Psychological and Behavioral Correlates of Baseline BMI in the Diabetes Prevention Program (DPP)

Psychological and Behavioral Correlates of Baseline BMI in the Diabetes Prevention Program (DPP) Linda M. Delahanty , MS, RD 1 , James B. Meigs , MD, MPH 2 , Doug Hayden , MA 3 , Donald A. Williamson , PHD 4 , David M. Nathan , MD 1 and the DPP Research Group 1 Diabetes Center, Massachusetts General Hospital, Boston, Massachusetts 2 General Medicine Division, Massachusetts General Hospital, Boston, Massachusetts 3 Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts 4 Pennington Biomedical Research Center, Baton Rouge, Louisiana Abstract OBJECTIVE —To determine psychological and behavioral correlates of baseline BMI in the Diabetes Prevention Program (DPP). RESEARCH DESIGN AND METHODS —Of 1,079 DPP lifestyle intervention participants, 274 completed validated questionnaires at baseline assessing weight loss history, stage of change, self-efficacy, dietary restraint, emotional eating, binge eating, perceived stress, depression, and anxiety. RESULTS —The mean age of subjects was 52.5 years, 65% were women, and their mean BMI was 33.9 kg/m 2 . Higher BMI correlated with more frequent weight cycling ( r = 0.50, P < 0.0001) and efforts at weight loss ( r = 0.34, P < 0.0001); younger age when first overweight ( r = −0.42, P < 0.0001); lower exercise efficacy ( r = −0.15, P = 0.015); lower weight loss efficacy ( r = −0.21, P < 0.001); a less advanced stage of change for weight loss ( r = −0.12, P = 0.04); more perceived stress ( r = 0.14, P = 0.02); emotional eating ( r = 0.19, P = 0.001); poor dietary restraint ( r = −0.14, P = 0.02); binge eating frequency ( r = 0.18, P = 0.004) and severity ( r = 0.30, P < 0.0001); feeling deprived, angry, or upset while dieting ( r = 0.27, P ≤ 0.0001); and food cravings while dieting ( r = 0.31, P < 0.0001). Correlations did not differ as a function of sex; however, correlations of BMI with anxiety and low-fat diet and weight loss self-efficacy differed as a function of ethnicity. In multivariate models, binge eating severity, poor dietary restraint, and food craving were independent correlates of baseline BMI. CONCLUSIONS —Many psychological and behavioral factors are associated with higher BMI in this ethnically diverse group of men and women. Whether strategies that help patients increase levels of dietary restraint and reduce binge eating and food craving lead to long-term weight loss maintenance needs longitudinal study. BES, Binge Eating Scale DPP, Diabetes Prevention Program Footnotes Address correspondence and reprint requests to Linda M. Delahanty, MS, RD, Massachusetts General Hospital, Diabetes Center, 50 Staniford St., Suite 340, Boston, MA 02114. E-mail: ldelahanty{at}partners.org . Received for publication 2 April 2002 and accepted in revised form 7 August 2002. A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances. DIABETES CARE