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Psychological Variables Associated with Weight Loss in Obese Patients Seeking Treatment at Medical Centers
No full textBackground: The identification of process and treatment variables associated with successful weight loss could be a pivotal strategy to reduce attrition and to improve the effectiveness of dietary treatment in obesity and could help find new therapeutic strategies.
Objective: The aim of study is to identify the psychological predictors of weight loss in patients with obesity compliant to continuous treatment at medical centers.
Design: Longitudinal observation of a large cohort of obese subjects entering weight loss programs in the years 2000-2002.
Subjects/setting: 500 obese patients who completed 12-month weight loss treatment by Italian medical centers offering different programs (78.8% females; age 46.2 ± 10.8 years; BMI 37.3 ± 5.6 kg/m2).
Main outcome measured and statistical analysis performed: Measurements were obtained at baseline and following a 12-month weight loss program. Psychological distress, binge eating, body uneasiness, attitude toward eating were evaluated by self-administered questionnaires (Symptom Check List-90, Binge Eating Scale, Body Uneasiness Test, and Eating Inventory (EI - dietary restraint, disinhibition and hunger), together with BMI changes. Weight loss expectations and primary motivation for seeking treatment (health or improving appearance) were also recorded.
Results: At follow-up, the mean percent weight loss was similar in males and females. Both hierarchical regression and logistic regression analysis revealed that increased dietary restraint and decreased disinhibition were the only independent psychological predictors of BMI change, after controlling for age, gender and baseline BMI (5% weight loss at 12 months: EI restraint (odds ratio (OR), 1.15; 95% confidence interval (CI), 1.09-1.21) and disinhibition (OR, 0.92; 0.85-0.99); 10% weight loss: restraint (OR, 1.11; 1.06-1.16) and disinhibition (OR, 0.91; 0.85-0.98)). Adjustment for centers did not change the results.
Conclusion: Successful weight loss was associated with increased dietary restraint and reduced disinhibition in obese patients seeking weight loss treatment in several medical centers throughout Italy
Snoring, hypertension and type 2 diabetes in obesity. Protection by physical activity
No full textABSTRACT
Sleep-related breathing disorders are recognized as major health problems in obesity. They are involved in both hypertension and type 2 diabetes, through mechanism(s) possibly related to increased sympathetic tone. We studied the association of habitual snoring with diabetes, hypertension, weight cycling and physical activity in a large Italian database of treatment-seeking obese subjects. Clinical and behavioural data were assessed by standardized questionnaires. Consecutive data of 1890 obese patients were analysed (average BMI, 38.2 kg/m2, median age 46 years, 78% females), from 25 obesity Italian centres, with low prevalence of clinical manifestations of cardiovascular disease. Habitual snoring was reported in 56% of cases, and was associated with day-time sleepiness. The prevalence increased with obesity class and waist circumference, and was positively associated with weight cycling and weight gain since age 20 years, and smoking. Regular physical activity had a protective effect. Snoring was associated with diabetes and hypertension at univariate analysis, but in multivariate analysis an independent effect was only observed for hypertension. After adjustment for age, gender and BMI, physical activity maintained an independent, protective effect on both snoring (odds ratio 0.65, 95% confidence interval 0.49 – 0.84; P = 0.001), diabetes (0.50, 0.30 – 0.86; P = 0.011) and hypertension (0.71, 0.53 – 0.95; P = 0.023). We conclude that in treatment-seeking, obese subjects with low prevalence of cardiovascular disease, snoring independently increases the risk of hypertension, whereas physical activity exerts a protective on both snoring and complications. These data underline the importance of lifestyle interventions to limit the burden of obesity and associated diseases
The Metabolic Syndrome in Treatment-Seeking Obese Persons
Get PDFObesity is a major risk factor for several metabolic diseases, frequently clustering to form the metabolic syndrome, carrying
a high risk of cardiovascular mortality. We aimed to assess the prevalence of the metabolic syndrome in treatment-seeking
obese subjects and the potential protective effect of physical activity. A cross-sectional analysis of data from a large Italian
database of treatment-seeking obese subjects was performed. The metabolic syndrome was defined according to the criteria
