Coping and personality in the obese. Results from the Swedish Obese Subjects Study

Abstract

The overall aims of this thesis were to evaluate coping and personality in obesity and the relation to weight change. Specific aims were to validate methods for assessing condition-specific coping and distress; to evaluate coping, distress and personality in relation to treatment preference before and 2 years after treatment start; and compare personality profiles with reference subjects. All study samples comprised participants in the Swedish Obese Subjects Intervention or Reference studies. In study 1 the Obesity-related Coping (OC) and Obesity-related Distress (OD) questionnaires were developed and evaluated in 2,510 patients, using multi-trait, exploratory and confirmatory factor analysis procedures. Study 2 is a 2-year follow-up of 1,146 surgically and 1,085 conventionally treated patients that completed the OC and OD at baseline. Within- and between-group differences were significance tested. Study 3 assessed personality, using the Karolinska Scales of Personality, in 3,270 patients. In study 4 personality traits were assessed prior to treatment and after 24 months in 1,380 surgically treated and 1,241 conventionally treated. In studies 3 and 4 results were compared with data obtained from 1,135 reference subjects. Within- and between-group differences were significance tested and effects sizes (ES) were calculated.Three coping (two adaptive/one maladaptive) and two distress factors were identified. Patients who preferred surgical treatment reported more maladaptive and less adaptive coping and, hence, more distress. Regarding personality traits at baseline obese patients were more anxiety prone, impulsive and irritable (particularly the surgical candidates) when compared to a reference group. In ES terms, though, these differences were trivial to moderate and the greatest differences could be traced to items tapping condition-specific symptoms. However, the difference in Impulsiveness could not be explained by item composition. Both obese and reference females reported more anxiety proneness compared to men (ES: small). Two years after treatment start, weight gainers decreased in both adaptive and maladaptive coping, leaving distress levels unchanged and personality traits remained mostly stable. Among patients that lost £ 20 kg a decrease was noted in maladaptive coping, distress and anxiety proneness together with an increase in Monotony Avoidance. Patients that lost ³20 kg also increased in adaptive coping, displayed even greater reduction of distress, anxiety proneness, Irritability and increase in Monotony Avoidance. However, the elevated levels of Impulsiveness remained stable in both patient groups.The use of certain coping strategies may partly explain psychological distress in obese patients and influence treatment choice. Despite the lack of coping intervention, participation in a weight program seems to reduce maladaptive coping, irrespective of treatment or weight change. Improvements in adaptive coping, however, are not as easily achieved. Concerning personality, our results did not provide any evidence of a general obese profile. Long-term weight reduction was associated with changes on practically all scales, particularly Psychasthenia. The one exception was in Impulsiveness that remained unaffected by weight change. Possible explanations are that Impulsiveness is not reflected in weight-related behaviour or that weight-reducers have found alternative ways to canalise this trait.