Abstract
Black women have a higher prevalence of obesity and tend to have suboptimal outcomes in behavioral weight loss programs for reasons that are not fully understood. Studies have shown a potential relationship between perceived psychological stress and weight loss in behavioral interventions. This study sought to assess whether baseline stress was directly or indirectly associated with 6-month weight change among Black women participating in a behavioral weight loss study. Indirect pathways of interest included depressive symptoms and dietary intake. A secondary analysis of data (n = 409) collected from a cluster, randomized behavioral weight loss trial was conducted. Demographics, anthropometry, surveys, and dietary data were collected at baseline and 6 months. Path analysis was used to test for direct and indirect effects of baseline stress on 6-month weight change while controlling for sociodemographic factors and intervention group. Baseline stress was not directly associated with 6-month weight change nor was it indirectly associated via depressive symptoms in the adjusted model. However, each of the direct paths linking baseline stress to weight loss were statistically significant. Stress was not associated with 6-month weight change via dietary intake. Baseline stress was positively associated with 6-month depressive symptoms which in turn was associated with less weight change. Depressive symptoms may offer an additional psychosocial target to consider when designing behavioral weight loss interventions for Black women.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Adam, T. C., & Epel, E. S. (2007). Stress, eating and the reward system. Physiology and Behavior, 91(4), 449–458. https://doi.org/10.1016/j.physbeh.2007.04.011
American Psychological Association. (2012). Stress by Gender. Retrieved from https://www.apa.org/news/press/releases/stress/2012/gender-report.pdf
American Psychological Association. (2014). Stress in America: Are teens adopting adults' stress habits. Retrieved from https://www.apa.org/news/press/releases/stress/2013/stress-report.pdf
American Psychological Association. (2017). Stress in America: The State of Our Nation. Stress in America Survey. Retrieved from https://www.apa.org/news/press/releases/stress/2017/state-nation.pdf
Andresen, E. M., Malmgren, J. A., Carter, W. B., & Patrick, D. L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D. American Journal of Preventive Medicine, 10, 77–84. https://doi.org/10.1016/S0749-3797(18)30622-6
Ard, J. D., Carson, T. L., Shikany, J. M., Li, Y., Hardy, C. M., Robinson, J. C., Williams, A. G., & Baskin, M. L. (2017). Weight loss and improved metabolic outcomes amongst rural African American women in the Deep South: six-month outcomes from a community-based randomized trial. Journal of Internal Medicine, 282, 102–113. https://doi.org/10.1111/joim.12622
Ball, K., & Lee, C. (2000). Relationships between psychological stress, coping and disordered eating: A review. Psychology and Health, 14, 1007–1035. https://doi.org/10.1080/08870440008407364
Belgrave, F., & Abrams, J. (2016). Reducing disparities and achieving equity in African American women’s health. American Psychologist, 71, 723. https://doi.org/10.1037/amp0000081
Berjot, S., & Gillet, N. (2011). Stress and coping with discrimination and stigmatization. Frontiers in Psychology, 2, 33. https://doi.org/10.3389/fpsyg.2011.00033
Björgvinsson, T., Kertz, S., Bigda-Peyton, J., McCoy, K., & Aderka, I. (2013). Psychometric Properties of the CES-D-10 in a Psychiatric Sample. Assessment, 20, 429–436. https://doi.org/10.1177/1073191113481998
Block, J. P., He, Y., Zaslavsky, A. M., Ding, L., & Ayanian, J. Z. (2009). Psychosocial stress and change in weight among US adults. American Journal of Epidemiology, 170, 181–192. https://doi.org/10.1093/aje/kwp104
Brantley, P., Appel, L., Hollis, J., Stevens, V., Ard, J., Champagne, C., Elmer, P., Harsha, D., Myers, V., Proschan, M., & Svetkey, L. (2008). Design considerations and rationale of a multi-center trial to sustain weight loss: The Weight Loss Maintenance Trial. Clinical Trials, 5, 546–556. https://doi.org/10.1177/1740774508096315
Brodish, A. B., Cogburn, C. D., Fuller-Rowell, T. E., Peck, S., Malanchuk, O., & Eccles, J. S. (2011). Perceived racial discrimination as a predictor of health behaviors: The moderating role of gender. Race and Social Problems, 3, 160–169. https://doi.org/10.1007/s12552-011-9050-6
Carson, T. L., Desmond, R., Hardy, S., Townsend, S. N., Ard, J. D., Meneses, K., Partrdge, E. E., & Baskin, M. L. (2015). A study of the relationship between food group recommendations and perceived stress: Findings from black women in the Deep South. Journal of Obesity, 2015, 7. https://doi.org/10.1155/2015/203164
Carson, T. L., Jackson, B. E., Nolan, T. S., Williams, A., & Baskin, M. L. (2017). Lower depression scores associated with greater weight loss among rural black women in a behavioral weight loss program. Translational Behaviour Medicine, 7, 320–329. https://doi.org/10.1007/s13142-016-0452-2
Cohen, S., & Janicki-Deverts, D. (2012). Who’s stressed? Distributions of psychological stress in the United States in probability samples from 1983, 2006, and 20091. Journal of Applied Social Psychology, 42, 1320–1334. https://doi.org/10.1111/j.1559-1816.2012.00900.x
Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385–396.
