Psychological Factors & Obesity: Antecedents or Consequences?

Transcription

1 Psychological Factors & Obesity: Antecedents or Consequences? Food, Health, Choice & Change Dublin, June 6-7 th 2012 Barbara Stewart-Knox

2 Background Growing evidence for a relationship between psychological well-being and obesity Research has focussed on depression and/or stress Lack of research into obesity and positive, potentially protective, psychological factors Resilience ability to bounce back Mood a central stable trait related to sociability Resilience and mood likely to interact with life experiences Stewart-Knox, BPS Bull., 2005

3 Studies of obesity and stress/depression ( ) Sample WC BMI Measure Bove et al N= yrs null Lower stress PSQ Van Jaarsveld et al N=4065 Higher stress Higher stress PSS Farag et al N=78/24-72 yrs - Higher stress PSS Lahari et al N=414 null null

4 Sample WC BMI Measure Zaninotto et al N=8688/52+yrs Higher depression Lower depression Bove et al N=106/79+yrs null null SRDS Kim et al N=1229 /60-85 yrs null Lower depression GDS Rice et al N=131 /m 66 yrs Higher depression Higher depression BDI Vogelzangs et al N=2547 /70-79 yrs Higher depression null- CESDS Papelbaum et al N=217 null null BDI Ucok et al N=70/19-26 yrs null null BDI Beydoun et al N=1789/30-64 yrs Higher depression - CESD Muhtz et al N=215/30-70 yrs Higher depression - PHQ Dunbar et al N=1690/25-84 yrs Higher depression null HADS Vogelzangs et al N=2088/70-79 yrs Higher depression null CESDS Ho et al N=2604 null Lower depression GDS Moreira et al N=217/18/75 yrs Higher depression Higher depression BDI

5 LIPGENE AIM: Determine the relative contribution of cultural, demographic, lifestyle, social and psychological factors to the prevention or development of obesity and the metabolic syndrome Explore interrelationships between cofactors Identify targets for intervention Consider health promotion requirements LIP GENE

6 Qualitative Studies We didn t actually have a psychologist available at all but it would have been brilliant if we had (GB; Dietitian) suffering with her nerves, sitting at home no longer a size 8 over the death of her dad (GB; Consumer; F; 42-49) Certainly there is a huge demand for psychology services in primary care and I think a lot of the prescribing budgets could be reduced if there was access to reasonably prompt support from the psychologist (GB; GP) de Almeida et al., Nut Bull., 2006 LIP GENE

7 Survey (N=1500+) GB (n=1000)/portugal (n=500) Demographic details Lifestyle Diet (FFQ) Physical activity History of Met Syn: Blood Pressure High Cholesterol High/Low Blood Sugar Anthropometric measures BMI Waist circ (WC) Validated Scales: Resilience Scale (RS11) (Wagnild & Young, 1993) Mood Survey (Underwood & Froming,1980) Hopelessness Scale (Beck et al., 1974) Perceived Stress Scale (PSS4) (Cohen et al., 1983) Life Events Scale (LES) (Mooy et al., 2000) Duffy M et al. (in press) BMS Public Health.

8 Correlation Analysis: Results Anthropometric Measures N=1722¹ BMI (kg/m 2 ) Waist Circumference (cm) Mood Valance -.05* -.02 Mood Variability.06**.09** Mood Intensity.07**.05* Hopelessness Resilience -.19** -.05* Perceived Stress ¹ Pearson s Bivariate Correlation ** P<0.001 * P<0.05 Duffy et al. (2009) Ann. Nut. Met. Duffy M et al. (in press) BMS Public Health.

