CENTER ON BEHAVIORAL MEDICINE

MIND-BODY CONNECTION

PSYCHONEUROENDOCRINE

Psychoneuroendocrine:  Research Article

Psychoneuroendocrine Menu

Psychoneuroendocrine Characteristics of Common Obesity Subtypes
   
CITATION:  JM Martins, J.M., et al.  (2001) Psychoneuroendocrine characteristics of common obesity clinical subtypes.  International Journal of Obesity (2001) 25, 24▒32.

ABSTRACT: 

Objective: To relate psychological pro«les, cerebral asymmetry and the hypothalamus ▒ pituitary ▒ adrenal axis (HPA) reactivity to clinical characteristics of common obesity.

Methods: Sixty consecutive adult female overweight and obese patients attending the outpatient endocrine department were included in this study. Clinical evaluation speci«cally selected a priori the following indexes: obesity age of onset, parenthood obesity, carbohydrate craving, binge eating with purging, obesity degree (de«ned by the body mass index (BMI)đweight (kg)=height (m2)), body fat distribution (de«ned by the abdominal ▒ thigh ratio (A=T)) and initial weight loss after medical treatment. Psychological evaluation was performed with the Minnesota Multiphasic Personality Inventory (MMPI). In the last 30 patients, the Edinburgh Inventory of Manual Preference (EIMP) and the corticotrophin-releasing hormone (CRH) test were also performed.

Results: Clinical characteristics de«ned a priori were independent variables as evaluated by contingency table analysis. Factorial analysis of variance (ANOVA) revealed a signi«cantly different MMPI pro«le, according to parental obesity, with posthoc signi«cantly higher scores on the hypochondriasis (Hs), paranoia (Pa), psychasthenia (Pt) and schizophrenia (Sc) scales in patients with obese parents. Obese patients presented signi«cantly higher dichotomized manual preference indexes in relation to overweight patients. Parental obesity, binge eating behaviour with purging, body fat distribution and the dichotomized
manual preference index were independent signi«cant factors for the ACTH response in the CRH test, together explaining 41% of the response variability. Age of onset of obesity and the dichotomized manual preference index were independent and signi«cant factors for the cortisol response, together explaining 37% of its variability. A non-normal distribution was found for the ACTH response: high- and low-responders presented signi«cantly different MMPI pro«les, with high-responders presenting higher scores on all clinical scales except masculinity=femininity (Mf). 

Conclusions: Overweight=obese subjects with parental obesity present a distinctive personality pro«le and a higher ACTH response in the CRH test. Cerebral asymmetry may be a relevant factor for obesity development and is associated with the HPA reactivity. HPA reactivity is a sensitive index integrating clinical, psychological and neural asymmetric factors.

References

1 National Institutes of Health consensus development panel on the health implications of obesity. Health implications of obesity. Ann Intern Med 1985; 103: 1073 ▒ 1077.

2 Colditz GA. The economic costs of obesity. Am J Clin Nutr 1992; 55: 503 ▒ 507.

3 James WPT. A public health approach to the problem of obesity. Int J Obes Relat Metab Disord 1995; 19(Suppl 3): S37 ▒ S45.

4 Lucas AR, Beard CM, O'Fallon WM, Kurland LT. 50-year trends in the incidence of anorexia nervosa in Rochester, Minn.: a population-based study. Am J Psychiat 1991; 148: 917 ▒ 922.

5 Kendler KS, MacLean C, Neale M, Kessler R, Health A, Eaves L. The genetic epidemiology of bulimia nervosa. Am J Psychiat 1991;148: 1627 ▒ 1637.

6 Hsu LKG. Editorial: can dieting cause an eating disorder? Psychol Med 1997; 27: 509 ▒ 513.

7 Adler N. Health psychology: why do some people get sick and some stay well? A Rev Psychol 1994; 45: 229 ▒ 259.

8 Wadden TA, Stunkard AJ. Psychopathology and obesity. Ann NY Acad Sci 1987; 499: 55 ▒ 65.

9 Wurtman JJ, Wurtman RJ, Growdon JH, Henry P, Lipscomb A, Zeisel SH. Carbohydrate craving in obese people: suppression by treatments affecting serotoninergic transmission. Int J Eating Disord 1981; 1: 2 ▒ 15.

10 Stunkard AJ. Eating patterns and obesity. Psychiat Q 1959; 33:284 ▒ 295.

11 Crumpton E,Wine DB, Groot H. MMPI pro«les of obese men and six other diagnostic categories. Psychol Rep 1966; 19: 1110.

