Psychological and Behavioral Correlates of Baseline BMI in the Diabetes Prevention Program (DPP)

Abstract

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...

Psychobehavioral and nutritional predictors of weight loss in obese women treated with sibutramine

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“…3 In the Diabetes Prevention Program, the weight loss self-efficacy correlated negatively with depression. 4 Moreover, depressed mood has been described as a trigger for dietary disinhibition, 26 which promotes weight gain. Weight loss in response to combined VLCD and behavior treatment is associated with a decrease in the BDI score.…”

“…Previous studies revealed that scores on the Beck Depression Inventory (BDI) 2 were related to body weight loss during obesity treatment. [3][4][5] Eating related motivation is frequently evaluated by the Three Factor Eating Questionnaire also known as the Eating Inventory (EI), which was developed by Stunkard and Messick. 6 The EI assesses dietary restraint, disinhibition and perceived hunger.…”

Food cravings and energy regulation: the characteristics of craved foods and their relationship with eating behaviors and weight change during 6 months of dietary energy restriction

“…[2][3][4][5][6] The frequency, strength and types of food cravings have been found to differ between men and women, 6 different phases of the menstrual cycle 7 and in some cases with body mass index (BMI). [8][9][10] However, the origins of cravings and their importance in the etiology and treatment of obesity remain uncertain. Although the underlying causes of food cravings remain poorly understood, there have been a number of theories concerning their origin.…”

Factors influencing dietary fat intake among black emerging adults

“…If individuals perceive themselves capable of successfully managing their dietary fat intake, then they are more likely to consume less dietary fat. Self-efficacy has been found to be a strong predictor of healthy nutrition-related behaviors (AbuSabha & Achterberg, 1997;Clark & Dodge, 1999;Delahanty, Hayden, Meigs, Nathan, & Williamson, 2002), with individuals who have higher self-efficacy practicing healthier eating behaviors.…”