Pediatric Neurology and Psychiatry Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Regional Center for Feeding and Eating Disorders in the Developmental Age, 40138 Bologna, Italy.
Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy.
Nutrients. 2023 Sep 9;15(18):3915. doi: 10.3390/nu15183915.
Various mental health and eating behavior variables have been independently associated with predicting weight loss in individuals with obesity. This study aims to investigate a mediation model that assesses the distinct contributions of these variables in predicting weight changes in patients with obesity following an outpatient behavioral weight loss intervention (BWLI).
General mental health (depression, anxiety, stress, impulsivity), eating behavior (cognitive restraint, disinhibition, hunger), eating disorder pathology, and body mass index (BMI) were assessed in a group of 297 patients with obesity at the admission of a BWLI program. BMI was re-evaluated during the final treatment session. A mediation model was employed to examine whether mental health and eating behavior variables predicted BMI changes, with eating disorder pathology serving as a mediator. The model was tested both overall and within two patient subgroups: those with regular binge eating (≥four episodes/month) and those without.
In the overall sample (n = 238), the relationships between depression, impulsivity, and cognitive restraint with BMI change were mediated by eating disorder pathology. In the subgroup with regular binge eating (n = 99, 41.6%), the associations between stress and disinhibition with BMI change were additionally mediated by eating disorder pathology. In the subgroup without regular binge eating, eating disorder pathology showed no mediating effect.
Multiple mental health and eating behavior variables assessed at admission predicted BMI changes, particularly when mediated by eating disorder pathology in patients with regular binge eating. A comprehensive psychopathological assessment prior to starting BWLI may help identify multiple factors affecting prognosis and treatment outcomes. Long-term follow-up studies in this field are required.
多项心理健康和饮食行为变量已被独立关联，以预测肥胖个体的体重减轻。本研究旨在调查一个中介模型，评估这些变量在预测肥胖患者接受门诊行为体重减轻干预（BWLI）后的体重变化方面的独特贡献。
在 BWLI 计划的入院时，对 297 名肥胖患者的一般心理健康（抑郁、焦虑、压力、冲动）、饮食行为（认知约束、抑制失控、饥饿）、饮食障碍病理和身体质量指数（BMI）进行评估。在最后一次治疗时重新评估 BMI。采用中介模型检验心理健康和饮食行为变量是否预测 BMI 变化，以饮食障碍病理为中介。模型在总体和两个患者亚组中进行了测试：那些有规律暴食（≥每月四次）和那些没有。
在总体样本（n=238）中，抑郁、冲动和认知约束与 BMI 变化的关系受到饮食障碍病理的中介。在有规律暴食的亚组（n=99，41.6%）中，压力和抑制失控与 BMI 变化的关联也受到饮食障碍病理的中介。在没有规律暴食的亚组中，饮食障碍病理没有中介作用。
入院时评估的多项心理健康和饮食行为变量预测 BMI 变化，尤其是在有规律暴食的患者中，由饮食障碍病理介导时。在开始 BWLI 之前进行全面的心理病理评估可能有助于识别影响预后和治疗结果的多个因素。需要在该领域进行长期随访研究。
