Severe obesity and personality: a comparative controlled study of personality traits

The role of decision-making and impulsivity in beverage consumption

Soft drink and alcohol consumption have become significant public health issues. This study aimed to explore the mediating role of decision-making processes in the relationship between trait impulsivity and calorie dense beverage consumption. Participants comprised a community sample of 300 adults (aged 19-75). They completed self-report measures assessing impulsivity (SUPPS-P), reward sensitivity (RST-PQ), and participated in decision-making tasks related to risk propensity (BART), short-term strategy preference (IGT), and delay discounting rate. Beverage consumption was calculated using the BEVQ-15. Impulsivity was conceptualised within the framework of the two-factor model as consisting of rash impulsivity and reward sensitivity. Both facets of impulsivity were positively associated with both alcohol and soft drink consumption, and each independently predicted consumption of these beverages. Additionally, there was a significant interaction between rash impulsivity and reward sensitivity on soft drink consumption. Importantly, there were significant indirect effects of both rash impulsivity and reward sensitivity on soft drink consumption via delay discounting. The results support the logic of the two-factor model of impulsivity in the prediction of consumption of unhealthy beverages. Furthermore, the mediating role of delay discounting supports the hypothesis that personality traits can pass through to behaviour via decision-making processes. Further research should extend these findings to other consumption domains in both clinical and non-clinical populations.

Binge Eating Before and After Bariatric Surgery

PURPOSE OF REVIEW

The purpose is to review the state of the literature of binge eating in the context of bariatric surgery including prevalence, conceptualization, assessment, course, and related sequela throughout the perioperative continuum, particularly highlighting new advancements and future directions.

RECENT FINDINGS

Accurate assessment of binge eating in bariatric samples is essential for optimization of patient outcomes. Binge eating is less prevalent after bariatric surgery; however, prevalence rates increase over time. Most studies do not find a relationship between pre-operative binge eating and suboptimal weight outcomes after surgery. Refinement in understanding and conceptualization of post-operative binge eating is needed; new conceptualizations have proposed such a definition. Emerging constructs relevant to binge eating for bariatric patients include food addiction and food insecurity. Despite the introduction of formal diagnostic criteria for binge eating disorder, many uncertainties regarding the prevalence, course, and effects of binge eating currently exist; varied assessment methods continue to be a barrier to research on binge eating in bariatric surgery samples. Consensus on operational definitions for post-operative binge eating and best practices for assessment are areas for future consideration.

Does the socio-demographic profile of patients limit access to bariatric surgery?

PURPOSE

Surgery remains the only treatment allowing for a significant and sustainable weight loss in case of severe obesity. Patients undergo a specific multidisciplinary preparation and selection before the operation. This study aims to correlate the psychosocial profile with the likelihood of undergoing bariatric surgery in patients enrolled in the preparation program of a Swiss reference center.

METHODS

All patients referred to an obesity center between January 1, 2016, and June 30, 2017, seeking a first bariatric procedure were included. Socio-demographic data, BMI, preoperative psychological and dietary evaluations were collected. Usually, the preoperative process lasts 1 year. Patients who left the preparation or who had not undergone surgery after more than 2 years of follow-up were considered withdrawers. Surgery completion predictors were reviewed with bivariate analysis and socio-demographic clusters established using the K-means method.

RESULTS

Out of a total of 221 patients, 99 (45%) patients had not undergone bariatric surgery 2 years after their first consultation. The patients were divided into four distinct socio-demographic clusters, among which a particularly deprived one. Criteria such as unfavorable psychological (p < 0.001) and dietary (p < 0.001) evaluations, and male gender (p < 0.05) were significantly associated with non-operation, unlike socio-demographic indicators and clusters (p > 0.1).

CONCLUSION

Almost half of the patients starting a bariatric program are not operated on, which is related to an unfavorable psychological or dietary evaluation and to the male gender. This study also demonstrates that a significant share of patients combines several factors of social deprivation, without influencing the likelihood of surgery completion.

LEVEL OF EVIDENCE

Level V: Descriptive study.

The role of rash impulsivity and sensitivity to reward in soft drink consumption

Soft drink consumption has become a major public health issue. The present study aimed to examine the role of rash impulsivity and reward sensitivity in soft drink consumption using the two-factor model of impulsivity. Participants were a community sample of 229 adults (19-77 years). They completed self-report measures of impulsivity (SUPPS-P), reward sensitivity (RST-PQ) and beverage consumption (BEVQ-15). A principal component analysis was used to produce purer measures of rash impulsivity and reward sensitivity. Both rash impulsivity and reward sensitivity were positively associated with soft drink consumption, and each independently predicted soft drink consumption. Importantly, there was a significant interaction between the two, whereby rash impulsivity moderated the effect of reward sensitivity on soft drink consumption. The results support the logic of the two-factor model of impulsivity in the prediction of soft drink consumption. Further research should extend these findings to other consumption domains in both clinical and non-clinical populations.

Obese Subjects without Eating Disorders Experience Binge Episodes Also Independently of Emotional Eating and Personality Traits among University Students of Southern Italy

It is widely acknowledged that obesity is a growing public clinical issue involving both physical and psychological well-being. Nevertheless, the relationship between psychological features and weight gain is still unclear. Although emotional eating (EE) and personality traits are considered significant predictors of eating disorders, their role in obesity without eating disorders (OB-wed) is far from proven. The present study aimed at investigating the cumulative effect of EE and personality traits on overeating behavior in a sample of 266 university students (169 female; mean age = 21.85, SD = 2.39) stratified based on their body mass index (BMI; normal weight, overweight, obese). They were enrolled during free screening days promoted by the Human Dietetic and Sport Service of a Southern Italian university. The results show a psychological pattern of increasing overeating behavior and lower Self-Directedness combined with higher Sadness and Anger. However, OB-wed subjects overate regardless of this emotional/personological configuration.

