General psychopathology and impulsivity as the pretreatment predictors of medical nutrition therapy outcome in the overweight and obese women

Abstract

Background/Aim. Obesity is the chronic disease and health threatening condition. The number of obese people in the world has taken epidemic conditions. Medical nutritional therapy is the first choice in the treatment of obesity, but it is also accompanied with a great percentage of attrition and a significant weight regain. The aim of our study was to evaluate if psychiatric and specific psychological factors (impulsivity) could be the predictors of successful weight loss. Methods. A study sample consisted of 84 consecutive overweight/obesity women, 20 to 40 years old, who were willing to adhere to the medical nutrition therapy after the initial anthropometric measurements were performed. All participants received a personalized nutritional counseling and a daily diet treatment with 20% caloric restriction from estimated daily energy requirement. At the beginning of the study, the 90-item Symptom Check-list (SCL-90) and the 30-item Barratt Impulsiveness scale (BIS11) were administrated. At the end of six months of caloric restriction, the conventional diet therapy and control weight measurement, the patients were divided into two groups: the group I - 40 participants (48%) who lost ≥ 10% of their initial body weight (successful group) and the group II - 44 participants (52%) who lost lt 10% of their initial weight (unsuccessful). Results. There were no significant differences between groups in the demographic data (age, education level, employment, marital status), baseline anthropometric measurements, and in the general psychopathology total score. Groups I and II were significantly different in the total BIS-11 score (p lt 0.001) and in Factor II (motor impulsivity) (p lt 0.05). Conclusion. Even though the successful and unsuccessful diet responded participants did not differ in the general psychopathology and symptom dimensions, our results pointed out impulsivity as a discriminative factor between them. The total impulsivity and Factor II (motor impulsivity) as an indicator of binge eating were higher in the unsuccessfully responding overweight/obese women on the conventional diet treatment. A focus on impulsivity in a psychotherapeutic work might lead to better outcomes in the medical nutrition therapy.

Uvod/Cilj. Gojaznost je hronično oboljenje sa značajnim nepovoljnim efektima na zdravlje, a broj gojaznih osoba u svetu dostigao je epidemijske razmere. Medicinska nutritivna terapija je terapija izbora, ali je njena uspešnost ograničena zbog značajnog procenta odustajanja, kao i ponovnog dobijanja na težini koje je prate. Cilj ove studije je bio da se proceni da li psihijatrijski i specifični psihološki faktori (impulsivnost) mogu biti pokazatelji pozitivnog ishoda lečenja. Metode. Studijom je bilo obuhvaćeno ukupno 84 predgojaznih i gojaznih žena životnog doba 20-40 godina, koje su bile motivisane za medicinsku nutritivnu terapiju. Sve ispitanice su prošle individualno savetovanje i dobile dnevni plan ishrane koji je podrazumevao kalorijsku restrikciju od 20% u odnosu na procenjene dnevne energetske potrebe. Na početku studije sprovedeno je antropometrijsko merenje i primenjene su Lista simptoma od 90 pitanja (90item Symptom Check-list) i Baratova skala impulsivnosti (Barratt Impulsiveness scale (BIS-11)). Nakon šest meseci primene kalorijski restriktivnog načina ishrane ponovljena su antropometrijska merenja. Ispitanice su podeljene u dve grupe: 40 ispitanica (48%) koje su izgubile ≥ 10% od početne telesne mase (uspešne) i 44 ispitanice (52%) koje su izgubile lt 10% od početne telesne mase (neuspešne). Rezultati. Nije bilo značajne razlike između grupa ispitanica u odnosu na demografske karakteristike (godine života, stepen obrazovanja, zaposlenost, bračni status) i antropometrijske parametre na početku studije, kao i na skor opšte psihopatologije i dimenzije simptoma. Statistički značajna razlika između uspešnih i neuspešnih predgojaznih/gojaznih ispitanica dobijena je za ukupni BIS-11 skor (p lt 0.001) i za Faktor II (motorna impulsivnost) (p lt 0.05). Zaključak. Ispitanice sa ponovljenim lošim odgovorom nisu se razlikovale po opštoj psihopatologiji od onih sa uspešnim odgovorom na nutritivnu terapiju. Naši rezultati ukazuju na impulsivnost kao mogući pokazatelj ishoda lečenja. Ukupna impulsivnost i motorna impulsivnost kao indikator povremenog impulsivnog prejedanja bili su viši u grupi predgojazih/gojaznih ispitanica koje nisu postigle terapijski cilj. Psihoterapijski rad na impulsivnosti možda bi mogao doprineti boljem ishodu medicinske nutritivne terapije.