Department of Bariatric & Metabolic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
BMC Public Health. 2024 Mar 1;24(1):653. doi: 10.1186/s12889-024-18015-w.
Bulimia, which means a person has episodes of eating a very large amount of food (bingeing) during which the person feels a loss of control over their eating, is the most primitive reason for being overweight and obese. The extended literature has indicated that childhood emotional abuse has a close relationship with adverse mood states, bulimia, and obesity. To comprehensively understand the potential links among these factors, we evaluated a multiple mediation model in which anxiety/depression and bulimia were mediators between childhood emotional abuse and body mass index (BMI). A set of self-report questionnaires, including the Childhood Trauma Questionnaire (CTQ), Beck Anxiety Inventory, Beck Depression Inventory (BDI), and Eating Disorder Inventory (EDI), was sent out. Clinical data from 37 obese patients (age: 29.65 ± 5.35, body mass index (BMI): 37.59 ± 6.34) and 37 demographically well-matched healthy people with normal body weight (age: 31.35 ± 10.84, BMI: 22.16 ± 3.69) were included in the investigation. We first performed an independent t-test to compare all scales or subscale scores between the two groups. Then, we conducted Pearson correlation analysis to test every two variables' pairwise correlation. Finally, multiple mediation analysis was performed with BMI as the outcome variable, and childhood emotional abuse as the predictive variable. Pairs of anxiety, bulimia, and depression, bulimia were selected as the mediating variables in different multiple mediation models separately. The results show that the obese group reported higher childhood emotional abuse (t = 2.157, p = 0.034), worse mood state (anxiety: t = 5.466, p < 0.001; depression: t = 2.220, p = 0.030), and higher bulimia (t = 3.400, p = 0.001) than the healthy control group. Positive correlations were found in every pairwise combination of BMI, childhood emotional abuse, anxiety, and bulimia. Multiple mediation analyses indicate that childhood emotional abuse is positively linked to BMI (β = 1.312, 95% CI = 0.482-2.141). The model using anxiety and bulimia as the multiple mediating variables is attested to play roles in the relationship between childhood emotional abuse and obesity (indirect effect = 0.739, 95% CI = 0.261-1.608, 56.33% of the total effect). These findings confirm that childhood emotional abuse contributes to adulthood obesity through the multiple mediating effects of anxiety and bulimia. The present study adds another potential model to facilitate our understanding of the eating psychopathology of obesity.
贪食症，即一个人在暴食期间会出现大量进食（暴食）的情况，而在此期间，他们会感到对自己的进食失去控制，这是超重和肥胖的最原始原因。扩展文献表明，儿童期情感虐待与不良情绪状态、贪食症和肥胖密切相关。为了全面了解这些因素之间的潜在联系，我们评估了一个多重中介模型，其中焦虑/抑郁和贪食症是儿童期情感虐待与体重指数（BMI）之间的中介因素。我们发放了一套自我报告问卷，包括童年创伤问卷（CTQ）、贝克焦虑量表、贝克抑郁量表（BDI）和饮食障碍量表（EDI）。调查包括 37 名肥胖患者（年龄：29.65±5.35，体重指数（BMI）：37.59±6.34）和 37 名年龄和体重匹配的健康人（年龄：31.35±10.84，BMI：22.16±3.69）。我们首先进行独立 t 检验比较两组之间的所有量表或子量表评分。然后，我们进行了 Pearson 相关性分析，以测试每两个变量的两两相关性。最后，以 BMI 为因变量，以儿童期情感虐待为预测变量，进行多重中介分析。焦虑、贪食症和抑郁、贪食症分别作为不同多重中介模型中的中介变量进行选择。结果表明，肥胖组报告的儿童期情感虐待（t=2.157，p=0.034）、情绪状态较差（焦虑：t=5.466，p<0.001；抑郁：t=2.220，p=0.030）和较高的贪食症（t=3.400，p=0.001）高于健康对照组。BMI、儿童期情感虐待、焦虑和贪食症之间存在正相关。多重中介分析表明，儿童期情感虐待与 BMI 呈正相关（β=1.312，95%置信区间=0.482-2.141）。使用焦虑和贪食症作为多重中介变量的模型证明在儿童期情感虐待和肥胖之间的关系中发挥了作用（间接效应=0.739，95%置信区间=0.261-1.608，总效应的 56.33%）。这些发现证实，儿童期情感虐待通过焦虑和贪食症的多重中介作用导致成年肥胖。本研究为我们理解肥胖的饮食病理学增加了另一个潜在模型。