provisionally set by the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults, based on waist circumference, fasting glucose, triglyceride (TG) and high-density lipoprotein-cholesterol
(HDL-C) levels, and arterial pressure. Data were available in 1,889 Caucasian subjects, 78% females, from 25 obesity
centers. Minimum criteria for the metabolic syndrome were fulfilled in 53% of cases. The prevalence increased with age and
obesity class and was negatively associated with participation in a structured program of physical activity (odds ratio, 0.76;
0.58 to 0.99; P .041), after correction for age, sex, and body mass. The prevalence of cardiovascular disease was higher in
subjects with the metabolic syndrome. A subset of 12.8% of cases had no metabolic abnormalities. They had a lower
prevalence of abdominal obesity and cardiovascular disease. Isolated obesity was significantly associated with physical
activity (odds ratio, 1.86; 1.33 to 2.60; P .0003). Multiple metabolic disorders are present in most obese patients, and their
prevalence is lower in physically active subjects. It is time to move towards a more integrated approach and to reconsider
resource allocation to improve lifestyle changes for large-scale control of obesity
The QUOVADIS Study: features of obese Italian patients seeking treatment at specialist centers
Get PDFObesity is a major risk factor for several chronic diseases, but the burden associated with it
also extends to psychosocial areas and to perceived health status. In 1999 an observational study on healthrelated
quality of life in obesity was planned. The study was entirely web-based. Case Report Forms and
the individual items of 7 self-administered questionnaires were directly implemented on a general database
via an extranet system from 25 Italian centers. By December 2001, after enrolment had stopped, the
database included anthropometric, socioeconomic and clinical data of 1944 patients (78% females). Weightcycling
was reported in over 80% of cases, overeating in 60-65%, structured physical activity in only 13-
15%. Several chronic illnesses were associated. Whereas the prevalence of diabetes and hypertension was
related to the degree of obesity, hyperlipidemia and coronary heart disease did not increase further with
increasing obesity. A disturbed psychological mood was twice more common in females. Concern for present
health was the main reason for seeking treatment in both genders; concern for body appearance was
more common in females. Male subjects were more frequently assigned to dietary counseling and physical
exercise, whereas in females psychotherapy was more frequently considered. Various forms of behavioral
approach were planned in approximately 50% of patients. Finally, very few patients were initially
considered for pharmacological intervention or bariatric surgery. The study provides a comprehensive
picture of Italian patients seeking treatment for obesity. Data on perceived health status, psychological
well being, body image awareness, eating behavior disorders and psychopathological distress will
provide clues to a comprehensive assessment of obesity, the effects of treatments and reasons for failure
Weight loss expectations in obese patients seeking treatment at medical centers.
No full textObjective: To investigate weight loss expectations (expected 1-year BMI loss, dream BMI, and maximum acceptable BMI) in obese patients seeking treatment and to examine whether expectations differ by sex, weight, diet and weight history, age, psychological factors, and primary motivations for weight loss.Research Methods and Procedures: 1891 obese patients seeking treatment in 25 Italian medical centers (1473 women; age, 44.7 +/- 11.0 years; BMI, 38.2 +/- 6.5 kg/m(2)) were evaluated. Diet and weight history, weight loss expectations, and primary motivation for seeking treatment (health or improving appearance) were systematically recorded. Psychiatric distress, binge eating, and body image dissatisfaction were tested by self-administered questionnaires (Symptom CheckList-90, Binge Eating Scale, and Body Uneasiness Test).Results: In 1011 cases (53.4%), 1-year expected BMI loss was greater than or equal to9 kg/m(2), dream BMI was 26.0 +/- 3.4 kg/m(2) (corresponding to a 32% loss), and maximum acceptable BMI was 29.3 +/- 4.4 kg /m(2) (-23%). BMI and age were the strongest predictors of weight goals. Weight loss necessary to reach the desired targets was largely in excess of weight loss observed during previous dieting. Psychiatric distress, body dissatisfaction, and binge eating did not predict weight loss expectations. The primary motivation for weight loss was concern for future or present health; women seeking treatment to improve appearance had a lower grade of obesity, were younger, and had first attempted weight loss at a younger age.Discussion: Obese Italian patients had unrealistic weight loss expectations. There were significant disparities between patients' perceptions and physicians' weight loss recommendations of desirable treatment outcome