The relationship between personality traits and BMI categories

OBJECTIVE:

To compare personality traits between average weight, overweight and obese people using Eysenck Personality Questionnaire Revised-Abbreviated Form (EPQR-A). Study design: Cross-sectional, descriptive study. Place and duration of study: S. B. U Kartal Dr. Lutfi Kirdar Training and Research Hospital Family Medicine Obesity Policlinic and Family Medicine Outpatient Clinics, from November 2018 to January 2019.

METHODS:

Participants aged between 18 and 65 years (279 female and 150 male) were layered according to Turkish Endocrinology and Metabolism Society (TEMD) Body Mass Index (BMI) categories to compare personality traits between normal weight, overweight and obese people. Each layer was compared to each other in this study. A questionnaire, including socio-demographic form, and EPQR-A Form were applied to the participants.

RESULTS:

Patients aged between 18 and 65 years (279 female and 150 male) were evaluated according to BMI categories. There was a significant difference in psychoticism score averages by BMI categories (p<0.001). The mean of psychoticism scores showed a V-shaped distribution according to the BMI categories. There were no significant differences between the average scores of neuroticism and extraversion according to BMI categories (p=0.094; p=0.157, respectively).

CONCLUSION:

There was a significant difference in psychoticism score averages by BMI categories. The mean of psychoticism scores showed a V-shaped distribution according to the BMI categories.

Promoting self-control in overweight and obese children

Introduction

Background and objective: impulsiveness might affect the ability of an individual to plan meals, eat regularly, and resist impulses to enjoy foods that are high in fat and sugars in a particular way. The objective of the present study was to evaluate the effectiveness of a fading strategy regarding a reinforcer dimension to promote the development of self-control and decrease impulsive choice among 14 overweight and obese children. Material and methods: to meet this objective, an experimental procedure of choice behavior was used to evaluate the impulsivity and self-control choices influenced by four reinforcer dimensions on a computer: reinforcement rate, reinforcer quality, immediacy of the reinforcement, and response effort. Results: the results indicate that the children's decisions were influenced primarily by the immediacy of the reinforcement and the reinforcement rate; therefore, the children's behavior can be classified as impulsive. Based on these results, a fading procedure was implemented for self-control training in which the immediacy values of the reinforcement and other influential dimensions that devalued the reinforcer were progressively increased. Conclusions: after this fading strategy, a change in preference was observed among the children with regard to the proportion of alternative responses that produced high rates of reinforcement or were of higher quality compared with the allocation of choices associated with immediate reinforcement, which required less effort and were of lower quality. It is possible to design strategies regarding the development of self-control based on the contrasting qualities of these dimensions and the gradual training of tolerance of restrictions on access to the reinforcer.

Food Addiction: Implications for the Diagnosis and Treatment of Overeating

With the obesity epidemic being largely attributed to overeating, much research has been aimed at understanding the psychological causes of overeating and using this knowledge to develop targeted interventions. Here, we review this literature under a model of food addiction and present evidence according to the fifth edition of the Diagnostic and Statistical Manual (DSM-5) criteria for substance use disorders. We review several innovative treatments related to a food addiction model ranging from cognitive intervention tasks to neuromodulation techniques. We conclude that there is evidence to suggest that, for some individuals, food can induce addictive-type behaviours similar to those seen with other addictive substances. However, with several DSM-5 criteria having limited application to overeating, the term 'food addiction' is likely to apply only in a minority of cases. Nevertheless, research investigating the underlying psychological causes of overeating within the context of food addiction has led to some novel and potentially effective interventions. Understanding the similarities and differences between the addictive characteristics of food and illicit substances should prove fruitful in further developing these interventions.

Epidemiology of childhood overweight, obesity and their related factors in a sample of preschool children from Central Iran

BACKGROUND

Childhood overweight and obesity are strongly associated with the psychological and physical health of those for the duration of the lifetime. The purpose of this study was to assess the epidemiology of childhood overweight and obesity and their related factors in Zarandieh city, of Iran, in 2017.

METHODS

In a cross-sectional study, 572 preschool-mother dyads from primary care Clinics were selected by multi-stage sampling method. BMI of the children and mothers were calculated using standard method and the demographic, children nutrition and physical activity habits; the mothers perceived threat toward obesity, and their life style data were collected by self-report questionnaires for the literate mothers and interviewing for illiterate mothers.

RESULT

The prevalence of overweight and obesity in mothers was 30.8 and 20.3% respectively. This rate in children was 15.5 and 9.9% respectively. The multiple logistic regression analysis showed that variables of mother's BMI, Birth weight, Mother's employment, watching TV > 2 h/day, Computer games> 2 h/day and daily breakfast eating (≥4/week), perceived threat, health responsibility, stress management, physical activity, and healthy eating were the significant predictors of the child's BMI respectively.

CONCLUSIONS

Our results indicated that the prevalence of overweight and obesity are high in preschool children and their mothers. It seems that necessary to have suitable intervention programs to help mothers understand the serious risk of childhood obesity and the importance of creating a healthy lifestyle by them in childhood.

