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Perceived stress as a predictor of eating behavior during the 3-year PREVIEW lifestyle intervention

Jalo, Elli; Konttinen, Hanna; Westerterp-Plantenga, Margriet; Adam, Tanja; Drummen, Mathijs; Huttunen-Lenz, Maija; Siig Vestentoft, Pia; Martinez, J. Alfredo; Handjiev, Svetoslav; Macdonald, Ian; Brand-Miller, Jennie; Poppitt, Sally; Swindell, Nils; Lam, Tony; Navas-Carretero, Santiago; Handjieva-Darlenska, Teodora; Taylor, Moira; Muirhead, Roslyn; Silvestre, Marta P.; Raben, Anne; Fogelholm, Mikael

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Elli Jalo

Hanna Konttinen

Margriet Westerterp-Plantenga

Tanja Adam

Mathijs Drummen

Maija Huttunen-Lenz

Pia Siig Vestentoft

J. Alfredo Martinez

Svetoslav Handjiev

Ian Macdonald

Jennie Brand-Miller

Sally Poppitt

Nils Swindell

Tony Lam

Santiago Navas-Carretero

Teodora Handjieva-Darlenska

Roslyn Muirhead

Marta P. Silvestre

Anne Raben

Mikael Fogelholm


To better support participants to achieve long-lasting results within interventions aiming for weight loss and maintenance, more information is needed about the maintenance of behavioral changes. Therefore, we examined whether perceived stress predicts the maintenance of changes in eating behavior (flexible and rigid restraint of eating, disinhibition, and hunger).

The present study was a secondary analysis of the PREVIEW intervention including participants with overweight (BMI ≥ 25 kg/m2) at baseline and high risk of type 2 diabetes (n = 1311). Intervention included a 2-month low-energy diet phase and a 34-month subsequent weight maintenance phase. The first 6 months were considered an active behavior change stage and the remaining 2.5 years were considered a behavior maintenance stage. Eating behavior was measured using the Three Factor Eating Questionnaire and stress using the Perceived Stress Scale. The associations between stress and eating behavior were analyzed using linear mixed effects models for repeated measurements.

Perceived stress measured after the active behavior change stage (at 6 months) did not predict changes in eating behavior during the behavior maintenance stage. However, frequent high stress during this period was associated with greater lapse of improved flexible restraint (p = 0.026). The mean (SD) change in flexible restraint from 6 to 36 months was −1.1 (2.1) in participants with frequent stress and −0.7 (1.8) in participants without frequent stress (Cohen’s ds (95% CI) = 0.24 (0.04–0.43)). Higher perceived stress at 6 months was associated with less flexible restraint and more disinhibition and hunger throughout the behavior maintenance stage (all p < 0.001).

Perceived stress was associated with features of eating behavior that may impair successful weight loss maintenance. Future interventions should investigate, whether incorporating stress reduction techniques results in more effective treatment, particularly for participants experiencing a high stress level.

Journal Article Type Article
Acceptance Date Oct 18, 2022
Online Publication Date Nov 5, 2022
Publication Date Nov 5, 2022
Deposit Date Jul 20, 2023
Publicly Available Date Jul 25, 2023
Journal Nutrition & Diabetes
Electronic ISSN 2044-4052
Peer Reviewed Peer Reviewed
Volume 12
Article Number 47
Keywords Endocrinology, Diabetes and Metabolism; Internal Medicine
Public URL
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