Cohen, S., Janicki-Deverts, D., Doyle, W. J., Miller, G. E., Frank, E., Rabin, B. S., & Turner, R. B. (2012). Chronic stress, glucocorticoid receptor resistance, inflammation, and disease risk. Proceedings of the National Academy of Sciences, 109, 5995–5999.
Conradt, M., Dierk, J. M., Schlumberger, P., Rauh, E., Hebebrand, J., & Rief, W. (2008). Who copes well? Obesity-related coping and its associations with shame, guilt, and weight loss. Journal of Clinical Psychology, 64, 1129–1144. https://doi.org/10.1002/jclp.20501
de Wit, L., Luppino, F., van Straten, A., Penninx, B., Zitman, F., & Cuijpers, P. (2010). Depression and obesity: A meta-analysis of community-based studies. Psychiatry Research, 178, 230–235. https://doi.org/10.1016/j.psychres.2009.04.015
Delahanty, L. M., Peyrot, M., Shrader, P. J., Williamson, D. A., Meigs, J. B., & Nathan, D. M. (2013). Pretreatment, psychological, and behavioral predictors of weight outcomes among lifestyle intervention participants in the Diabetes Prevention Program (DPP). Diabetes Care, 36, 34–40. https://doi.org/10.2337/dc12-0733
DeLany, J. P., Jakicic, J. M., Lowery, J. B., Hames, K. C., Kelley, D. E., & Goodpaster, B. H. (2014). African–American women exhibit similar adherence to intervention but lose less weight due to lower energy requirements. International Journal of Obesity, 38, 1147–1152. https://doi.org/10.1038/ijo.2013.240
Dhurandhar N. (2015 Nov 2). TOS opening session. Presented at: ObesityWeek, Los Angeles
Elder, C. R., Gullion, C. M., Funk, K. L., Debar, L. L., Lindberg, N. M., & Stevens, V. J. (2012). Impact of sleep, screen time, depression and stress on weight change in the intensive weight loss phase of the LIFE study. International Journal of Obesity, 36, 86–92. https://doi.org/10.1038/ijo.2011.60
Enders, C. K. (2010). Applied missing data analysis. Guilford Press.
Epel, E., Lapidus, R., McEwen, B., & Brownell, K. (2001). Stress may add bite to appetite in women: a laboratory study of stress-induced cortisol and eating behavior. Psychoneuroendocrinology, 26, 37–49.
Errisuriz, V. L., Pasch, K. E., & Perry, C. L. (2016). Perceived stress and dietary choices: The moderating role of stress management. Eating Behaviors, 22, 211–216. https://doi.org/10.1016/j.eatbeh.2016.06.008
Fitzgibbon, M. L., Tussing-Humphreys, L. M., Porter, J. S., Martin, I. K., Odoms-Young, A., & Sharp, L. K. (2012). Weight loss and African–American women: A systematic review of the behavioural weight loss intervention literature. Obesity Reviews, 13, 193–213. https://doi.org/10.1111/j.1467-789X.2011.00945.x
Flegal, K. M., Kruszon-Moran, D., Carroll, M. D., Fryar, C. D., & Ogden, C. L. (2016). Trends in obesity among adults in the united States, 2005 to 2014. JAMA, 315, 2284–2291. https://doi.org/10.1001/jama.2016.6458
Folkman, S., & Lazarus, R. S. (1988). Coping as a mediator of emotion. Journal of Personality and Social Psychology, 54, 466–475.