Impulsivity and consideration of future consequences as moderators of the association between emotional eating and body weight status

Background

Emotional eating (EmE) is characterized by an over consumption of food in response to negative emotions and is associated with an increased weight status. Consideration of Future Consequences (CFC) or a low level of impulsivity could influence the association between EmE and weight status. The objective was to analyze the moderating influence of CFC and impulsivity on the relationship between EmE and BMI.

Methods

A total of 9974 men and 39,797 women from the NutriNet-Santé cohort study completed the revised 21-item Three-Factor Eating Questionnaire to assess their EmE, the CFC questionnaire (CFC-12) to assess their level of time perspective, and the Barratt Impulsiveness Scale (BIS-11) to assess their impulsivity. Weight and height were self-reported each year over a median follow-up of 5.3 years. The associations between EmE and repeated measures of BMI were estimated by multiple linear mixed-effects regression models stratified by gender, tertiles of the CFC, or tertiles of the BIS-11, taking into account sociodemographic and lifestyle factors.

Results

Overall, EmE was positively associated with BMI. CFC and impulsivity did not moderate the effect of EmE on changes of BMI per year, but quantitatively moderated the effect of EmE on overall BMI. In women, the strength of the association between EmE and weight status increased with CFC level. Difference of BMI slopes between a low and a high level of CFC was − 0.43 kg/m² (95% CI: -0.55, − 0.30) (p < .0001). In addition, the strength of the association between emotional eating and weight status increased with impulsivity level. Difference of BMI slopes between a low and a high level of impulsivity was + 0.37 kg/m² (95% CI: 0.24, 0.51) (p < .0001). In men, only individuals with a low CFC presented a stronger association of EmE with BMI.

Conclusions

Impulsivity and consideration of future consequences moderated the association between emotional eating and body weight status. This study emphasizes the importance of taking into account psychological traits in obesity prevention.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0721-1) contains supplementary material, which is available to authorized users.

Mood and restrained eating moderate food-associated response inhibition in obese individuals with binge eating disorder

Recent research suggests that obese individuals with binge eating disorder (BED) show deficits in response inhibition, but findings are not consistent, especially when food-associated stimuli are presented. The aim of the present study was to assess the role of moderating factors by taking into account restrained eating and mood. Seventeen obese women with BED, 20 obese women without BED and 20 normal-weight controls (NW) were recruited. A go/no-go task with food-associated and control stimuli and questionnaires were administered. Obese BED showed less impairment of response inhibition to food-associated than to control stimuli, while this pattern was reversed in NW; no differences were observed for obese participants. Interestingly, group differences were moderated by the interaction of restrained eating and mood, and obese BED made the most commission errors to food-associated stimuli when they were restrained eaters and in a very positive mood at the time of testing. Our results might explain why some studies did not observe deficits in response inhibition to food-associated cues in BED.

Aspiring personality: Patients waiting for obesity treatment

The aim of the present study was to investigate differences in temperament and character between patients (N = 70) waiting for obesity surgery and the general population. Patients waiting for obesity surgery scored higher in Harm-Avoidance, Reward Dependence, Persistence, and Cooperativeness and also lower in Self-Directedness.

Body mass and wages: New evidence from quantile estimation

I estimate the effect of body mass index (BMI) on wages across the unconditional distribution of wages. I find that for whites and Hispanics the effect of BMI is generally decreasing across the wage distribution; at the .9 quantile of the wage distribution, a two standard deviation increase in BMI reduces wages by 8% for white males, 13% for white females, 9% for Hispanic males, and 16% for Hispanic females. Conversely, at the .1 quantile, a two standard deviation increase in BMI affects wages by less than 2% for all these groups. For black males, the effect of BMI is positive, and either increasing or non-linear in wages. For black females, the estimates tend to be more uniform across the wage distribution. I discuss possible explanations for these inter-quantile differences including preference discrimination, productivity differences, and statistical discrimination. The results point to a new explanation for the observed correlation between socioeconomic status and body weight: individuals with higher income earning potential have differential incentives to maintain a lower BMI.

Interactive and indirect effects of trait impulsivity facets on body mass index

Impulsivity is a personality trait that may be a risk factor for overweight and obesity. Increasing evidence suggests, however, that only specific facets of impulsivity are associated with eating- and weight-related variables. Moreover, there seem to be interactive effects such that eating-related self-regulation is low when more than one impulsivity facet is elevated. Finally, the effect of impulsivity on body weight appears to be indirect, that is, is mediated by eating behaviors. In the current study, 790 adults (83% female, 80% students) completed a short form of the Barratt Impulsiveness Scale and the Perceived Self-Regulatory Success in Dieting Scale online and reported their current height and weight. Scores on attentional and motor impulsivity were interactively associated with perceived self-regulatory success in weight regulation: Higher attentional impulsivity was associated with lower perceived self-regulatory success at high levels of motor impulsivity, but not at low levels of motor impulsivity. A moderated mediation model revealed an indirect effect of attentional impulsivity on body mass index (BMI) via perceived self-regulatory success in weight regulation at high, but not low levels of motor impulsivity. Non-planning impulsivity was unrelated to perceived self-regulatory success in weight regulation and BMI. Results support previous findings such that attentional and motor impulsivity are interactively associated with eating- and weight-related measures. Specifically, eating-related self-regulation is low when both attentional and motor impulsivity levels are high. Moreover, results further support that self-reported trait impulsivity is not directly related to BMI, but indirectly via eating behaviors as potential mediators.

