THE DPP RESEARCH GROUP
OBJECTIVE -To determine psychological and behavioral correlates of baseline BMI in the Diabetes Prevention Program (DPP).RESEARCH DESIGN AND METHODS -Of 1,079 DPP lifestyle intervention participants, 274 completed validated questionnaires at baseline assessing weight loss history, stage of change, self-efficacy, dietary restraint, emotional eating, binge eating, perceived stress, depression, and anxiety.RESULTS -The mean age of subjects was 52.5 years, 65% were women, and their mean BMI was 33.9 kg/m 2 . Higher BMI correlated with more frequent weight cycling (r ϭ 0.50, P Ͻ 0.0001) and efforts at weight loss (r ϭ 0.34, P Ͻ 0.0001); younger age when first overweight (r ϭ Ϫ0.42, P Ͻ 0.0001); lower exercise efficacy (r ϭ Ϫ0.15, P ϭ 0.015); lower weight loss efficacy (r ϭ Ϫ0.21, P Ͻ 0.001); a less advanced stage of change for weight loss (r ϭ Ϫ0.12, P ϭ 0.04); more perceived stress (r ϭ 0.14, P ϭ 0.02); emotional eating (r ϭ 0.19, P ϭ 0.001); poor dietary restraint (r ϭ Ϫ0.14, P ϭ 0.02); binge eating frequency (r ϭ 0.18, P ϭ 0.004) and severity (r ϭ 0.30, P Ͻ 0.0001); feeling deprived, angry, or upset while dieting (r ϭ 0.27, P Յ 0.0001); and food cravings while dieting (r ϭ 0.31, P Ͻ 0.0001). Correlations did not differ as a function of sex; however, correlations of BMI with anxiety and low-fat diet and weight loss self-efficacy differed as a function of ethnicity. In multivariate models, binge eating severity, poor dietary restraint, and food craving were independent correlates of baseline BMI.CONCLUSIONS -Many psychological and behavioral factors are associated with higher BMI in this ethnically diverse group of men and women. Whether strategies that help patients increase levels of dietary restraint and reduce binge eating and food craving lead to long-term weight loss maintenance needs longitudinal study.
Diabetes Care 25:1992-1998, 2002T he Diabetes Prevention Program (DPP) was a randomized clinical trial comparing the efficacy of intensive lifestyle, metformin, and placebo in the prevention of type 2 diabetes in people with impaired glucose tolerance. Subjects randomly assigned to the lifestyle intervention had goals of losing at least 7% of their body weight and maintaining activity levels at Ն150 min per week over 3-6 years (1). Psychological and behavioral determinants of eating and exercise behaviors may be strong predictors of body weight, and understanding these determinants is critical to the goals and outcomes of the DPP. Self-efficacy, perceived stress, depression, anxiety, dietary restraint, emotional eating, binge eating, and stage of change related to weight loss are potentially modifiable variables frequently cited in the literature as important correlates of body weight (2-14). However, it is unclear which of these psychological and behavioral measures are the most robust correlates of weight outcomes. Moreover, most of the research on these correlates of weight outcomes has been conducted primarily in young and middle-aged Caucasian women. Data for men, other races and et...