15 research outputs found
Weight management, psychological distress and binge eating in obesity. A reappraisal of the problem
The psychological effects of dieting and weight loss have been an area of controversy in obesity. As part of
a large multicenter study involving 1944 obese subjects seeking treatment at Italian medical centers, we
investigated the effects of weight loss on psychological distress and binge eating in 500 subjects
remaining in continuous treatment at different centers with slightly different strategies (78.8% females;
age: M = 46.2 years, SD = 10.8; BMI: M = 37.3 kg/m2, SD = 5.6). At baseline and after 12 months all
subjects were evaluated by the SymptomCheckList-90 Global Severity Index (SCL-GSI) and by the Binge
Eating Scale (BES). In both males and females, weight loss was associated with improved psychometric
testing. Changes in SCL-GSI were associated with changes in BMI (b = 0.13; t = 2.85; p < 0.005), after
adjustment for age, gender, initial BMI and center variability. Similarly, BES changes were associated
with BMI change (b = 0.15; t = 3.21; p < 0.001). We conclude that in subjects compliant to follow-up a
successful management of obesity, not directly addressing psychological distress, is associated with a
significant improvement of both psychological distress and binge eating, linearly related to the amount
of weight loss, independently of treatment procedures
The Metabolic Syndrome in Treatment-Seeking Obese Persons
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 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 Effect of Obesity Management on Body Image in Patients Seeking Treatment at Medical Centers
treatment-
seeking patients with obesity. We aimed to investigate
the effects of obesity management on body image in patients
with obesity attending Italian medical centers for
weight loss programs.
Research Methods and Procedures: A total of 473 obese
patients seeking treatment in 13 Italian medical centers
(80% females; age, 45.9 standard deviation 11.0 years;
BMI, 36.8 5.7 kg/m2) were evaluated at baseline and after
a 6-month weight loss treatment. Body uneasiness, psychiatric
distress, and binge eating were tested by Body Uneasiness
Test (BUT, Part A), Symptom CheckList-90 (SCL-
90), and Binge Eating Scale (BES), respectively.
Results: At 6-month follow-up, the percentage weight loss
was significantly higher in men (9.0 6.3%) than in
women (6.8 7.3%; p 0.010). Both men and women had
a significant improvement in BUT Global Severity Index
and in all of the BUT subscales with the exception of the
Compulsive Self-Monitoring subscale. Linear regression
analysis selected baseline psychological and behavioral
measures (global score of BUT and SCL-90) and improved
psychiatric distress and binge eating as independent predictors
of changes in basal body dissatisfaction in females,
whereas in males, changes were associated only with baseline
BUT-Global Severity Index score, binge eating, and its
treatment-associated improvement. Pre-treatment BMI and
BMI changes did not enter the regression.
Discussion: Obesity treatment, even with a modest degree
of weight loss, is associated with a significant improvement
of body image, in both females and males. This effect
depends mainly on psychological factors, not on the amount
of weight loss
Weight Loss Expectations in Obese Patients and Treatment Attrition: An Observational Multicenter Study
Objective: To investigate the influence of weight loss expectations
(expected 1-year BMI loss, dream and maximum
acceptable BMI) on attrition in obese patients seeking treatment.
Research Methods and Procedures: Obese subjects (1785;
1393 women; median age, 46 years; median BMI, 36.7
kg/m2) seeking treatment in 23 medical Italian centers were
evaluated. Baseline 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 at baseline by self-administered
questionnaires (Symptom Check List-90, Binge Eating
Scale, and Body Uneasiness Test). Attrition and BMI
change at 12 months were prospectively recorded.
Results: At 12 months, 923 of 1785 patients (51.7%) had
discontinued treatment. Compared with continuers, dropouts
had a significantly lower age, a lower age at first
dieting, lower dream BMI, a higher expected 1-year BMI
loss, and a higher weight phobia. At logistic regression
analysis, the strongest predictors of attrition at 12 months
were lower age and higher expected 1-year BMI loss. The
risk of drop-out increased systematically for unit increase in
expected BMI loss at 12 months (hazard ratio, 1.12; 95%
confidence interval, 1.04 to 1.20; p 0.0018). The risk was
particularly elevated in the first 6 months.
Discussion: Baseline weight loss expectations are independent
cognitive predictors of attrition in obese patients entering
a weight-losing program; the higher the expectations,
the higher attrition at 12 months. Unrealistic weight goals
should be tackled at the very beginning of treatment
Weight loss and clinical characteristics of young adults patients seeking treatment at medical centers: Data from the QUOVADIS Study
OBJECTIVE: To compare clinical characteristics, attrition, weight loss, and psychological
changes of obese young adults and obese adults seeking treatment. MATERIALS
AND METHODS: 1530 individuals seeking treatment in 18 Italian medical centers were evaluated.
382 cases (25%) were classified as young adults (age≤35 years), 1148 (75%) as adults (>35
years). Psychological distress, binge eating, body uneasiness, and attitude towards eating were
evaluated, at baseline and after a 12-month weight-loss program, together with BMI
changes. Weight-loss expectations and primary motivation for seeking treatment were also
recorded. RESULTS: At baseline, young adults reported significantly higher BMI at age 20,
weight loss expectations and body uneasiness scores than adults. A significantly higher percentage
of young adults also reported improving appearance as primary reason for seeking
treatment. The attrition rate was significantly larger in young adults. Among completers, the
mean percent weight loss at 12 months and improvement of psychosocial variables were significantly
higher in young adults than in adults. By intention to treat, BMI changes were no
longer significant between groups. DISCUSSION: Obese young adults lose more weight
and considerably improve psychological distress, but show a higher attrition rate after 12
months of continuous care in a real world medical setting
Clinical and psychological correlates of health-related quality of life in obese patients
<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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/m<sup>2</sup>) 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.</p> <p>Results</p> <p>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.</p> <p>Conclusions</p> <p>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
Snoring, hypertension and Type 2 diabetes in obesity. Protection by physical activity
Sleep-related breathing disorders are recognized as major health problems in obesity. They are involved in both hypertension and Type 2 diabetes, through mechanisms 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 behavioral data were assessed by standardized questionnaires. Consecutive data of 1890 obese patients were analyzed [average body mass index (BMI), 38.2 kg/m(2), median age: 46 yr, 78% females], from 25 obesity Italian centers, with low prevalence of clinical manifestations of cardiovascular disease. Habitual snoring was reported in 56% of the 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 the age of 20, 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 protection on both snoring and complications. These data underline the importance of lifestyle interventions to limit the burden of obesity and associated diseases.ABSTRACT. Sleep-related breathing disorders
are recognized as major health problems in obesity.
They are involved in both hypertension and
Type 2 diabetes, through mechanisms 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 treatmentseeking
obese subjects. Clinical and behavioral
data were assessed by standardized questionnaires.
Consecutive data of 1890 obese patients
were analyzed [average body mass index (BMI),
38.2 kg/m2, median age: 46 yr, 78% females], from
25 obesity Italian centers, with low prevalence of
clinical manifestations of cardiovascular disease.
Habitual snoring was reported in 56% of the 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 the age of
20, 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 protection on both snoring and complications.
These data underline the importance of
lifestyle interventions to limit the burden of obesity
and associated diseases
Psychological Distress in Morbid Obesity in Relation to Weight History
Background: 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\u2019s 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