9 Mood Variability & Waist Circumference (cm) Waist Circumference (cm) Association between Mood Variability and Waist Circumference (cm) for Total Sample (N=1722) R 2 = Mood Variability W Circum (cm)

10 Mood Variability & BMI: Association between Mood Variability and BMI for Total Sample (N=1722) R 2 = 0.55 BMI BMI Mood Variability

11 Mood Intensity & Waist Circumference (cm) Association between Mood Intensity and WC (cm) for Total Sample (N=1722) WC (cm) R 2 = Mood Intensity WC (cm)

12 Mood Intensity & BMI 30 Association between Mood Intensity and BMI tor Total Sample (N=1722) 28 R 2 = 0.34 BMI BMI Mood Intensity

13 Resilience (RS11) & Waist Circumference Waist Circumference R Sq Linear = Resilience Sum (N=1000) 80.00

14 Multinomial Logistic Regression Analysis (N-1500+) Anthropometric measures body fat distribution (BMI) and waist circumference (WC) Predictor variables: Demographic information sex; age; sex/age; working/not working; and, education level (primary/secondary/tertiary) Physical/sedentary activity - week days/weekend Dietary habits - Food Frequency Questionnaire (FFQ) - 3 factors: alcohol ; healthy ; and, unhealthy Resilience Scale (RS11) Mood Survey Hopelessness Scale (BDI) Perceived Stress Scale (PSS4)- 2 factors: emotional and control Life Events Scale (LES) 5 Factors: relationships ; financial ; illness ; bereavement ; and, employment Duffy M et al. (in press) BMS Public Health.

15 Body Mass Index Waist Circumference GB β Portugal β GB β Portugal β Sex ** 0.17* Working Stat Age (Yrs) ** Ed (Yrs) ** -0.14** Age/Sex ** 0.19* Relationships Financial Illness 0.13** ** 0.05 Bereavement Employment Sedentary act 0.13** ** 0.08 Physical act Duffy M et al. (in press) BMS Public Health.

16 Body Mass Index Waist Circumference GB β Portugal β GB β Portugal β FFQ alcohol FFQ unhealthy FFQ healthy Mood Valance Mood Intensity Mood Variability ** Hopelessness Resilience ** -0.11* Stress emotion Stress control *P<0.05, **P<0.01, 10% significant FFQ=Food Frequency Questionnaire Duffy M et al. (in press) BMS Public Health.

17 BMI Less education Illness in family Alcohol Sedentary behaviour Total = 5% GB Portugal Being older Lower resilience Total = 1% WC Being male Less education Illness in family Sedentary behaviour Lower resilience Total = 23% Being male Less education Total = 7%

18 BMI Less education Illness in family Alcohol Sedentary behaviour Total = 5% GB Portugal Being older Lower resilience Total = 1% WC Being male Less education Illness in family Sedentary behaviour Lower resilience Total = 23% Being male Less education Total = 7%

19 What are the possible mechanism/s though which psychological factors trigger/exacerbate obesity?

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21 Nutrient/brain interactions? Neurotransmitters are synthesised de novo using precursors in food: Phenethylamines - dopamine, epinephrine, norepinephrine, tyramine, octopamine Indolamines - serotonin, melatonin, tryptamine Cholinergics - acetylcholine, choline Amino acids - glutamate, aspartate, glycine, taurine, histamine, gamma-amino butyric acid (GABA)

22 The Wurtman hypothesis? Carbohydrates enhance mood through the release of tryptophan (a precursor of serotonin) (Wurtman & Wurtman, 1995) Stress-prone individuals self-medicate with high calorie carbohydrates (Corsica & Spring, 2008; Markus, 2002; Oliver et al., 2000; Macht, 1999; Steptoe et al., 1998) Obese individuals tend to binge eat when in negative mood (Chua et al., 2004) Positive mood associated with healthy eating and negative mood with unhealthy eating (Garg et al., 2007; Williams et al., 2004)

23 The Leptin hypothesis? Leptin a hormone released by adipose tissue Higher levels observed in obese May mediate glucose and fat metabolism (Nonogaki, 2000) Signals to neuro-chemicals in the central nervous system (CNS) (Halford, 2001) May stimulate SNS activity (Esler et al., 2001)

24 The cortisol/immune hypothesis? Sympathetic nervous system (SNS), inflammatory and immune system share foetal origins Chronic stress associated with abdominal obesity (Steptoe & Marmot, 2003; Bjorntrop & Rosmond, 2000) Salivary cortisol and abdominal obesity correlated (Ward et al., 2004; Rosmond et al., 2000)

25 The serotonin (5-HT) hypothesis? Abdominal obesity associated with: High 5HT activity (Eikelis et al., 2004) Schizophrenia (Basu etal., 2004) and clinical depression (McElroy, 2004) Prolonged use of anti-psychotic drugs (Vieta, 2004) Serotonin agonists increase plasma leptin and cortisol response in obese women (Oppert et al., 1997)