Modelling Gender Differences in the Economic and Social Influences of Obesity in Australian Young People

In Australia, as in many other developed economies, the prevalence of obesity has risen significantly in all age groups and especially in young males and females over the past decade. Using data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, this paper investigates the influence of economic, personality and social factor demographics on the incidence of obesity in Australian youths. The study uses two random parameters logit models, including one that allows for gender-specific differences in the conditioning variables. The models reveal notable differences between the most important variables affecting the incidence of obesity amongst females compared to males. These differences are notable to consider for policy and intervention programs aimed at reducing the problem of obesity.

Association between Impulsivity and Weight Status in a General Population

The objective of this study is to examine the association between impulsivity and weight status in a large sample of the adult general population in France, and the influence of gender on this relationship. A total of 11,929 men and 39,114 women participating in the NutriNet-Santé cohort were selected in this cross-sectional analysis. The Barratt Impulsiveness Scale (BIS-11) was used to assess impulsivity. Weight and height were self-reported. The association between impulsivity and BMI was estimated using logistic regressions adjusted for socio-demographic and lifestyle factors. Individuals with high impulsivity levels (BIS-11 total score >71) were more likely to be obese (Odds Ratio (OR) = 1.80, 95% Confidence Interval (CI): 1.39, 2.33 in men; OR = 1.30, 95% CI: 1.15, 1.48 in women) compared to individuals in the average range of impulsivity. The strongest associations between impulsivity and obesity were observed in men, where highly impulsive participants were more likely to be class III obese (BMI > 40 kg/m²) (OR = 3.57, 95% CI: 1.86, 6.85). This large sample analysis supports the existence of a relationship between impulsivity and weight status and the importance of psychological factors in the prevention of obesity.

Factors Influencing the Incidence of Obesity in Australia: A Generalized Ordered Probit Model

The increasing health costs of and the risks factors associated with obesity are well documented. From this perspective, it is important that the propensity of individuals towards obesity is analyzed. This paper uses longitudinal data from the Household Income and Labour Dynamics in Australia (HILDA) Survey for 2005 to 2010 to model those variables which condition the probability of being obese. The model estimated is a random effects generalized ordered probit, which exploits two sources of heterogeneity; the individual heterogeneity of panel data models and heterogeneity across body mass index (BMI) categories. The latter is associated with non-parallel thresholds in the generalized ordered model, where the thresholds are functions of the conditioning variables, which comprise economic, social, and demographic and lifestyle variables. To control for potential predisposition to obesity, personality traits augment the empirical model. The results support the view that the probability of obesity is significantly determined by the conditioning variables. Particularly, personality is found to be important and these outcomes reinforce other work examining personality and obesity.

General Habit Propensity Relates to the Sensation Seeking Subdomain of Impulsivity But Not Obesity

According to dual-system theory, instrumental learning and performance depend on the balance between goal-directed and habitual action control. Overreliance on habits has been argued to characterize clinical conditions such as drug addiction or obsessive-compulsive disorder as well as obesity and excessive impulsivity. A tendency toward habitual action control in obesity has already been indicated in the food domain. However, impairments might not be restricted to eating behavior. This has been suggested by domain-general obesity-associated disturbances in executive function as well as alterations in corticostriatal circuits underlying the goal-directed and habitual systems. In this study we examined the balance of goal-directed and habitual action control in a sample of normal-weight, overweight, and obese participants (n = 105) using the slips-of-action test in a non-food context. We tested for continuous or group-based associations between body weight status (BMI) and the devaluation sensitivity index (DSI), a parameter representing the balance of the goal-directed and habitual systems in action control. As personality differences in the domain of impulsivity might affect this relationship, we also examined whether the interaction between BMI and self-reported impulsivity, based on the UPPS Impulsive Behavior Scale, was related to the DSI. In addition to that, we tested for direct, i.e., weight status independent, relationships between UPPS subdomains of impulsivity and the DSI. We failed to find evidence for a relationship between weight status and sensitivity to devaluation as indexed by the DSI. However, independent of weight status, we observed lower sensitivity to devaluation in sensation seekers, a subtype of impulsivity. To conclude, behavioral flexibility in the sense of disturbances in the balance between the habitual and goal-directed systems seems to be unaffected by weight status in a non-food context. Consequently, stimuli and behavior might not be generally excessively linked in overweight or obesity. However, according to ceiling effects we cannot rule out subtle effects the paradigm was not able to disentangle. Further, future studies are needed to clarify the role of specific subtypes of obesity (e.g., food addiction). The indicated habit propensity in sensation seekers may account for previous reports of weak avoidance behavior and risky decision making.

The asthma-anxiety connection

BACKGROUND

The literature reports a significant association between various mental disorders and asthma, in particular depression and/or anxiety, with some more robust data regarding anxiety disorders. However, the nature of this association remains largely unclear.

OBJECTIVES

(1) To test the hypothesis of a specific association of anxiety and depressive disorder (according to the DSM-IV) with asthma and (2) to test the bidirectional hypothesis of causality between asthma and psychiatric disorders.

METHODS

Ninety-six adults were compared with 96 control subjects matched according to main socio-demographic variables (i.e., gender, age, marital status, cohabiting/non-cohabiting, and BMI). Subjects with asthma were divided according to GINA and ACT classifications. All subjects underwent Structured Clinical Interviews for DSM-IV Axis I (SCID-I) diagnosis.

