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

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: This secondary analysis of the PREVIEW intervention included participants with overweight (BMI ≥ 25 kg/m²) at baseline and high risk of type 2 diabetes (n = 1311). The 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 a behavior maintenance stage. Eating behavior was measured using the Three Factor Eating Questionnaire and stress using the Perceived Stress Scale. Associations 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 d, 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.