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

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningfagfællebedømt


  • 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
  • Moira Taylor
  • Roslyn Muirhead
  • Marta P Silvestre
  • Mikael Fogelholm

Background: 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). 

Methods: 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. 

Results: 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). 

Conclusions: 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.

TidsskriftNutrition and Diabetes
Antal sider8
StatusUdgivet - 2022

Bibliografisk note

CURIS 2022 NEXS 277

Funding Information:
The PREVIEW project was funded by the following institutions: EU framework programme 7 (Grant number 312057); The Glycemic Index Foundation Australia through royalties to The University of Sydney; The NZ Health Research Council (14/191) and University of Auckland Faculty Research Development Fund; The Danish Agriculture & Food Council; The Danish Meat and Research Institute; National Institute for Health Research Biomedical Research Centre (NIHR BRC) (UK); Engineering and Physical Sciences Research Council (EPSRC) (UK); Juho Vainio Foundation (FIN); Academy of Finland (grant numbers: 272376, 314383, 266286); Finnish Medical Foundation; Gyllenberg Foundation; Novo Nordisk Foundation; Finnish Diabetes Research Foundation; University of Helsinki; Government Research Funds for Helsinki University Hospital (FIN). The Cambridge Weight Plan© donated all products for the 8-weeks low-energy diet period. Nutritics (Dublin) donated all dietary analyses software used by UNOTT. EJ has received personal grants for the preparation of this manuscript from Jenny and Antti Wihuri Foundation (FIN) and Emil Aaltonen Foundation (FIN). Preparation of this manuscript has also been funded by the Academy of Finland (grants 314135 and 309157 to HK). Open access publication was funded by Helsinki University Library. The funding sources had no role in study design, data collection and analysis, interpretation of the data, preparation of the manuscript or decision to publish the results.

Publisher Copyright:
© 2022, The Author(s).

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