RESULTS

Significant association between asthma and lifetime anxiety disorders emerged (OR 3.03; p = 0.003); no significant association with other psychiatric diagnosis emerged. Moreover, lifetime and current anxiety were associated with asthma severity levels (p < 0.01 and p = 0.001 based on age). Asthma preceded anxiety in 48% of cases; in 52% of cases, anxiety preceded asthma, without significant group differences. The risk of asthma, particularly of severe, uncontrolled forms (p < 0.01), resulted higher in lifetime anxiety disorder patients (p = 0.003 and p = 0.001 based on age at onset). Current anxiety increased the risk of asthma, and that of an uncontrolled form (p < 0.05). Asthma increased the risk of lifetime anxiety disorders (p = 0.002 and p = 0.018 using ages). Intermittent asthma increased the risk of lifetime and current anxiety disorders (p < 0.01).

CONCLUSIONS

Anxiety disorders, in particular Lifetime Anxiety Disorders, represent the only psychiatric disorder significantly associated with asthma, with a possible bidirectional, anxiety-asthma relationship, each of which can be caused or result from the other.

Trait impulsivity and body mass index: A cross-sectional investigation in 3073 individuals reveals positive, but very small relationships

Impulsivity has been suggested to be associated with obesity. However, findings are fairly inconsistent and it appears that only specific facets of impulsivity are related to overeating and body mass. In this study, relationships between scores on a short form of the Barratt Impulsiveness Scale and body mass index were examined in a heterogeneous sample (N = 3073). After controlling for age and sex, only scores on attentional and motor impulsivity, but not non-planning impulsivity, were predictive of higher body mass index. The magnitude of these relationships, however, was very small. Thus, future research needs to address possible mediators and moderators of the relationship between impulsivity and body mass in order to explain why only specific facets of impulsivity appear to play a role in obesity and under which circumstances heightened impulsivity levels are associated with higher body weight.

External eating mediates the relationship between impulsivity and unhealthy food intake

Recent evidence from the eating domain shows a link between impulsivity and unhealthy food intake. However, the mechanism underlying this relationship remains unclear. One possibility is an external eating style, which has been linked to both impulsivity and food intake. The current study investigated the potential mediating role of external eating in the relationship between impulsivity and food intake. Participants were 146 undergraduate women who completed measures of impulsivity and external eating, and took part in a laboratory taste test as a behavioural index of unhealthy snack food intake. It was found that attentional and motor impulsivity interacted in predicting sweet food intake, but only motor impulsivity predicted both external eating and sweet food intake. Furthermore, the relationship between motor impulsivity and food intake was mediated by external eating. These findings support the development of interventions aimed at targeting specific aspects of impulsivity in order to reduce unhealthy eating behaviour.

Personality traits and obesity: a systematic review

Based on a bio-social-ecological systems model of the development and maintenance of obesity, there has been in the last few years a growing research interest in the association of obesity and personality traits. The aim of the present review was a comprehensive and critical evaluation of the existing literature taking into account the methodological quality of studies to enhance our understanding of personality traits associated with body weight, the development of overweight and obesity as well as the effectiveness of weight loss interventions including bariatric surgery. Personality traits play an important role both as risk as well as protective factors in the development of overweight and obesity. While thus in particular 'neuroticism', 'impulsivity' and 'sensitivity to reward' appear as risk factors, 'conscientiousness' and 'self-control' have been shown to have a protective function in relation to weight gain. Conscientiousness is a measure of regulation of internal urges and self-discipline, and may thus provide a potential source of control over impulsive reward-oriented behaviour. The results of the present review suggest that, within the context of therapeutic weight reduction measures, it is meaningful to identify subgroups of patients for whom specific treatment options need to be developed, such as measures for strengthening self-control skills.

Personality characteristics in surgery seeking and non-surgery seeking obese individuals compared to non-obese controls

It is currently unknown what makes some obese individuals opt for bariatric surgery whereas others choose not to. The aim of this study was to examine whether personality characteristics differed between obese individuals signed up for Roux-en-Y gastric bypass (RYGB) (N=30) and obese individuals not seeking RYGB (N=30) compared to non-obese controls (N=30). All participants completed the NEO Personality Inventory-Revised. The obese RYGB group displayed higher levels of Neuroticism and borderline lower levels of Extraversion compared to the obese non-RYGB and the non-obese group, while the two latter groups did not differ in terms of personality. The Neuroticism domain and possibly the Extraversion domain may therefore be worthwhile to consider in future studies investigating the outcome of bariatric surgery.

Body weight status, eating behavior, sensitivity to reward/punishment, and gender: relationships and interdependencies

Behavioral and personality characteristics are factors that may jointly regulate body weight. This study explored the relationship between body mass index (BMI) and self-reported behavioral and personality measures. These measures included eating behavior (based on the Three-Factor Eating Questionnaire; Stunkard and Messick, 1985), sensitivity to reward and punishment (based on the Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scales) (Carver and White, 1994) and self-reported impulsivity (based on the Barratt Impulsiveness Scale-11; Patton et al., 1995). We found an inverted U-shaped relationship between restrained eating and BMI. This relationship was moderated by the level of disinhibited eating. Independent of eating behavior, BIS and BAS responsiveness were associated with BMI in a gender-specific manner with negative relationships for men and positive relationships for women. Together, eating behavior and BIS/BAS responsiveness accounted for a substantial proportion of BMI variance (men: ∼25%, women: ∼32%). A direct relationship between self-reported impulsivity and BMI was not observed. In summary, our results demonstrate a system of linear and non-linear relationships between the investigated factors and BMI. Moreover, body weight status was not only associated with eating behavior (cognitive restraint and disinhibition), but also with personality factors not inherently related to an eating context (BIS/BAS). Importantly, these relationships differ between men and women.