The metabolic syndrome in treatment-seeking obese persons
No full textABSTRACT
Obesity is a major risk factor for several metabolic diseases, frequently clustering to form the metabolic syndrome, carrying a high risk of cardiovascular mortality. We aimed to assess the prevalence of the metabolic syndrome in treatment-seeking obese subjects, and the potential protective effect of physical activity. A cross-sectional analysis of data from a large Italian database of treatment-seeking obese subjects was carried out. The metabolic syndrome was defined according to the criteria provisionally set by the National Cholesterol Education Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults, based on waist circumference, fasting glucose, triglyceride and HDL-cholesterol levels, and arterial pressure. Data were available in1889 patients, 78% females, from 25 obesity centres. Minimum criteria for the metabolic syndrome were fulfilled in 53% of cases. The prevalence increased with age and obesity class, and was negatively associated with the participation to a structured program of physical activity (odds ratio, 0.76; 0.58 – 0.99; P = 0.041), after correction for age, sex and body mass. The prevalence of cardiovascular disease was higher in subjects with the metabolic syndrome. A subset of 12.8% of cases had no metabolic abnormalities. They had a lower prevalence of abdominal obesity and cardiovascular disease. Isolated obesity was significantly associated with physical activity (odds ratio, 1.86; 1.33 – 2.60; P = 0.0003). Multiple metabolic disorders are present in most obese patients, and their prevalence is lower in physically active subjects. It is time to move towards a more integrated approach and to reconsider resource allocation to improve lifestyle changes for a large-scale control of obesity
Construct Validity of the Short Form-36 Health Survey and Its Relationship with BMI in Obese Outpatients
Get PDFObjective: To investigate the construct validity of the Short
Form-36 (SF-36) Health Survey questionnaire in obese patients.
Research Methods and Procedures: Our series consisted of
1735 obese patients (age, 44.7 11.0 years; 1346 women)
consecutively enrolled in the QUOVADIS study, an observational
multicenter study of obese treatment-seeking outpatients.
The construct validity of the SF-36 was assessed
by main component analysis. Age-, gender-, and educationadjusted
general linear models were used to investigate the
relationship between BMI and SF-36 domains or factors
identified by main component analysis.
Results: BMI was significantly associated with poor healthrelated
quality of life in all eight SF-36 domains, and the
strongest association was observed with physical activity.
Main components analysis generated a six-factor solution
explaining 59% of the observed variance. BMI was strongly
associated with factors based on the loading of items regarding
the physical activity domain and factors based on
role-physical and role-emotional items or general health and
bodily pain items. In contrast, mental health-, vitality-, and
social functioning-based factors were not related to BMI.
Discussion: In obese treatment-seeking outpatients, the
clustering of SF-36 items in main components is not significantly
different from the domain-based approach generally
used, thus confirming the robustness of such a generic
questionnaire in this specific condition. However, the peculiar
clustering of some SF-36 items and their relationship
with BMI suggest that the health-related quality of life
profile of subjects belonging to that population may be
better described with alternative aggregations of the SF-36
items or with disease-tailored questionnaires
WEIGHT LOSS EXPECTATIONS IN OBESE PATIENTS SEEKING TREATMENT AT MEDICAL CENTERS
No full textObjective: To investigate weight loss expectations (expected
1-year BMI loss, dream BMI, and maximum acceptable
BMI) in obese patients seeking treatment and to examine
whether expectations differ by sex, weight, diet and
weight history, age, psychological factors, and primary motivations
for weight loss.
Research Methods and Procedures: 1891 obese patients
seeking treatment in 25 Italian medical centers (1473 women;
age, 44.7 11.0 years; BMI, 38.2 6.5 kg/m2) were
evaluated. Diet and weight history, weight loss expectations,
and primary motivation for seeking treatment (health
or improving appearance) were systematically recorded.
Psychiatric distress, binge eating, and body image dissatisfaction
were tested by self-administered questionnaires
(Symptom CheckList-90, Binge Eating Scale, and Body
Uneasiness Test).