26 Possible Pathways to Obesity? Central Nervous System (CNS) Limbic System Immune System Acute Phase Response (APR) Cytokines Sympathetic Nervous System (SNS) Fight & Flight Response Serotonin (5HT) Leptin/Grehlin Visceral Fat Insulin Resistance

27 Possible Pathways to Obesity? Central Nervous System (CNS) Limbic System Immune System Acute Phase Response (APR) Cytokines Sympathetic Nervous System (SNS) Fight & Flight Response Serotonin (5HT) Leptin/Grehlin Visceral Fat Insulin Resistance

28 Method Sample (N=68) Healthy male (n=23) and female (n=45) volunteers aged years Measures Whole blood serotonin Anthropometry Anthropometric assessment Body Mass Index (BMI) Waist circum (WC) Dual Energy X-Ray Absorptiometry (DEXA) Total body fat Lean tissue Android fat Gynoid fat Hodge S et al. (in press) Obesity Facts.

29 Whole blood serotonin (5-HT) and body weight (N=61) (X 2 =-.262; P=0.040) Hodge S et al. (in press) Obesity Facts.

30 Whole blood serotonin (5-HT) and waist circumference (N=61) (X 2 =-.334; P=0.008) Hodge S et al. (in press) Obesity Facts.

31 Hodge S et al. (in press) Obesity Facts. DEXA Scanning

32 Hodge S et al. (in press) Obesity Facts.

33 Whole blood serotonin (5-HT) and body mass (N=62) (X 2 =-.288; P=0.022) Hodge S et al. (in press) Obesity Facts.

34 Whole blood serotonin (5-HT) and % body fat (N=62) (X 2 =-.359; P=0.004) Hodge S et al. (in press) Obesity Facts.

35 Whole blood serotonin (5-HT) and % android fat (N=62) (X 2 =-.356; P=0.004) Hodge S et al. (in press) Obesity Facts.

36 Obesity Police Fighting Obesity

37 Conclusion Positive, protective psychological factors more important than negative factors (eg. stress and depression) in determining obesity Psychological intervention required to prevent and treat obesity effectively Target - Males Older people Carers Promote - Physical activity Resilience

38 THANKS Professor Mike Gibney Professor Daniel Almeida Professor Brendan Bunting Dr Maresa Duffy Mrs Heather Parr Dr Silvia Pinhao Ms Stephanie Hodge FCNAUP LIP GENE

39 References: Theories Chua JL, Touyze S & Hill AJ (2004) Negative mood-induced overeating in obese binge eaters: an experimental study. Int J Obesity, 28, Corsica JA & Spring BJ (2008) Carbohydrate craving: a double blind, placebo-controlled test of the self medication hypothesis. Eating Behaviors, 9, Garg N et al. (2007) The influence of incidental affect on consumers food intake. J Marketing, 71, Gibson EL (2006) Emotional influences on food choice: sensory, physiological and psychological pathways. Physiology & Behavior, 89, Killgore WDS & Yurgelun-Todd DA (2006) Affect modulates appetite-related brain activity to images of food. Int J Eating Disorders, 39, Marchesini G, Bellini M, Natale S, Belsito C, Isacco S, Nuccitelli C, Pasqui F, Baraldi L, Forlandi G & Melchionda N (2003) Psychiatric distress and health related quality of life in obesity. Diabetes Nutrition and Metabolism, 16, Oliver G, Wardle J & Gibson EL (2000) Stress and food choice: a laboratory study. Psychosomatic Medicine, 62, Rose G, Kumlin L, Dimberg L, Bengtsson C, Orth-Gomer K & Cai X (2006) Work-related life events, psychological well-being and cardiovascular risk factors in male Swedish automotive workers. Occupational Medicine-Oxford, 56, Steptoe A, Lipsey Z & Wardle J (1998) Stress, hassles and variations in alcohol consumption, food choice and physical exercise: a diary study. British J Health Psychology, 3, Wurtman R & Wurtman J (1995) Brain serotonin, carbohydrate craving, obesity and depression. Obesity Research, 3, 477S-480S.