12 Pomerantz AS, Greenberg I, Blackburn GL. MMPI pro«les of obese men and women. Psychol Rep 1977; 41: 731 ▒ 734.

13 Williamson DA, Kelley ML, Davis CJ, Ruggiero L, Bluoin DC. Psychopathology of eating disorders: a controlled comparison of bulimic, obese and normal subjects. J Cons Clin Psychol 1985; 53:161 ▒ 166.

14 Telch CF, Agras WS. Obesity, binge eating and psychopathology: are they related? Int J Eating Disord 1994; 15: 53 ▒ 61.

15 Korkeila M, Kaprio J, Rissanen A, Koskenvuo M, Sorensen TIA. Predictors of major weight gain in adult «nns: stress, life satisfaction and personality traits. Int J Obes Relat Metab Disord 1998; 22:949 ▒ 957.

16 Poston WS, Ericsson M, Linder J, Nilsson T, Goodrick GK, Foreyt JP. Personality and the prediction of weight loss and relapse in the treatment of obesity. Int J Eating Disord 1999; 25: 301 ▒ 309.

17 Pasquali R, Cantobelli S, Casimirri F, Capelli M, Bortoluzzi L, Flamia R, Labate MM, Barbara L. The hypothalamic ▒ pituitary ▒ adrenal axis in obese women with different patterns of body fat distribution. J Clin Endocrinol Metab 1993; 77: 341 ▒ 346.

18 Rosmond R, Dallman MF, Bjorntorp P. Stress-related cortisol secretion in men: relationships with abdominal obesity and endocrine, metabolic and hemodynamic abnormalities. J Clin Endocrinol Metab 1998; 83: 1853 ▒ 1859.

19 Bjorntorp P. Neuroendocrine anomalies. In: Angel A, Anderson H, Bouchard C, Lau D, Leiter L, Mendelson R (eds). Progress in Obesity Research: 7. J Libbey: London; 1996. pp 153 ▒ 159.

20 Rosmond R, Bjorntorp P. Psychosocial and socio-economic factors in women and their relationship to obesity and regional body fat distribution. Int J Obes Relat Metab Disord 1999; 23:138 ▒ 145.

21 Gold PW, Gwirtsman H, Avgerinos PC, Nieman LK, Gallucci WT, Kaye W et al. Abnormal hypothalamic ▒ pituitary ▒ adrenal function in anorexia nervosa. New Engl J Med 1986; 314: 1335 ▒ 1342.

22 Gold PW, Loriaux L, Roy A, Kling MA, Calabrese JR, Kellner CH et al. Responses to corticotropin-releasing hormone in the hypercortisolism of depression and Cushing's disease. New Engl J Med 1986; 314: 1329 ▒ 1334.

23 Nemeroff CB, Widerlov E, Bissette G, Walleus H, Karlsson I, Eklund K et al.  Elevated concentrations of CSF corticotropinreleasing factor-like immunoreactivity in depressed patients. Science 1984; 226: 1342 ▒ 1344.

24 Rosmond R, Eriksson E, Bjorntorp P. Personality disorders in relation to anthropometric, endocrine and metabolic factors. J Endocrinol Invest 1999; 22: 279 ▒ 288.

25 Geschwind N, Galaburda AM. Cerebral lateralization. Biological mechanisms, associations and pathology. I. A hypothesis and program for research. Arch Neurol 1985; 42:428 ▒ 459.

26 Geschwind N, Galaburda AM. Cerebral lateralization. Biological mechanisms, associations and pathology: II. A hypothesis and program for research. Arch Neurol 1985; 42: 521 ▒ 552.

27 Geschwind N, Galaburda AM. Cerebral lateralization. Biological mechanisms, associations and pathology: III. A hypothesis and program for research. Arch Neurol 1985; 42: 634 ▒ 654.

28 Witling W. Psychophysiological correlates of human brain asymmetry: blood pressure changes during lateralized presentation of emotionally laden «lm. Neuropsychologia 1990; 28: 457 ▒ 470.

29 WitlingW, P»uger M. Neuroendocrine hemispheric asymmetries: salivary cortisol secretion during lateralized viewing of emotionrelated and neutral «lms. Brain Cogn 1990; 14: 243 ▒ 265.

30 Weisz J, Balazs L, Adam G. Hemispheric preference and obesity. Neuropsychologia 1990; 28: 1261 ▒ 1271.

31 Martins JM, Carreiras F, Falca─o J, Afonso A, da Costa JC. Dyslipidaemia in female overweight and obese patients. Relation to anthropometric and endocrine factors. Int J Obes Relat Metab Disord 1998; 22: 164 ▒ 170.

