ISSN: 1301-2193 E-ISSN: 1308-9846
  • Turkish Journal of
    Endocrinology and Metabolism

Summary

Obesity is a serious disorder and its treatment involves dietitians, psychologists, and psychiatrists. Long-term weight loss in obese subjects often has a poor outcome. A Dietetic education in association with eating behavior therapy is necessary to improve the prognosis. Among the possible etiologies of obesity, the psychological and emotional factors could have an improtant role. All subjects who took part in this study were recruited from endocrinology outpatient clinics of Baskent University Adana Hospital. All the subjects were tested for psychiatric pathology. The group involved 397 non-diabetic women (n=268) and men (n=129). Both obese and non-obese subjects were divided into four groups depending upon their personality (PERSONA test). This test defines four types of personality, based on the level of emotion (expansive or reserved) anr the degree of power (dominant or consenting). Most of the analyzing subjects were obese (83.3%). None of the controlling group was obese and most of the subjects in facilitating group were non-obese (84.7%). Analyzers were older and had higher BMI than facilitators (51.17±3.57 vs. 33.40±0.69 yr, q<0.001; 34.91±3.51 vs 24.75±0.34 kg/m2, p<0.02, respectively) and controllers (51.17±3.57 vs 26.50±2.53 yr, p<0.0001; 34.91±3.51 vs 23.40±1.57 kg/m2, p<0.01, respectively). Promoters had higher BMI than facilitators (29.40±1.04 vs 24.75±0.34 kg/m2, p<0.0001). Personalities of the individuals may affect their eating behaviors. Diet advices in respect to their personalities may be helpful to achieve long-term weight loss in obese subjects.
Keywords: obesity, personalities



Introduction

Obesity is a serious disorder and its treatment in-volves dietitians, psychologists, and psychiatrists. Long-term weight loss in obese subjects often has a poor outcome. Even specialized centers have demonstrated that success after 3 years is less than 30 % [1,2]. A dietetic education in association with eating behavior therapy is necessary to improve the prognosis [2,3]. The role of psychological issues in obesity is equivocal, and so is the fact whether emotional and behavioral disturbances are causes or consequences of an individual's overweight condition.
Retrospective studies had shown social problems, the absence of support from the entourage, work problems, social conflicts and psychological prob-lems as the reasons of failure of weight loss [4-6]. Among the possible etiologies of obesity, the psychological and emotional factors might have an important role [7]. Role of psychiatric problems in the origin of obesity is contradictory. Two studies conclude that psychiatric problems are no more prevalent in the obese population than they are in a non-obese population [8,9]. In another study, most obese subjects begin treatment scoring in the normal or high-normal range of depression [10]. Halmi et al. compared morbid obese patients with normal weight subjects using the DSM III criteria and did not find any difference between the groups [11]. An exception to this finding is obese subjects who also have binge eating disorders [12-14].
In the present study, we aimed to study the per-sonality types of obese subjects in order to propose therapeutic strategies adapted to their personality.


