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Psychological factors affecting obesity

Insomnia, depression and eating behaviour in bariatric candidates

Sleep disturbances and depressive symptoms may be considered as a risk factor, which contributes to unhealthy eating behaviours that might result in the development of obesity

Insomnia and depression in patients with obesity are associated with eating habits and - in some patients - these associations are major factors affecting obesity development, according to researchers from Poland. The study examined the relationship between insomnia, depressive symptoms and eating habits, as well as metabolic parameters in bariatric surgery candidates.

The paper, ‘Insomnia and depressive symptoms in relation to unhealthy eating behaviors in bariatric surgery candidates’, published in BMC Psychiatry by researchers from the Medical University of Warsaw, Warsaw, Poland, hypothesised that sleep problems as assessed by Athens Insomnia Scale (AIS) are associated with unhealthy eating habits in bariatric surgery candidates. In addition, the researchers also theorised that the relationships between the insomnia and depressive symptoms, sedentary lifestyle and obstructive sleep apnoea (OSA) that often coexists with obesity - could be of importance for effective obesity treatment.

In total, 361 patients with obesity included in this study and were assessed for the severity of sleep problems (measured with AIS) and the severity of depressive symptoms (assessed with the Beck Depression Inventory (BDI-II)). Obstructive sleep apnoea (OSA) was assessed by the Apnea Hypopnoea Index (AHI), in addition to information on demographics, eating habits and lifestyle.


The mean age of the study group was 43.6 ± 11.5 years and the mean BMI was 42.3±6.4 and the majority of the participants (63%) had a BMI above 40, 28% had a BMI in the range of 35–39.9 and 9% of the subjects had a BMI in the range of 30.0–34.9. The study group had a significantly higher representation of women (73%) than men (p<0.001).

A total of 29% were diagnosed with type 2 diabetes and in 14% increased fasting glucose concentrations were found. In patients with T2D, 43% patients received hypoglycaemic drugs, 32% patients received insulin, while 25% patients received insulin and hypoglycaemic drugs. Patients with dyslipidaemia who were taking hypolipidemic drugs received statins (74%), fibrates (16%) or statins plus fibrates (10%). Despite treatment, in 42% of the patients, total cholesterol was above 190mg/dL; in 46%, LDL-cholesterol exceeded 115mg/dL; and in 21%, triglycerides levels were above 200mg/dL. Weak but statistically significant correlations were found between the AIS scores and triglycerides and glucose concentrations.

Insomnia was diagnosed in 47% (171) participants scoring ≥6 (higher cut-off score) and the authors reported no significant differences in the AIS scores between BMI-based categories of obesity (p=0.765), and no correlation was found between insomnia severity (AIS) and BMI. However, a strong correlation was noted between the AIS and BDI-II total scores (p= 0.000).

BDI-II scores showed that 3% (n=11) of participants scored 29–63, indicating severe depression, 14% (n=52) scored 20–28 indicating moderate symptoms, 19% (n=67) participants scored 14–19 corresponding to mild depression and 64% (n = 231) scored 0–13 corresponding to “minimal symptoms according to generally accepted BDI-II scores interpretation.”

Sixty-six participants (18%) reported daily consumption of snack foods and they had the highest AIS and BDI-II scores. Of the studied patients with obesity, 65% described their physical activity as low or reported no psychical activity and classified their lifestyle as sedentary. The researchers also reported that individuals who reported ‘no’, ‘low’ or ‘moderate’ physical activity had significantly higher AIS sores, compared with those with self-reported ‘high’ physical activity.

Two percent of patients reported daily episodes of eating at night, which was associated with high AIS and BDI-II scores, and 67% (n=243) reported eating in response to various emotional states. Significantly higher AIS and BDI-II scores were found in this group in comparison to the subjects who did not report eating when emotional. In addition, participants who reported more emotions (three or more) associated with a desire-to-eat had higher AIS and BDI-II scores than those who reported fewer emotions.

The researchers also reported that daily consumption of snack foods, self-reported eating in response to more than three emotions, night eating and physical inactivity were all significantly associated with clinical insomnia (AIS score ≥ 6) and depression (BDI-II score ≥ 14). Adjusted multivariate logistic regression analysis revealed that clinical insomnia was most strongly associated with daily consumption of snack foods, while depressive symptoms were strongly associated with both eating in response to ≥3 specific emotions, as well as with daily consumption of snack foods. In addition, insomnia was the strongest predictor of daily consumption of snack foods and this association was even stronger than for depression - indicating a bidirectional relation between the daily consumption of snack foods and insomnia – the researchers write.

Although the study suggests a bidirectional relation between sleep disturbances and eating habits, the researchers note that it is not clear whether sleep disturbances influence consumption of snack foods or vice versa.

“The results of the study show new data on the associations between insomnia, depression and eating behaviours in bariatric surgery candidates, and highlight the importance of the potential consequences of poor sleep or depression in obesity,” the researchers conclude. “This should stimulate further research in this area leading to the development of innovative and effective strategies for obesity prevention and treatment.”

To access this paper, please click here

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