Personality characteristics and body image in obese individuals

INTRODUCTION

The aim of this study was to determine the personality characteristics of obese and morbidly obese individuals with no psychiatric disorder and the correlation between these characteristics and body image and self-esteem.

METHODS

Sixty-nine obese individuals and 69 healthy controls, matched in age, sex and marital status, were included in the study. Psychiatric disorders were excluded for all participants using SCID-I and II. Obese and healthy volunteers were compared in terms of body image, self-esteem and personality characteristics.

RESULTS

TCI harm avoidance scores were higher in obese individuals compared to healthy controls. Harm avoidance scores were also higher in individuals with morbid obesity compared to non-morbid individuals, while self-directedness and persistence scores were lower. Body image dissatisfaction was higher in obese individuals. There was a negative correlation in obese individuals between body image and self-esteem scale scores and harm avoidance scores, and a positive correlation with self-directedness scores.

DISCUSSION

An elevated harm avoidance temperament characteristic may be correlated with obesity. Furthermore, high harm avoidance, low self-directedness and low persistence may be significant personality characteristics in a process leading to morbid obesity. In addition, harm avoidance temperament and self-directedness personality characteristics may be correlated with body image dissatisfaction and self-esteem in obese individuals.

Flexibility in weight management

The purpose of the study was to investigate the relationships between changes in flexible vs. rigid restraints of eating during weight management, as well as how changes in the cognitive restraint of eating were related to psychological well-being and flexibility. The data includes information on 49 overweight persons who participated in a weight loss and maintenance (WLM) intervention and a follow-up assessment after 8-9 months. An increase in flexible cognitive restraint during the weight loss intervention was related to better weight loss maintenance and well-being. The more flexible restraint increased during the WLM intervention, the more psychological distress decreased. Moreover, larger reduction of rigid restraint during the follow-up period (between the WLM intervention and the follow-up assessment) was related to a better maintenance of improved psychological well-being at the follow-up endpoint. These results suggest that increasing flexible control while reducing rigid control of eating after an active weight loss phase improves success in weight management and the psychological well-being of weight losers.

Obesity and time-inconsistent preferences

SUMMARY

As obesity becomes a major health and economic issue of the current age, interventions and policies are being targeted to influence individuals' diet and exercise behaviors. Examining the deviations of reality from a baseline model of rational choice provides insights into the economic rationales for interventions to modify individuals' choices. In addition to the more classical economic rationales for intervention, insights from behavioral economics and psychology have recently led to a focus on the role of time-inconsistent preferences, in particular present-biased preferences, in the choices that lead to obesity. While individuals can use self-control techniques to mitigate the problem, there is also potential for targeted interventions and policies to improve the welfare of individuals. Further interdisciplinary research in the area may lead to behavioral obesity interventions tailored to individuals' incentives, resulting in higher compliance rates.:

Psychopathology in a sample of candidate patients for bariatric surgery

BACKGROUND

The prevalence of morbid obesity and the popularity of bariatric surgery have grown in recent years. Many surgical protocols require that the candidates undergo a pre-operative psychological evaluation. We describe the psychopathological characteristics of both clinical syndromes (Axis I of the DSM-IV), as well as personality disorders (Axis II of the DSM-IV), in a sample of morbidly obese patients accepted as bariatric surgery candidates and who participate in a specific surgery preparatory programme, and we analyze its relationship with personality clusters.

METHODS

The Millon Clinical Multiaxial Inventory-III (MCMI-III) scores from 50 patients attending for bariatric surgery were cluster analyzed in hopes of identifying clinical subgroups corresponding to typical personality profiles.

RESULTS

With regard to personality disorders, the highest prevalence was found in the histrionic disorder, followed by obsessive- compulsive disorder. Cluster analysis revealed three personality profiles, which were validated by examining demographics, morphological variables, scores on anxiety and depression psychometric scales, and MCMI-III clinical scales scores. Groups were different in virtually all the MCMI-III clinical scores, as well as in depression and trait anxiety, with Cluster 3 presenting the worst scores.

CONCLUSIONS

These findings suggest that morbidly obese patients are heterogeneous in their psychological profiles, highlighting Cluster C disorders.

Risk of completed suicide after bariatric surgery: a systematic review

Bariatric surgery is one of the most effective treatments for morbid obesity, and a large body of research indicates significant long-term weight loss. While overall mortality decreases in patients who received bariatric surgery, a number of studies have shown that suicide rates are higher in bariatric patients than in control groups. The objective of this study was to present a systematic review of suicide mortality after bariatric surgery and calculate an estimate for the suicide rate. Literature researches of the databases PubMed, Web of Knowledge, PsychInfo, ScienceDirect and Google Scholar were conducted. Thirty studies concerning bariatric surgery and completed suicides met the inclusion criteria. We included 28 studies in the estimation of a suicide rate for the bariatric population. Only one study (Tindle et al.) put a main focus on suicide after bariatric surgery; this was therefore chosen as an adequate reference figure for comparison. The other 27 chosen studies were compared with World Health Organization data and the suicide rate reported by Tindle et al. Twenty-three thousand eight hundred eighty-five people were included in the analysis. In the literature, we found a total of 95 suicides when examining 190,000 person-years of post-bariatric surgery data. Little information was provided describing the reasons for suicide and the time-point of these events after surgery. We estimated a suicide rate of 4.1/10,000 person-years (95% confidence interval [3.2, 5.1]/10,000 person-years). A comparison with Tindle et al. demonstrates that their rate is significantly higher than our estimate (P = 0.03). Bariatric surgery patients show higher suicide rates than the general population. Therefore, there is a great need to identify persons at risk and post-operative psychological monitoring is recommended.