Fritz, M. S., & Mackinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18, 233–239. https://doi.org/10.1111/j.1467-9280.2007.01882.x
González, H. M., Croghan, T., West, B., Williams, D., Nesse, R., Tarraf, W., Taylor, R., Hinton, L., Neighbors, H., & Jackson, J. (2008). Antidepressant use in black and white populations in the United States. Psychiatric Services, 59, 1131–1138. https://doi.org/10.1176/appi.ps.59.10.1131
Grundy, A., Cotterchio, M., Kirsh, V. A., & Kreiger, N. (2014). Associations between anxiety, depression, antidepressant medication, obesity and weight gain among Canadian women. PloS one, 9, e99780. https://doi.org/10.1371/journal.pone.0099780
Hammen, C. (2005). Stress and depression. Annual Review of Clinical Psychology, 1, 293–319. https://doi.org/10.1146/annurev.clinpsy.1.102803.143938
Isasi, C. R., Parrinello, C. M., Jung, M. M., Carnethon, M. R., Birnbaum-Weitzman, O., Espinoza, R. A., Penedo, F. J., Perreira, K. M., Schneiderman, N., Sotres-Alvarez, D., Van Horn, L., & Gallo, L. C. (2015). Psychosocial stress is associated with obesity and diet quality in Hispanic/Latino adults. Annals of Epidemiology, 25(2), 84–89. https://doi.org/10.1016/j.annepidem.2014.11.002
Jantaratnotai, N., Mosikanon, K., Lee, Y., & McIntyre, R. S. (2017). The interface of depression and obesity. Obesity Research and Clinical Practice, 11, 1–10. https://doi.org/10.1016/j.orcp.2016.07.003
Kandiah, J., Yake, M., Jones, J., & Meyer, M. (2006). Stress influences appetite and comfort food preferences in college women. Nutrition Research, 26, 118–123.
Kessler, R. C. (1997). The effects of stressful life events on depression. Annual Review of Psychology, 48(1), 191–214. https://doi.org/10.1146/annurev.psych.48.1.191
Khan, S., & Khan, R. A. (2017). Chronic stress leads to anxiety and depression. Annals of Psychiatry and Mental Health, 5(1), 1091.
Kim, K. H., Bursac, Z., DiLillo, V., White, D. B., & West, D. S. (2009). Stress, race, and body weight. Health Psychology, 28(1), 131–135. https://doi.org/10.1037/a0012648
Kirkpatrick, S. I., Subar, A. F., Douglass, D., Zimmerman, T. P., Thompson, F. E., Kahle, L. L., Evans, K., Walton, J., Flynn, A., Gibney, E. R., & Potischman, N. (2014). Performance of the Automated Self-Administered 24-hour Recall relative to a measure of true intakes and to an interviewer-administered 24-h recall. American Journal of Clinical Nutrition, 100, 233–240. https://doi.org/10.3945/ajcn.114.083238
Kline, R. B. (2011). Principles and practice of structural equation modeling. (3rd ed.). Guilford Press.
