Association of body composition and eating behavior in the normal weight obese syndrome

  • Laura Di Renzo
  • Elaine Tyndall
  • Paola Gualtieri
  • Chiara Carboni
  • Roberto Valente
  • Alessia Sabrina Ciani
  • Maria Giovanna Tonini
  • Antonino De Lorenzo
Original Article



Our aim was to identify psychological and behavioral characteristics of women affected by normal weight obese (NWO) syndrome.


Anthropometric, body composition, eating behavior and physical activity were evaluated in 79 women.


48.10 % of the subjects were found to be normalweight obese (NWO), 22.79 % normalweight lean (NWL), and 29.11 % pre-obese-obese (PreOB/OB) according to BMI and body composition. Significant differences (p < 0.001) among the groups were identified on analysis of the subscales of the Eating Disorder Inventory-2 (EDI-2), suggesting progressively increased presence of psychopathology relative to body composition. In a further analysis, results of the subscales of the EDI-2 were compared with body composition parameters, revealing that BMI co-varied with body composition variables and psychological responses. %TBFat co-varied exclusively with body composition variables (height, weight, BMI, KgTBFat, and a decrease of KgTBLean (R 2 = 0.96; Q 2 = 0.94). The NWO was discriminated from PreOB/OB group (compared to BMI) only on the basis of body composition variables (R 2 = 0.68; Q 2 = 0.60).


NWO women appeared to find themselves at a cognitive crossroads, attaining intermediate scores on the EDI-2 between normal weight lean women and pre-obese or obese women, in particular in terms of drive for thinness and body dissatisfaction. The NWO syndrome not only conveys an increased risk of cardiovascular and metabolic disease, but may also significantly overlap with other eating disorders in terms of psychological symptomatology, the correct identification of which may be the key in the successful management of these patients.

Trial registration: NCT01890070


Normal weight obese syndrome Eating behavior Body fat Dual-energy X-ray absorptiometry 



We are indebted to all the subjects who volunteered in the study.

This study was supported by grants from Ministry of Agriculture, Food and Forestry (D.M.; 2017188).

Compliance with ethical standards

Conflict of interest

The authors declare no conflict of interest.

Ethical approval

All procedures of the study were performed in accordance with the1964 Helsinki declaration.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Laura Di Renzo
    • 1
  • Elaine Tyndall
    • 1
  • Paola Gualtieri
    • 1
  • Chiara Carboni
    • 1
  • Roberto Valente
    • 1
  • Alessia Sabrina Ciani
    • 1
  • Maria Giovanna Tonini
    • 1
  • Antonino De Lorenzo
    • 1
    • 2
  1. 1.Division of Clinical Nutrition and Nutrigenomics, Department of Biomedicine and PreventionUniversity of Rome “Tor Vergata”RomeItaly
  2. 2.“Nuova Annunziatella” ClinicRomeItaly

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