Neurobehavioural correlates of body mass index and eating behaviours in adults: a systematic review

The worldwide increase in obesity has spurred numerous efforts to understand the regulation of eating behaviours and underlying brain mechanisms. These mechanisms can affordably be studied via neurobehavioural measures. Here, we systematically review these efforts, evaluating neurocognitive tests and personality questionnaires based on: (a) consistent relationship with obesity and eating behaviour, and (b) reliability. We also considered the measures' potential to shed light on the brain mechanisms underlying these individual differences. Sixty-six neurocognitive tasks were examined. Less than 11%, mainly measures of executive functions and food motivation, yielded both replicated and reliable effects. Several different personality questionnaires were consistently related to BMI. However, further analysis found that many of these questionnaires relate closely to Conscientiousness, Extraversion and Neuroticism within the Five-Factor Model of personality. Both neurocognitive tests and personality questionnaires suggest that the critical neural systems related to individual differences in obesity are lateral prefrontal structures underpinning self-control and striatal regions implicated in food motivation. This review can guide selection of the highest yield neurobehavioural measures for future studies.

Personality subtypes in female pre-bariatric obese patients: do they differ in eating disorder symptoms, psychological complaints and coping behaviour?

In the pre-bariatric psychological assessment of 102 morbidly obese women, two personality subtypes emerged: a resilient/high functioning subtype with a 'normal' personality profile and an emotional dysregulated/ undercontrolled subtype, characterized by high neuroticism and low extraversion/conscientiousness. Emotional dysregulated/ undercontrolled patients showed more concerns about eating/weight/shape, more binge eating driven by emotions and external triggers, more psychological complaints (such as depression and anxiety) and more avoidance and depressive coping reactions than resilient/high functioning patients. Further research should clarify whether these clearly different psychological profiles are related to different outcomes (weight loss or well-being) of bariatric surgery.

Childhood Obesity and Impulsivity: An Investigation With Performance-Based Measures

The study investigated whether obese children are more impulsive than lean children, taking into account the multidimensionality of the construct. Responses of 41 overweight children were compared to those of 40 lean children. The Stop Task, Circle Drawing Task and Opposite Worlds Task were administered to measure executive inhibitory control, and the Maudsley Index of Childhood Delay Aversion and the Door Opening Task were administered to measure motivational inhibitory control. On the Stop Task, the overweight children showed less inhibitory control. On the Opposite Worlds task, we found no significant difference, whereas on the Circle Drawing Task an unexpected group difference was found. Although on the Door Opening Task the overweight children showed greater reward sensitivity, they were equally motivated to wait on the Maudsley Index of Childhood Delay. We conclude that the findings were different depending on the measure used, but that they suggest that overweight children can be characterised by a decrease in executive and motivational inhibitory control.

Association between impulsivity, reward responsiveness and body mass index in children

BACKGROUND

Childhood obesity is a major health problem. An association between children's body mass index (BMI) and overeating has been established, but mechanisms leading to overeating are poorly understood. The personality characteristics impulsivity and reward responsiveness may be involved in the tendency to overeat. Impulsivity might relate to overeating through poor inhibition of food intake; reward responsiveness through the rewarding value of food.

OBJECTIVE

This study aimed to reveal the relationships between impulsivity, reward responsiveness, overeating and BMI in a sample of 346 Dutch children aged 6-13 years. The BMI distribution in the sample was representative of the BMI distribution in the Dutch pediatric population.

METHODS

Impulsivity and reward responsiveness were measured with the Dutch version of the parent-report Sensitivity to Punishment and Sensitivity to Reward Questionnaire for children. Overeating was assessed with the Dutch translation of the parent-report Children's Eating Behaviour Questionnaire.

RESULTS

Overeating, impulsivity and reward responsiveness were significantly associated with childhood BMI. Mediation analysis revealed that impulsivity and reward responsiveness equally and significantly predicted BMI indirectly through overeating.

CONCLUSIONS

The personality characteristics impulsivity and reward responsiveness predict childhood BMI indirectly through overeating. This suggests that these personality characteristics are risk factors for obesity.

The development and validation of the food craving acceptance and action questionnaire (FAAQ)

Research has suggested that mindfulness and acceptance may be important factors in the development, maintenance and treatment of both obesity and eating disorders. However, very few scales exist that apply constructs of acceptance and mindfulness to eating behavior. A measure of acceptance about food related thoughts would be especially beneficial in investigating links between acceptance and problematic eating, and in better understanding mechanisms of action of effective treatments for obesity and eating disorders. The Food Acceptance and Awareness Questionnaire (FAAQ) was developed to measure acceptance of urges and cravings to eat or the extent to which individuals might try to control or change these thoughts. The FAAQ is a self-report questionnaire made up of ten items each rated on a seven-point Likert scale (1=very seldom true to 6=always true). Higher scores indicate greater acceptance of motivations to eat. The FAAQ was given to a sample of 463 undergraduate students along with several other measures of eating behavior and other psychological variables. Concurrent associations with variables theorized to be closely linked (Eating Attitudes Test, EAT; the Dutch Eating Behavior Questionnaire, DEBQ; body mass index, BMI) and not very closely linked (the Depression Anxiety Stress Scale, DASS) were evaluated in order to indicate the new scale's convergent and divergent validity. These results demonstrated highly significant correlations with these measures in the expected direction, with stronger correlations for the theoretically-consistent variables than the theoretically-inconsistent variables. Exploratory factor analyses confirmed a structural two-factor model. Factor 1 seems to measure one's ability to regulate eating despite urges and cravings, and Factor 2 seems to measure desire to maintain internal control over eating thoughts. The FAAQ was also administered to a separate sample of 29 overweight or obese women enrolled in a weight loss program, and found to be predictive of weight loss. Taken together, results suggest that the FAAQ is a psychometrically sound instrument which might be a valuable tool for assessing acceptance of food related thoughts and urges.