Kumanyika, S. K., Obarzanek, E., Stevens, V. J., Hebert, P. R., Whelton, P. K., & Kumanyaka, S. K. (1991). Weight-loss experience of black and white participants in NHLBI-sponsored clinical trials. American Journal of Clinical Nutrition, 53, 1631s–1638s. https://doi.org/10.1093/ajcn/53.6.1631S
Laugero, K. D., Falcon, L. M., & Tucker, K. L. (2011). Relationship between perceived stress and dietary and activity patterns in older adults participating in the Boston Puerto Rican Health Study. Appetite, 56, 194–204. https://doi.org/10.1016/j.appet.2010.11.001
Lee, E. H. (2012). Review of the psychometric evidence of the perceived stress scale. Asian Nurs Res (Korean Soc Nurs Sci), 6, 121–127. https://doi.org/10.1016/j.anr.2012.08.004
Leung, A. W., Chan, R. S., Sea, M. M., & Woo, J. (2017). An overview of factors associated with adherence to lifestyle modification programs for weight management in adults. International journal of environmental Research and Public Health, 14(8), 922. https://doi.org/10.3390/ijerph14080922
Loeys, T., Moerkerke, B., & Vansteelandt, S. (2014). A cautionary note on the power of the test for the indirect effect in mediation analysis. Frontiers in Psychology, 5, 1549. https://doi.org/10.3389/fpsyg.2014.01549
MacCallum, R. C., Browne, M. W., & Sugawara, H. M. (1996). Power analysis and determination of sample size for covariance structure modeling. Psychological Methods, 1, 130–149. https://doi.org/10.1037/1082-989X.1.2.130
MacKinnon, D. P., Lockwood, C. M., Hoffman, J. M., West, S. G., & Sheets, V. (2002). A comparison of methods to test mediation and other intervening variable effects. Psychological Methods, 7, 83–104. https://doi.org/10.1037/1082-989x.7.1.83
Mackinnon, D. P. (2008). Introduction to statistical mediation analysis. Taylor & Francis.
Mackinnon, D. P., Fairchild, A. J., & Fritz, M. S. (2007). Mediation analysis. Annual Review of Psychology, 58, 593–614. https://doi.org/10.1146/annurev.psych.58.110405.085542
Morgado, P., & Cerqueira, J. J. (2018). The impact of stress on cognition and motivation. Frontiers in Behavioral Neuroscience, 12, 326. https://doi.org/10.3389/fnbeh.2018.00326
Murawski, M. E., Milsom, V. A., Ross, K. M., Rickel, K. A., DeBraganza, N., Gibbons, L. M., & Perri, M. G. (2009). Problem solving, treatment adherence, and weight-loss outcome among women participating in lifestyle treatment for obesity. Eating Behaviors, 10, 146–151. https://doi.org/10.1016/j.eatbeh.2009.03.005
Muthén, L. K., & Muthén, B. O. (2012). Mplus statistical modeling software: Release 7.0. Los Angeles, CA: Muthén & Muthén.
O’Brien, M. J., Perez, A., Alos, V. A., Whitaker, R. C., Ciolino, J. D., Mohr, D. C., & Ackermann, R. T. (2015). The feasibility, acceptability, and preliminary effectiveness of a Promotora-Led Diabetes Prevention Program (PL-DPP) in Latinas: A pilot study. The Diabetes Educator, 41(4), 485–494. https://doi.org/10.1177/0145721715586576
Perreira, K. M., Gotman, N., Isasi, C. R., Arguelles, W., Castañeda, S. F., Daviglus, M. L., Giachello, A. L., Gonzalez, P., Penedo, F. J., Salgado, H., & Wassertheil-Smoller, S. (2015). Mental health and exposure to the United States: Key correlates from the Hispanic Community Health Study of Latinos. The Journal of nervous and mental disease, 203, 670. https://doi.org/10.1097/NMD.0000000000000350
Puhl, R. M., Andreyeva, T., & Brownell, K. D. (2008). Perceptions of weight discrimination: Prevalence and comparison to race and gender discrimination in America. International Journal of Obesity, 32, 992–1000. https://doi.org/10.1038/ijo.2008.22
Radloff, L. (1977). The CES-D scale: A self report depression scale for research in the general population. Applied Psychological Measurements, 1, 385–401.
