Psychological features in obesity: A network analysis

Objective Enhanced understanding of psychosocial factors associated with obesity may improve knowledge of their interplay mechanisms. The aim of this study was to assess the relationship between psychosocial variables in individuals with obesity using a network analysis. Methods Patients seeking treatment for obesity were consecutively recruited from a rehabilitative residential treatment program for severe obesity between January 2016 and March 2019. Each patient completed the following questionnaires: Eating Disorder Examination Questionnaire, Symptom Checklist-90, Obesity Related Well-Being, and Weight Bias Internalization Scale. In addition, current body mass index (BMI) was measured, and maximum acceptable and dream BMI were assessed. Results The sample comprised 996 patients with obesity (age 52.3 [SD = 16.0] years; BMI 41.8 [SD = 7.8] kg/m(2); 65.7% women; 52.2% married or living with a partner). Network analysis showed that interpersonal sensitivity and shape-weight concern, but also internalized weight stigma, were the most central and highly interconnected nodes in the network. In contrast, objective binge-eating episodes and dietary restraint were the most peripheral and least connected nodes. Eating disorder features and psychological distress formed two clearly separate clusters. No difference in network structure was found between men and women. Conclusions The pattern of network node connections supports the importance of assessing psychological distress, interpersonal sensitivity, shape-weight concern, and internalized weight stigma in patients seeking treatment for obesity.