Association Between Dysfunctional Eating Behaviors and Weight Loss Among Adults in Puerto Rico: A Cross-Sectional Analysis from the PROSPECT Cohort Study

Abstract

Obesity has become one of the most urgent and costly public health crises of the 21st century, with rates climbing at an unprecedented pace across the globe. Since the late 20th century, prevalence has surged due to a complex interplay of environmental, behavioral, and socioeconomic factors. The condition is strongly linked to life-altering non-communicable diseases, including type 2 diabetes, cardiovascular disease, and certain cancers. This contributes to increased illness, premature death, and soaring healthcare costs. By 2035, an estimated 1.53 billion adults worldwide will be classified with obesity. In the United States, between 2013 and 2016, 66.7% of adults living with obesity and 49% of the adults classified as overweight attempted to lose weight. Unfortunately, research shows that 95% of all dieters fail to achieve weight loss and maintain their results for more than three years. Despite the high level of interest and frequent attempts to lose weight, obesity rates continue to rise. The eating behaviors associated with successful weight loss, particularly dysfunctional behaviors such as emotional or uncontrolled eating, remain unknown among individuals who previously had obesity, especially when success is defined as maintaining weight loss. It was hypothesized that the participants who experienced weight loss would have a higher association with lower dysfunctional eating scores, such as lower uncontrolled eating and lower emotional eating. To test the hypothesis, this thesis used cross-sectional data (n = 545) from the PROSPECT cohort study of adults aged 30-75 years to investigate the dysfunctional eating behavioral attributes (using a validated three-factor eating questionnaire, TEQ R-18) linked to weight loss. The PROSPECT data included clinic-based anthropometric measurements, along with self-reported data on eating behaviors, lifestyle factors, demographics, and socioeconomic status. All eligible participants were assigned to either a Weight Loss Group based on a self-reported question asking if the participant had intentionally lost at least 10 pounds in the previous 6-months) or No Weight Loss (combining Normal Weight Group (no weight loss and BMI .0 kg/m2) and High Weight Group (no weight loss and BMI ≥25.0 kg/m2)). Logistic models (unadjusted and adjusted for sociodemographic, behavioral, and health factors) were run to determine the likelihood of experiencing dysfunctional eating behaviors (i.e., emotional eating (EE), uncontrolled eating (UE), cognitive restraint (CR), and overall dysfunctional eating (TEQ)) by weight loss status. The unadjusted results showed that participants who lost a minimum of 10 pounds exhibited a lower association with UE, but a higher association with CR, EE, and overall TEQ scores. In the unadjusted analysis, high UE was associated with lower odds of being in the Weight Loss Group compared to participants with no to moderate UE scores. High EE was associated with higher odds of being in the Weight Loss Group compared to participants with no to moderate EE scores. High CR was associated with significantly higher odds of being in the Weight Loss Group compared to participants with no to moderate CR scores. After adjusting for demographic, socioeconomic, lifestyle, and health-related covariates, the associations for UE and EE were largely attenuated and non-significant. No significant interactions between sex and UE, CR, EE, or TEQ were observed in the adjusted models. The adjusted model did display significant results, indicating that higher CR is associated with higher odds of being in the Weight Loss Group. Furthermore, current alcohol consumption is associated with significantly lower odds of being in the Weight Loss Group. Though significant results were observed, further exploration of eating behaviors related to successful weight loss maintenance needs to be evaluated by performing a longitudinal data analysis on a larger sample size.