Reyes, N. R., Oliver, T. L., Klotz, A. A., Lagrotte, C. A., Vander Veur, S. S., Virus, A., Bailer, B. A., & Foster, G. D. (2012). Similarities and differences between weight loss maintainers and regainers: Qualitative analysis. Journal of the Academy of Nutrition and Dietetics, 112, 499–505. https://doi.org/10.1016/j.jand.2011.11.014
Sedaqat, F., Rabiei, S., Faria, S., & Rastmanesh, R. (2013). Correlates of snacking with stress and depression in obese and non-obese women. Journal of Obesity and Weight Loss Theraphy, 3, 2. https://doi.org/10.4172/2165-7904.1000161
Sims, R., Gordon, S., Garcia, W., Clark, E., Monye, D., Callender, C., & Campbell, A. (2008). Perceived stress and eating behaviors in a community-based sample of African Americans. Eating Behaviors, 9, 137–142. https://doi.org/10.1016/j.eatbeh.2007.06.006
Sims, M., Diez-Roux, A. V., Gebreab, S. Y., Brenner, A., Dubbert, P., Wyatt, S., Bruce, M., Hickson, D., Payne, T., & Taylor, H. (2016). Perceived discrimination is associated with health behaviours among African-Americans in the Jackson Heart Study. Journal of Epidemiology and Community Health, 70, 187–194. https://doi.org/10.1136/jech-2015-206390
Subar, A. F., Si, K., Mittl, B., Zimmerman, T. P., Fe, T., & Bingley, C. (2012). Willis g, islam Ng, Baranowski T, McNutt S, Potischman N: The Automated Self-Administered 24-hour dietary recall (ASA24): A resource for researchers, clinicians, and educators from the National Cancer institute. J Acad Nutr Diet, 112, 1134–1137. https://doi.org/10.1016/j.jand.2012.04.016
Sutin, A., Robinson, E., Daly, M., & Terracciano, A. (2016). Weight discrimination and unhealthy eating-related behaviors. Appetite, 102, 83–89. https://doi.org/10.1016/j.appet.2016.02.016
Svetkey, L. P., Ard, J. D., Stevens, V. J., Loria, C. M., Young, D. Y., Hollis, J. F., Appel, L. J., Brantley, P. J., Kennedy, B. M., Kumanyika, S. K., Batch, B. C., & Vollmer, W. M. (2012). Predictors of long-term weight loss in adults with modest initial weight loss, by sex and race. Obesity, 20(9), 1820–1828. https://doi.org/10.1038/oby.2011.88
Torres, S. J., & Nowson, C. A. (2007). Relationship between stress, eating behavior, and obesity. Nutrition, 23, 887–894.
Trief, P. M., Cibula, D., Delahanty, L. M., & Weinstock, R. S. (2014). Depression, stress, and weight loss in individuals with metabolic syndrome in SHINE, a DPP translation study. Obesity, 22, 2532–2538. https://doi.org/10.1002/oby.20916
van Praag, H. M. (2004). Can stress cause depression? Progress in Neuro-Psychopharmacology and Biological Psychiatry, 28, 891–907. https://doi.org/10.1016/j.pnpbp.2004.05.031
Wardle, J., Steptoe, A., Oliver, G., & Lipsey, Z. (2000). Stress, dietary restraint and food intake. Journal of Psychosomatic Research, 48, 195–202. https://doi.org/10.1016/S0022-3999(00)00076-3
Wardle, J., Chida, Y., Gibson, E. L., Whitaker, K. L., & Steptoe, A. (2011). Stress and adiposity: A meta-analysis of longitudinal studies. Obesity, 19, 771–778. https://doi.org/10.1038/oby.2010.241
Warren, J. R., Thomas, J. L., Okuyemi, K. S., Lindgren, B., & Ahluwalia, J. S. (2010). Development and validation of a multidimensional measure of stress among African American light smokers. Journal of the National Medical Association, 102, 890–897. https://doi.org/10.1016/s0027-9684(15)30707-0
Yau, Y. H., & Potenza, M. N. (2013). Stress and eating behaviors. Minerva endocrinologica, 38, 255–267.
Funding
The Project was funded by National Cancer Institute by Grant No. K01CA190559 and U54CA153719.
Author information
Authors and Affiliations
Contributions
MLB conceived the original research study. TLC conceived the research question for this secondary analysis. TLC and MB collected data. KM analyzed data. DL critically reviewed the paper. KM, MB, and TLC were involved in data interpretation. KM and TLC co-led writing the paper. All authors reviewed and approved the final versions.
Corresponding author
Ethics declarations
Conflict of interest
The authors Kristine Molina, Monica L. Baskin, Dustin Long and Tiffany L. Carson declared no conflict of interest.
Ethical approval
All study-related protocols and ques-tionnaires received approval from The University of Alabama at Birmingham Institutional Review Board for human subjects.
Informed consent
Informed consent was obtained from all patients for being included in the study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Molina, K., Baskin, M.L., Long, D. et al. Psychological and behavioral pathways between perceived stress and weight change in a behavioral weight loss intervention. J Behav Med 44, 822–832 (2021). https://doi.org/10.1007/s10865-021-00231-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10865-021-00231-z