A prospective investigation of the role of stress in weight loss and weight loss maintenance in obese adults

Abstract

Obesity has been widely acknowledged as a major global health concern associated with medical, economic, and psychosocial challenges. The current understanding and treatment of obesity is suboptimal, and there is a dearth of research related to the role of psychological factors. As behavioural patterns are core contributory factors in the development, maintenance, and treatment of obesity, there is significant potential for the role of psychological research in increasing our understanding in these areas. Psychological factors that could be of relevance include stress, coping, and motivation. The first study in the present research hypothesised that increased stress amongst obese individuals would result in lower motivation to manage weight, and subsequently less successful weight loss and weight loss maintenance. The participants in this prospective study were 124 obese individuals taking part in a 12-month weight loss intervention. The results failed to reveal an association between either stress or motivation and weight loss or weight loss maintenance. However, increased stress was associated with lower self-efficacy for weight control, and significant relationships were observed between stress and motivational constructs during the follow-up phase. The second prospective study aimed to improve on the first study by using a more specialised measure of stress that also addressed coping, and by measuring the constructs over shorter periods of time (three monthly compared to yearly) amongst a subset of Study 1 participants. Significant and complicated relationships emerged between stress, coping, motivation, weight loss and weight loss maintenance, with the nature of these relationships varying depending on the time assessed and stage in treatment. The results emphasise both the significance and the complexity inherent in the relationships between these variables. The third study comprised the Research Practicum study, and provided a preliminary qualitative investigation into the role of stress and coping in five patients with anorexia nervosa. The aim of this study was to draw attention to the way in which stress may play a role not only in obesity but also in the broader conceptualisation of disordered eating. Participant responses suggested that stress was perceived to be both a cause and consequence of disordered eating. The participants were able to subjectively identify multiple mechanisms linking stress to their own disordered eating (such as understanding their disordered eating as a stress management strategy), as well as the ways in which stress interferes with recovery. Overall, the findings of the current program of research indicate that stress, coping, and motivation are relevant in the maintenance and treatment of disordered eating patterns, obesity and other clinical manifestations of disordered eating. Sufficient complexity needs to be ascribed to the way in which these variables are related. The roles of stress, coping, and motivation in weight loss, weight loss maintenance and normalising eating more broadly, fluctuate over time and may differ between and within individuals. Greater understanding of the ways in which stress relates to obesity and disordered eating, and methods to address coping skills in treatment, may contribute to improved prevention and intervention efforts in the context of these highly debilitating conditions. Show more