Methods

This prospective study was conducted at Baskent University Adana Hospital. Every patient was asked to participate in the study after the first consultation. All the patients were tested for psychiatric pathology as usually clinical screening by a multidisciplinary medical team involving an endocrinologist, a family practioner, a psychiatrist, nurses and dieticians. Those presenting a psychiatric pathology were excluded from the study. The group involved 397 non-diabetic women (n=268) and men (n=129). Weight and height were mea-sured with the patient in light clothes and without shoes.
All subjects were asked to fill out the PERSONA questionnaire. Charles Osgood built the test accor-ding to Carl Jung’s theory defining four funda-mental interpersonal needs: Appreciation (being recognized as a unique individual, distinct from others), Admission (being affiliated to groups in a climate of consensus), Realization (accomplishing results, challenging oneself), and Security (mana-ging accountable exchanges on the basis of tested analysis). These four interpersonal behaviors de-pend upon two fundamental dimensions: power relationship and level of emotion [15,16]. People establish power relationship in their exchanges by being either dominant or consenting. They develop a level of emotion by showing themselves rather expansive or rather reserved with their interlo-cutors.
The PERSONA test involves 60 items in pairs of opposite words which establish the power rela-tionship in people’s exchanges (either dominant or consenting) and the level of emotion (rather expansive or rather reserved). The interpretation of the test allows for the differentiation of four per-sonality types (Table 1).
Table 1: Characteristics of four social types.
The Promoting type (dominant and expansive) is open-minded, creative and quick with his deci-sions. These are multiple and are made without much research. The promoting type shows himself to be open to exchange, to dialog, to new ideas; he anticipates. His interpersonal need is appreciation. The Controlling type (dominant and reserved) pri-marily seeks realization and efficiency. He makes a single decision, often his own quickly and after reflection. He is characterized by his authenticity and honesty, which explains that he is sometimes ill-received. His interpersonal need is realization. The Facilitating type (consenting and expansive) likes society and his inclusion within it. He always shares your opinion and makes his decisions per-ceptively after numerous hesitations. His inter-personal need is admission. The Analyzing type (consenting and reserved) seeks security. Very trust on way, he lacks openness and creativity. He makes a single decision after a long reflection. His interpersonal need is security. the validation analysis indicated 81% of the common variance between items [16]. The PERSONA test may be used in obesity and diabetes clinics to improve the compliance in both obese and diabetic patients [17].
Statistical analysis was done using SPSS software, version 9.05 (SPSS, Inc., Chicago, Illinois, USA). The numeric variables are given as means ± standard deviation (SD), the categorical variables as percentage and p values less than 0.05 were considered significant. Differences between four groups were analyzed by one-way analysis of variance (ANOVA) and x2 test or Fisher’s Exact test, and comparisons of the groups with each other were analyzed by independent students t test or Mann-Whitney U test where appropriate; homo-geneity of variance was assessed with Levene’s test. Linear or logistic regression analysis was performed to determine independent risk factors for obesity.


Results

The obese patients in our study are unequally distributed according to their social styles (Table 2). Most of the analyzing subjects were obese (80%). None of the controlling group was obese and most of the subjects in facilitating group were non-obese (85.5%). Analyzers were older and had higher BMI than facilitators (49.20±3.65 vs 33.31±0.68 year, p<0.006; 34.91±3.51 vs 24.75±0.34 kg/m2, p<0.002, respectively) and controllers (49.20±3.65 vs 26.50±2.53 yr, p<0.003; 34.91±3.51 vs 22.13±1.13 kg/m2, p<0.03, respectively). Pro-moters were older and had higher BMI than facilitators (37.83±2.26 vs 33.31±0.68 year, p<0.05; 29.39±1.05 vs 24.62±0.34 kg/m2, p<0.0001, res-pectively), more obese than controllers (29.39±1.05 vs 22.13±1.13 kg/m2, p<0.04), and younger than analyzers (49.20±3.65 vs 37.83±2.26 year, p<0.02). Obese subjects were older than non-obese subjects (44.79±1.58 vs 31.50±0.64 year, p<0.0001). In regression analysis, age (p<0.0001) and personality (p<0.02) found as risk factors for obesity.
Table 2: Physical characteristics of subjects


Discussion

Discussion In present study, we have attempted to better understand the obese patient by looking for psychopathological troubles and/or disorders of eating behavior according to their personality. Our research shows an inequality in the distribution of obese patients according to their social style. Most of the analyzing subjects were obese. They like to eat traditional foods with their families and tra-ditional foods in our region contain high amounts of fat and carbohydrate. They also make systematic dietary errors, eat in regular, an even routine manner and this is how dietetic errors are passed from generation to generation. Alcoholism, among analyzing subjects, tends to be the solitary kind. Drinking also becomes routine, and alcohol may be used as antidepressant or to help for sleeping.
In our study, none of the controlling group was obese and most of the subjects in facilitating group were non-obese. Controllers think that eating is a waste of time. The present moment is what counts for them and they do not like meals to drag out. They eat because of necessity. They drink dis-creetly thinking that they have the situation under control. Detecting alcoholism in controllers is difficult, only very rarely does a controller have too much to drink. Facilitators like eating out with friends. They do not like to be alone while eating because, for them, food represents sharing. They enjoy trading recipes, and sharing meals and impressions with their inner circle. One of the problems that they have is, not knowing how to turn down an invitation. If their friends or members of family eat high calorie diets and drink alcohol, the facilitators also eat and drink with them. They like social life and share good times with their relatives and friends. Probably those obese facilitators in our study belong to a com-munity in which eating is a kind of pleasure.
Analyzers were older than facilitators and con-trollers. In the literature we did not find any study showing the change of personalities of people by age. This difference may be due to a change in their personality, as one has more experience.
Unfortunately economical conditions in Turkey worsen. Life is getting more complex and difficult, this may force people to be more self-possessed and also eat traditional carbohydrate rich foods.
Promoters eat for pleasure. They like good food and they are always on the lookout for a new gourmet restaurant. They like different and exotic dishes, and many of them have a little black book with all their favorite places to eat. They are a gourmet and the way dishes are presented, as well as the decor of a restaurant are very important to them. They enjoy good company. They do not necessarily have a drink every day, but if the occasion arises and they are having is good, they are capable of carried away. They may spend more time for eating than controllers, because of their social status, and this may be the reason for their obesity.
Obese subjects were older than non-obese subjects. This may due to decreased metabolic rate and that older people follow traditions more than young ones. Probably they eat traditional foods often, have less physical exercise and have less metabolic rate. In regression analysis we found age and personality as independent risk factor for obesity. This finding also confirms the opinion mentioned above. As a conclusion, age and personalities of the individuals may affect their eating behaviors. Diet advices in respect to their personalities may be helpful to achieve long-term weight loss in obese subjects.


