Access Type

Open Access Dissertation

Date of Award

January 2024

Degree Type

Dissertation

Degree Name

Ph.D.

Department

Nutrition and Food Science

First Advisor

Paul Burghardt

Abstract

Obesity is a multifaceted and complex disease. Weight loss in efforts to combat obesity often result in weight regain, posing a significant challenge to long-term weight management. This dissertation investigates the cognitive, emotional, and physiological factors contributing to weight loss maintenance, emphasizing the roles of eating behaviors, depressive symptoms, and inflammation. In a retrospective cohort study, data was collected on individuals enrolled in the Michigan Weight Management Program who consented to involvement in this research. The data was collected at baseline, post-weight loss (after 10% weight loss at 6 months), and on one-year and two-year follow-ups. The Yale Three Factor Eating Questionnaire was used to measure cognitive restraint, uncontrolled eating and emotional eating. Depressive symptoms were measured using the Inventory of Depressive Symptomatology-Self Report (IDS-SR). Serum inflammatory markers (IL-1β, IL-6, IL-8 and TNF-α) were analyzed. Statistical analyses included the use of general linear models, hierarchical logistic regression, repeated measures ANOVAs and post-hoc analysis. In the eating behaviors cohort, 51 participants out of 109 were categorized as Maintainers. Maintainers had higher cognitive restraint, lower uncontrolled and emotional eating at the one-year follow-up. Uncontrolled eating in Regainers reverted toward baseline levels during the maintenance phase. However, the overall predictability of our model was less than chance. In the depressive symptomatology cohort, 118 participants of 230 were categorized as Maintainers. Depressive symptoms decreased with weight loss and were sustained throughout the maintenance phase. Females had significantly higher depressive symptomatology scores than males and female Regainers had higher scores than female Maintainers. In the inflammatory cohort, 25 of 57 participants were categorized as Maintainers. IL-8 and TNF-α were different between Maintainers and Regainers after weight loss. IL-1β, IL-8 and TNF-α levels were associated with depressive symptoms. Particularly TNF-α at post-weight loss was a predictor of IDS-SR scores after the maintenance phase. This research emphasizes the role of eating behavior, depressive symptoms and inflammatory processes in weight loss maintenance. The results highlight the importance of CR and UE, gender-specific differences with depressive symptoms and inflammatory markers and their relationship to weight loss maintenance. These findings can aid in the improvement of a more tailored approach to obesity treatment and management.

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