and government officials about UEHs in the Libyan context. This could inform establishing and developing new interventions for preventing and controlling the obesity epidemic through food system improvements.

Are Peripheral Biomarkers Determinants of Eating Styles in Childhood and Adolescence Obesity? A Cross-Sectional Study

Disturbances in eating behaviors have been widely related to obesity. However, little is known about the role of obesity-related biomarkers in shaping habitual patterns of eating behaviors (i.e., eating styles) in childhood. The objective of the present study was to explore the relationships between several biomarkers crucially involved in obesity (ghrelin, insulin resistance, and leptin/adiponectin ratio) and eating styles in children and adolescents with obesity. Seventy participants aged between 8 and 16 (56.2% men) fulfilled the Spanish version of the Dutch Eating Behavior Questionnaire for Children to measure external, emotional, and restrained eating styles. In addition, concentrations of ghrelin, leptin, adiponectin, insulin, and glucose were obtained through a blood test. Hierarchical multiple regression analyses controlling for age and sex were computed for each eating style. Results indicated that individuals with higher ghrelin concentration levels showed lower scores in restrained eating (β = -0.61, p < 0.001). The total model explained 32% of the variance of the restrained pattern. No other relationships between obesity-related biomarkers and eating behaviors were found. This study highlights that one of the obesity-risk factors, namely lower plasma ghrelin levels, is substantially involved in a well-known maladaptive eating style, restraint eating, in childhood obesity.

"Better If They Laugh with Me than at Me": The Role of Humor in Coping with Obesity-Related Stigma in Women

This study investigated the role of perceived stigmatization in the relationship between humor styles and coping with stress among young women suffering from stigma due to obesity. In the 21st century, obesity is an increasing global health issue with many physical and mental consequences for obese women. As a chronic stigmatizing disease, it requires that the affected individuals cope with social consequences; women with obesity are more prone to such consequences than men. Humor fosters the breaking of stereotypes and alleviating the consequences of stigmatization. A total of 127 young adult women (age M = 25.74, SD = 2.73) participated in the study (n = 54 with overfat and n = 73 with healthy fat). Participants filled out the Humor Styles Questionnaire, Perceived Stigmatization Questionnaire, and the Brief COPE Scale. Anthropometric data were gathered using a body composition analyzer. Results indicate that, when perceiving hostile behaviors toward themselves and using humor as a coping strategy, women with overfat select maladaptive styles of humor (i.e., self-defeating and aggressive styles). Women with overfat were also more likely to use humor as a coping strategy in difficult situations. Furthermore, none of the participants were satisfied with their body mass. At the same time, among women without obesity, a lack of compliments was not treated as a problem, even if they had high body fat.

Multidisciplinary lifestyle modification program (IM-FIT) for cancer survivors: implementation of a reimbursable model in a cancer hospital

PURPOSE

We examined the initial effects of a real-world application of a multimodal, reimbursable program to improve lifestyle and promote healthy weight loss in cancer survivors as part of their care.

METHODS

The lifestyle program (Integrative Medicine Fitness Program; IM-FIT) focusing on increasing physical activity and strength training, improving nutrition, and facilitating stress management and behavior change was delivered in a group format over 12 weeks. Patients met weekly with a physical therapist, dietitian, and psychologist. Body composition and behavioral data were collected at the start and end of 12 weeks, as well as fitness, nutrition, and psychological data. The first cohort started in September 2017, and the last cohort ended in August 2019.

RESULTS

Twenty-six patients (92% female; mean age = 62.7, SD = 9) completed the program, which was pre-approved and covered as in-network by their health insurance. Patients lost an average of 3.9% of their body weight (SD =  - 2.2). There was a significant reduction in white bread and desserts and increase in legumes and non-dairy milk. Time spent in vigorous exercise (p < .001), strength training (p < .001), and total exercise (p < .001) significantly increased. Patients reported reduction in depression (7.76 to 4.29; p = .01), anxiety (6.14 to 3.29; p < .01), and overall distress (4.70 to 3.40; p < .01).

CONCLUSION

We demonstrated that a multi-disciplinary weight loss program can be tailored to cancer survivors leading to weight reduction and improvements in lifestyle factors and mental health. This program showed successful real-world implementation with insurance reimbursement.

Emotional eating across different eating disorders and the role of body mass, restriction, and binge eating

OBJECTIVE

Different subtypes of eating disorders (ED) show dysfunctional eating behaviors such as overeating and/or restriction in response to emotions. Yet, systematic comparisons of all major EDs on emotional eating patterns are lacking. Furthermore, emotional eating correlates with body mass index (BMI), which also differs between EDs and thus confounds this comparison.

METHOD

Interview-diagnosed female ED patients (n = 204) with restrictive (AN-R) or binge-purge anorexia nervosa (AN-BP), bulimia nervosa (BN), or binge-eating disorder (BED) completed a questionnaire assessing "negative emotional eating" (sadness, anger, anxiety) and "happiness eating." ED groups were compared to BMI-matched healthy controls (HCs; n = 172 ranging from underweight to obesity) to exclude BMI as a confound.

RESULTS

Within HCs, higher BMI was associated with higher negative emotional eating and lower happiness eating. AN-R reported the lowest degree of negative emotional eating relative to other EDs and BMI-matched HCs, and the highest degree of happiness eating relative to other EDs. The BN and BED groups showed higher negative emotional eating compared to BMI-matched HCs. Patients with AN-BP occupied an intermediate position between AN-R and BN/BED and reported less happiness eating compared to BMI-matched HCs.

DISCUSSION

Negative emotional and happiness eating patterns differ across EDs. BMI-independent emotional eating patterns distinguish ED subgroups and might be related to the occurrence of binge eating versus restriction. Hence, different types of emotional eating can represent fruitful targets for tailored psychotherapeutic interventions. While BN and BED might be treated with similar approaches, AN-BP and AN-R would need specific treatment modules.

Affective Temperament is Associated with Stress Coping Strategies and Work Stress Perception Among Polish Bank Employees

Background

Stress in the banking workplace is associated with psychological and health problems. Intensity of work-related stress experiences is associated with specificity of job stress factors personal features such as affective temperament. The aim of the study was to evaluate associations between affective temperament, coping stress strategies, and perceived job stress in bank employees.

Methods

Subjects were 209 bank workers aged 22–55 years (n = 101 managers and 108 non-managers). Affective temperament and stress coping strategies were evaluated using the Temperament Evaluation of Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) and Coping Inventory for Stressful Situations (CISS), respectively. Both questionnaires, TEMPS-A and CISS, show good internal consistency and are proper research methods in the bank employee group. Perceived job-related stress was rated for different sources of job stress common among bank workers.

Results

Depressive temperament was negatively associated with coping style focused on avoidance, and with job stress regarding “responsibility for decisions regarding other people” and “frequent trips.” Irritable temperament was positively correlated with coping style focused on task and job stress regarding “frequent trips.” Cyclothymic temperament was positively correlated with job stress regarding “direct work with money” and “organizational conditions of work.” Multidimensional linear regression showed that irritable and anxious temperaments were associated with coping style focused on task; depressive temperament was associated with coping style focused on avoidance; and cyclothymic temperament was associated with intensity of job stress. The results obtained indicate different levels of job-related stress associated with different sources in bank employees, working with managers and non-managers positions. Affective temperament was associated with stress coping strategies and intensity of perceived job stress. On the basis of affective temperament dimensions it is possible to predict stress coping styles and work-related stress perception in bank employees.

Conclusion

Affective temperament traits measured by TEMPS-A were associated with stress coping strategies and intensity of work stress perception in Polish bank employees.