32 Williamson DA, Davis CJ, Duchmann EG, McKenzie SJ, Watkins PC. Assessment of Eating Disorders. Pergamon Press: New York; 1990.

33 Van der Kooy K, Seidell JC. Techniques for the measurement of visceral fat: a practical guide. Int J Obes Relat Metab Disord 1993; 17: 187 ▒ 196.

34 Montenegro A. Inventa┬rio multifa┬sico de personalidade do Minnesota. Traduc╦a─o portuguesa. Universidade de Coimbra: Coimbra; 1982.

35 Old«eld RC. The assessment and analysis of handedness: the Edinburgh inventory. Neuropsychologia 1971; 9: 97 ▒ 113.

36 Wonnacott TH, Wonnacott RJ. Introductory Statistics, 4th edn. Wiley: New York; 1990.

37 Norman GR, Streiner DL. Biostatistics. The Bare Essentials. Mosby-Year Book: St. Louis; 1994.

38 Leibowitz SF. Brain neurotransmitters and hormones in relation to eating behavior and its disorders. In: Bjorntorp P, Brodoff BN (eds). Obesity. JB Lippincott Company: Philadelphia, A; 1992. pp 184 ▒ 205.

39 MacDonald IA. Energy expenditure in humans: the in»uence of activity, diet and the sympathetic nervous system. In: Kopelman PG, Stock MJ (eds). Clinical Obesity. Blackwell Science: Oxford; 1988. pp 112 ▒ 128. 

40 Brownell KD, Kramer FM. Behavioral management of obesity. Med Clin N Am 1989; 73: 185 ▒ 201.

41 Vague J. Obesities. Libbey: London; 1991.

42 Bray GA. Classi«cation and evaluation of the obesities. Med Clin N Am 1989; 73: 161 ▒ 184.

43 Wadden TA. The treatment of obesity: an overview. In: Stunkard AJ, Wadden TA (eds). Obesity. Theory and Therapy, 2nd edn. Raven Press: New York; 1993. pp 197 ▒ 217.

44 Mills JK, Andrianopoulos GD. The relationship between childhood onset obesity and psychopathology in adulthood. J Psychol 1993; 127: 547 ▒ 551.

45 Mills JK. A note on the interpersonal sensitivity and psychotic symptomatology in obese adult outpatients with a history of childhood obesity. J Psychol 1995; 129: 345 ▒ 348.

46 Molinari E, Ragazzoni P, Morosin A. Psychopathology in obese subjects with and without binge-eating disorder and in bulimic subjects. Psychol Rep 1997; 80: 1327 ▒ 1335.

47 Antony MM, Johnson WG, Carr-Nangle RE, Abel JL. Psychopathology correlates of binge eating and binge eating disorder. Comp Psychiat 1994; 35: 386 ▒ 392.

48 Wurtman JJ. Disorders of food intake: excessive carbohydrate snack intake among a class of obese people. Ann NY Acad Sci 1987; 499: 197 ▒ 202.

49 Annett M. A classi«cation of hand preference by association analysis. Br J Psychol 1970; 61: 303 ▒ 321.

50 Derryberry D. Right hemispheric sensitivity to feedback. Neuropsychologia 1990; 28: 883 ▒ 887.

51 Bertagna X, Coste J, Raux-Demay MC, Letrait M, Strauch G. The combined corticotropin-releasing hormone=lysine vasopressin test discloses a corticotroph phenotype. J Clin Endocrinol Metab 1994; 79: 390 ▒ 394.

52 Kirschbaum C, Wust S, Faig H-G, Hellhammer DH. Heritability of cortisol responses to human corticotropin-releasing hormone, ergometry, and psychological stress in humans. J Clin Endocrinol Metab 1992; 75: 1526 ▒ 1530.

53 Meaney MJ, Bhatnagar S, Larocque S, McCormick C, Shanks N, Sharma S et al. Individual differences in the hypothalamic ▒ pituitary ▒ adrenal stress response and the hypothalamic CRF system. Ann NY Acad Sci 1993; 697: 70 ▒ 85.

54 Saudino KJ, Plomin R. Personality and behavioral genetics: where have we been and where are we going? J Res Personality 1996; 30:335 ▒ 347.

55 Zuckerman M. Measures and models, problems and progress. In: Psychobiology of Personality. Cambridge University Press: Cambridge; 1994. pp 399 ▒ 428.