Psychological distress in morbid obesity in relation to weight history

Background: Very few data are available on psychological distress in morbidly obese subjects in relation to weight history. In subjects with childhood obesity, psychological distress might be better than in adult-onset obesity, because of progressive adaptation to the social stigma. Method: we tested psychological distress in relation to BMI at age 20 years (BMI-20), weight history and somatic comorbidities in 632 treatment-seeking, morbidly obese participants from the QUOVADIS cohort (130 men, 502 women; mean age 45.5 years). The number of dieting attempts/year, BMI increase and cumulative BMI loss since age 20 were calculated as weight cycling parameters. The Symptom Check List-90 (SCL-90), the Psychological General Well-Being (PGWB), the Binge-Eating Scale and the ORWELL-97 questionnaire were used to score psychometry and health-related quality of life. Complications were quantitatively assessed by a modified Charlson’s score. Results: BMI-20 was normal in 35% of cases and >35 kg/m2 in only 14%. Psychometric scores were not different in relation to BMI-20, when corrected for age, with the exception of the General Health scale of PGWB, showing a greater distress in subjects with normal BMI-20. In most cases, the prevalence of pathological results of questionnaires showed a J-shaped curve, with participants with normal BMI-20 or those with Class II-III obesity in early adulthood having the highest prevalence of psychological/ psychiatric distress and poor HRQL. Weight cycling was a risk factor for binge-eating, depression and interpersonal sensitivity at SCL-90, whereas somatic comorbidities adversely affected most SCL-90 and all PGWB scales. Conclusion: Weight cycling and somatic comorbidities, but not age of onset of obesity, are the main factors negatively influencing psychological health in treatment-seeking, morbidly obese subjects.