Obesity and psychopathology. A study of psychiatric comorbidity among patients attending a specialist obesity unit

Aims – The study aims to evaluate the frequency of association between Axis I and II disorders according to DSMIVTR criteria and obesity, and use of mental health services in a clinical sample of patients attending a centre for the diagnosis and treatment of Obesity. Methods – 150 consecutive patients (32 Males, 118 females, mean age 44.614.3 yrs; mean BMI 35.46.2) were interviewed by means of SCID I and SCID II. Results – Lifetime Prevalence of Axis I disorders was 58% (males 50%; females 61%); the highest prevalence rate was found for Anxiety Disorders (approx 35%), whilst 30% of subjects were affected by Mood disorders, chiefly Major Depression (20%), and 18% by Eating Disorders. 28% of obese patients presented a Personality Disorder, 23% of patients being affected both by an Axis I and Axis II disorder. Mood Disorders, in particular Major Depression, were significantly prevalent among female obese. 50% of females and approx 37% males included in the sample had contacted mental health units for treatment. Conclusion – Data obtained in the present study confirm the high prevalence rates of mental disorders in obese patients seeking treatment. Specialist units should therefore include thorough psychiatric evaluation of patients as a routine practice.

Declaration of Interest: The study was supported by a research grant by University of Cagliari (ex 60% funding, financial year 2006); the authors declare no conflict of interest.

Prevalence of unhealthy lifestyle patterns among overweight and obese adults

This study determined the prevalence of unhealthy eating, exercise, and coping pattern traits among a large sample of overweight and obese adults. We analyzed responses to a 53-item lifestyle pattern questionnaire posted on a commercial weight loss program Web site collected from 2004 through 2008. Subjects included 446,608 healthy weight, overweight, and obese adults, 18-65 years old, average age 31.9 (s.d. = 11.8), average BMI 30.5 kg/m(2) (s.d. = 7.5). Categorically, 25.5% were healthy weight, 29.0% were overweight, 33.7% were class I-II obesity, and 11.8% class III obesity. A stratified random sample was used to estimate the prevalence of the 21 lifestyle patterns (7 eating, 7 exercise, and 7 coping) in the general population, and the prevalence of patterns in the complete dataset was further analyzed by gender, age, and BMI. Finally, we analyzed the odds ratio of the pattern prevalence for each BMI category. We found that unhealthy lifestyle patterns in diet, exercise, and coping were highly prevalent among this population. In general, the prevalence of these patterns rose with increasing BMI and is correlated with advancing age. Gender differences were seen with many of the patterns, most noticeably among the coping patterns. The odds ratio for 18 of the 21 patterns was >1.0 and steadily increased with higher BMI categories. We conclude that unhealthy lifestyle patterns in diet, exercise, and coping are highly prevalent among the overweight and obese population. Pattern recognition represents a new method to analyze the cluster of behaviors, attitudes, and traits seen among this population.

Body mass correlates inversely with inhibitory control in response to food among adolescent girls: an fMRI study

Self-report and behavioral data suggest that impulsivity may contribute to the development and maintenance of obesity. Neuroimaging studies implicate a widespread neural network in inhibitory control and suggest that impulsive individuals show hypoactivity in these regions during tasks requiring response inhibition. Yet, research has not directly tested whether body mass correlates inversely with activation of these regions during response inhibition tasks. The present study used functional magnetic resonance imaging (fMRI) to investigate neural activations during a food-specific go/no-go task in adolescent girls ranging from lean to obese. When required to inhibit prepotent responses to appetizing food, body mass index (BMI) correlated with response inhibition at both the behavioral and neural levels, with more overweight adolescents showing greater behavioral evidence of impulsivity as well as reduced activation of frontal inhibitory regions, including superior frontal gyrus, middle frontal gyrus, ventrolateral prefrontal cortex, medial prefrontal cortex, and orbitofrontal cortex, than leaner individuals. As well, activation in food reward regions (e.g., temporal operculum/insula) in response to food images correlated positively with BMI. Results suggest that hypofunctioning of inhibitory control regions and increased response of food reward regions are related to elevated weight.

Avoidance and inflexibility as a common clinical pathway in obesity and smoking treatment

This brief study presents reductions in avoidance and inflexibility as a potential common clinical pathway to intervene on for both smoking cessation and weight control. A mediation analysis--using the Avoidance and Inflexibility Scale (AIS)--was conducted on a group of participants (N = 84) who were shown to improve weight control outcomes after receiving an Acceptance and Commitment Therapy (ACT) intervention. Results were then compared to a previous study using the same process measure (AIS) for smoking cessation. Results suggest a common clinical pathway.