Results: In 1011 cases (53.4%), 1-year expected BMI loss
was 9 kg/m2, dream BMI was 26.0 3.4 kg/m2 (corresponding
to a 32% loss), and maximum acceptable BMI was
29.3 4.4 kg/m2 (23%). BMI and age were the strongest
predictors of weight goals. Weight loss necessary to reach
the desired targets was largely in excess of weight loss
observed during previous dieting. Psychiatric distress, body
dissatisfaction, and binge eating did not predict weight loss
expectations. The primary motivation for weight loss was
concern for future or present health; women seeking treatment
to improve appearance had a lower grade of obesity,
were younger, and had first attempted weight loss at a
younger age.
Discussion: Obese Italian patients had unrealistic weight
loss expectations. There were significant disparities between
patients’ perceptions and physicians’ weight loss
recommendations of desirable treatment outcome
Clinical and psychological correlates of health-related quality of life in obese patients
Get PDFAbstract Background Health-related quality of life (HRQL) is poor in obese subjects and is a relevant outcome in intervention studies. We aimed to determine factors associated with poor HRQL in obese patients seeking weight loss in medical units, outside specific research projects. Methods HRQL, together with a number of demographic and clinical parameters, was studied with generic (SF-36, PGWB) and disease-specific (ORWELL-97) questionnaires in an unselected sample of 1,886 (1,494 women; 392 men) obese (BMI > 30 kg/m2) patients aged 20-65 years attending 25 medical units scattered throughout Italy. The clinics provide weight loss treatment using different programs. General psychopathology (SCL-90 questionnaire), the presence of binge eating (Binge Eating scale), previous weight cycling and somatic comorbidity (Charlson's index) were also determined. Scores on SF-36 and PGWB were compared with Italian population norms, and their association with putative determinants of HRQL after adjustment for confounders was assessed through logistic regression analysis. Results HRQL scores were significantly lower in women than in men. A greater impairment of quality of life was observed in relation to increasing BMI class, concurrent psychopathology, associated somatic diseases, binge eating, and weight cycling. In multivariate analysis, psychopathology (presence of previously-diagnosed mental disorders and/or elevated scores on SCL-90) was associated with lower HRQL scores on both psychosocial and somatic domains; somatic diseases and higher BMI, after adjustment for confounders, were associated with impairment of physical domains, while binge eating and weight cycling appeared to affect psychosocial domains only. Conclusions Psychopathological disturbances are the most relevant factors associated with poor HRQL in obese patients, affecting not only psychosocial, but also physical domains, largely independent of the severity of obesity. Psychological/psychiatric interventions are essential for a comprehensive treatment of obesity, and to improve treatment outcome and to reduce the burden of disease.</p
Psychological Distress in Morbid Obesity in Relation to Weight History
Get PDFBackground: Very few data are available on psychological
distress in morbidly obese subjects in relation
to the history of their weight. In subjects with childhood
obesity, psychological distress might be better
than in adult-onset obesity, because of progressive
adaptation to the social stigma.
Methods: Psychological distress was tested in relation
to BMI at age 20 years (BMI-20), weight history
and somatic co-morbidities in 632 treatment-seeking,
morbidly obese participants from the QUOVADIS
cohort (130 men, 502 women; mean age 45.5 years).
The number of dieting attempts/year, BMI increase
and cumulative BMI loss since age 20 were calculated
as weight cycling parameters.The Symptom Check
List-90 (SCL-90), the Psychological General Well-
Being (PGWB), the Binge-Eating Scale, and the
ORWELL-97 questionnaire were used to score psychometry
and health-related quality of life (HRQL).
Complications were quantitatively assessed by a
modified Charlson’s score.
Results: BMI-20 was normal in 35% of cases and >35
kg/m2 in only 14%. Psychometric scores were not different
in relation to BMI-20, when corrected for age,
with the exception of the General Health scale of
PGWB, showing a greater distress in subjects with
normal BMI-20. In most cases, the prevalence of
pathological results of questionnaires showed a Jshaped
curve, with participants with normal BMI-20 or
those with Class II-III obesity in early adulthood having
the highest prevalence of psychological/psychiatric
distress and poor HRQL.Weight cycling was a risk factor
for binge-eating, depression and interpersonal
sensitivity in SCL-90, whereas somatic co-morbidities
adversely affected most SCL-90 and all PGWB scales.
Conclusion: Weight cycling and somatic co-morbidities,
but not age of onset of obesity, are the main
factors negatively influencing psychological health in
treatment-seeking, morbidly obese subjects
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