ScandinaviaOdense, home town of Hans Christian Andersen

Psychological Determinants of Obesity Presentation by Marianne Vámosi Post doc., Ph. D.,

Worldwide Worldwide obesity has more than doubled since In 2008, more than 1.4 billion adults, 20 and older, were overweight. Of these over 200 million men and nearly 300 million women were obese. 65% of the world's population live in countries where overweight and obesity kills more people than underweight. More than 40 million children under the age of five were overweight in Obesity is preventable.. BMI = Body Mass Index = weight (kg)/height (m)² Normalweight: 18.5 ≤BMI<24,9 Overweight defined as BMI ≥ 25 Obesity :BMI ≥ 30. Facts about overweight and obesity

Hypertension Type 2 diabetes Metabolic syndrome Cardiovascular diseases Sleep apnoea Musculoskeletal disorders  Mortality (Rössner 2002) Overweight and obesity are among others responsible for:

Consequences of obesity Social and economical consequences Social rejection Discrimination Negative stereotyping Personal economic and social costs Low employment prospects, Stigmatization Social integration

Consequences of obesity Psychological consequences of obesity Negative impact on quality of life Negative impact on body image Negative impact on psychological distress Negative consequences for self-image Negative consequences for self-esteem Negative consequences for mood Profound psychological costs

Causes of overweight and obesity Genetic predisposition (Perusse 2001) Environmental factors Energy balance: Energy intake Physical activity (Rössner 2002) Social and psychological factors: Family environment Psychosocial causes: present and in childhood (Astrup 2002)

Psychosocial factors in childhood related to weight gain in adulthood Parental education Parental occupation Quality of dwelling School performance Difficulties in school Scholastic proficiencies below average Children who received special education Sleeping problems during early childhood Traumatic events in childhood Psychosocial stress Depression Abuse

Flow-chart for the individual twin participants

Subjects The criteria for participation in the present study were: 1.Twin pairs, MZ as well as DZ, who according to their answers to the Omnibus 2002 questionnaire were discordant of BMI, i.e. one twin should have a normal BMI (20.0kg/m² to 24.9kg/m²) and the co-twin should have a BMI ≥ 30.0kg/m². 2. The twins in a pair should be of the same sex. 3. All the participants should be between 20 and 50 years in 2002.

Methods Contact to the participants Preparing the interview Accomplishment of the interview The questionnaire Clinical examination Blood sampling Statistical analysis

The questionnaire 1.The Omnibus-02 twin cohort questionnaire. Question No. one to The SF 12 Questionnaire. Question No. 12 to The perceived stress scale. Question No. 23 to The SOC 13 Questionnaire. Question No. 33 to The Bully/Victim Questionnaire. Question No. 46 to Growth and height history. Question No. 59 to EDI-C. Questions on body shape body image and present eating habits. Question No. 72 to Questions about perception of own body shape. Question No. 90 and CECA.Q, parental care questionnaire. Question No. 92 to 145.

Results Descriptive statistics

The results from the growth- curve model of the BMI from the Bully and Victim questionnaire

The trend of proportions with increasing intra-pair comparison of BMI in 2006 Results from the CECA Q questionnaire 20 twin couples 19 twin couples 39 twin couples 21 twin couples

Discussion Strengths of the study in general: High rate of participants: 81.7 %. The selected group of participants was based on twin individuals The participants were analysed to be representative related to non participants None of the participants reported been bullied or lack of parental care as causation for weight changes The same interviewer accomplished all the interviews and the anthropometric measurements The co- twin was not present at the interview

Being bullied in childhood Participants bullied had a higher BMI with 1.4 kg/m², than the non bullied participants. The association could be measured from age years. Changes in life events could affect and decrease the association. We included twin participants only if normal weight when starting school. The twins in the same class? The Bully/Victim-questionnaire is not defined bully as a concept. The Bully/Victim-questionnaire has no score system. The biological relationship between bullied and overweight/obesity remains to be studied further.

Lack of parental care in childhood There was found an association between obesity and maternal antipathy in the age of 20 and an association for maternal neglect in 2006 This indicates that maternal care has an effect on BMI later on in life There was no significant results of the association between obesity/overweight and paternal care. Why the difference between maternal and paternal care? The CECA Q questionnaire key words are well defined. The CECA Q questionnaire has its own cut- score system. The biological relationship between parental care and overweight/obesity remains to be studied further.

Future perspectives One of the aims of this study was to determine if being bullied and if the perception of parental neglect and care could be related to later overweight and obesity in adulthood. The analysis has shown that such associations could exist. The findings are important news in the keys to the enigma of obesity. Prevention must be a possibility and is needed. Treating overweight and obesity has not been an unconditional success, as after weight loss it is common to regain the lost weight. With this study, new pathways to avoid later obesity are being opened. The health care system, the GP’s, the professionals in the school system and kindergartens, but first of all the parents should be informed about the importance of psychological care and attention to the child in prevention of overweight and obesity.

Thank you so much for your attention!!