References

1) Levy AS, Heaton AW. Weight control practices of U.S. adults trying to lose weight. Ann Intern Med 119: 661-666, 1993.
2) Wadden TA, Stunkard AJ, Liebschutz J. Three years follow-up of the treatment of obesity by very low calorie diet, behavior therapy and their combination. J Consult Clin Psychol 56: 925-928, 1988.
3) Wadden TA, Foster GD, Letizia KA. One year behavioral treatment of obesity: comparison of moderate and severe caloric restrictions and effects of weight maintenance therapy. J Consult Clin Psychol 62: 165-171, 1994.
4) Jeffery RW, Bjornson-Benson WM, Rosenthal BS, Lindquist RA, Kurth CL, Johnson SL. Correlates of weight loss and its maintenance over two years of follow-up among middle-aged men. Prev Med 13: 155-168, 1984.
5) Marston AR, Criss J. Maintenance of successful weight loss: incidence and prediction. Int J Obes 8: 435-439, 1984.
6) Holt CL, Clark EM, Kreuter MW. Weight locus of control and weight-related attitudes and behaviors in an overweight population. Addict Behav 26: 329-340, 2001.
7) Wadden TA, Stunkart AJ. Social and psychological con-sequences of obesity. Ann Intern Med 103: 1062-1067, 1985.
8) Kittel F, Rustin RM, Dramaix M, de Backer G, Kornitzer M. Psychosocio-biological correlates of moderate over-weight in an industrial population. J Psychosom Res 22: 145-149, 1978.
9) Hallstrom T, Noppa H. Obesity in women in relation to mental illness, social factors and personality traits. J Psychol Res 25: 75-82, 1981.
10) Telch CF, Agras WS. Obesity, binge eating and psycho-pathology. Int J Eat Disord 15: 53-62, 1994.
11) Halmi KA, Long M, Stunkard AJ. Psychiatric diagnosis of morbidly obese gastric bypass patients. Am J Psychiatry 137: 470-472, 1980.
12) Spitzer RL, Yenovski S, Wadden TA. Binge eating disorder: its further validation. Int J Eating Disord 13: 137-150, 1993.
13) Yanovski SZ. Binge eating disorders: current knowledge and future directions. Obes Res 1: 306-324, 1993.
14) Sansone RA, Wiederman MW, Sansone LA. The pre-valence of borderline personality disorder among indi-viduals with obesity: a critical review of the literature. Eating Behav 1: 93-104, 2000.
15) Osgood CE, Tannenbaum PH. The principle of congruity in the predictions of attitude change. Psychol Rev 62: 42-45, 1995.
16) Golay A, Hagon I, Painot D, Rouget P, Allaz AF, Morel Y, Nicolet J, Archinard M. Personalities and alimentary behaviors in obese patients. Pat Educ Couns 31: 103-112, 1997.
17) Golay A, Nicolet J, Hagon I, Assal J. How to improve compliance in diabetic patients. Pat Educ Couns 23: 109, 1994.