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Coping and Distress: What Happens After Intervention? A 2-Year Follow-up From the Swedish Obese Subjects (SOS) Study

From the Health Care Research Unit (A.R., J.K., M.S., C.T.) and the Department of Body Composition and Metabolism (J.S.T.), Institute of Internal Medicine, Sahlgrenska University Hospital, Göteborg University, Sweden.

Address reprint requests to: Anna Rydén, Health Care Research Unit, Institute of Internal Medicine, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. Email: anna.ryden{at}medicine.gu.se

OBJECTIVE: The study examined effects of weight change on coping and distress in severely obese subjects treated conventionally or undergoing weight reduction surgery.

METHODS: We used the Obesity Coping (OC) scale measuring emotion-focused, maladaptive coping (Wishful Thinking) and problem-focused, adaptive coping (Social Trust and Fighting Spirit). We also used the Obesity Distress (OD) scale (Intrusion and Helplessness) and the Hospital Anxiety and Depression (HAD) scale. A total of 1146 surgical candidates and 1085 conventionally treated patients completed the OC and OD before treatment and after 24 months.

RESULTS: Weight gainers reduced their use of both problem- and emotion-focused coping, thus leaving distress levels unchanged. All participants who lost weight decreased in emotion-focused coping and distress. Participants losing 20 kg or more also increased in problem-focused coping, resulting in even greater improvements regarding distress.

CONCLUSIONS: Two years after starting treatment, the pattern and magnitude of change in coping and distress was the same irrespective of type of treatment and was, instead, related to the amount of weight change (the more weight change the greater the changes in coping and distress). Increases in problem-focused coping required major weight reduction, whereas minor weight gain led to a decrease. Emotion-focused coping decreased irrespective of direction of weight change, suggesting a general intervention effect of receiving professional help and support. These results have implications concerning behavior-based interventions of obese patients.

Key Words: coping • distress • severe obesity • clinical trial • treatment outcome

Abbreviations: BMI = body mass index;; CI = confidence interval;; GFI = goodness-of-fit indices;; HAD = Hospital Anxiety and Depression;; OC = Obesity Coping;; OD = Obesity Distress;; RMSEA = root mean square error adjusted;; SEM = structural equation modeling;; SOS = Swedish obese subjects.

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