The Effect of Body Weight on Eating Behavior and Risk for Diabetes, Health Literacy among Turkish Adults Effect of Body Weight on Eating Behavior

Main Article Content

Bircan Ulas Kadioglu
Pınar Soylar


Eating behavior; body weight; body mass index; diabetes mellitus; health literacy


Objective This study was aimed to investigate the effect of body weight on eating behavior, risk for diabetes and health literacy of individuals in a primary healthcare center.

Design Body weight, eating behavior, risk for diabetes and health literacy level were evaluated in this cross-sectional descriptive study. A total of 210 individuals with normal weight (BMI of 18.5 to <25), overweight (BMI of 25 to <30 kg/m2) and obese (BMI ≥30 kg/m2) were included in the study. The three-factor eating questionnaire (TFEQ) was used to investigate the eating behaviors of the participants. Turkish Health Literacy Scale-32 (THLS-32) and FINDRISC Type 2 Diabetes Risk Assessment Form was used.

Results A significant relationship was determined the total score of TFEQ scale and body mass index categories. The risk of diabetes was higher in obese individuals. The scores obtained from THLS-32 were lower in obese individuals. The chances of obese individuals being in the high-risk group for diabetes are 8.47 times higher compared to individuals with normal weight. According to the results of multivariate analysis, this risk is 9.92 times.

Conclusions It was determined that increased the body weight associated TFEQ scale and the risk for diabetes and also Health Literacy. Weight management practices should be conducted by a multidisciplinary team for individuals in risk group with high BMI in healthcare centers.

Keywords Eating behavior; body weight; body mass index; diabetes mellitus; health literacy


Download data is not yet available.
Abstract 128 | PDF Downloads 58


1. World Health Organization, Obesity and Overweight.

2. Di Renzo L, Tyndall E, Gualtieri P, Carboni C, Valente R, Ciani AS, Tonini MG, De Lorenzo A (2016) Association of body composition and eating behavior in the normal weight obese syndrome. Eat Weight Disord 21(1):99-106. doi: 10.1007/s40519-015-0215-y.

3. Campos-Uscanga Y, Gutiérrez-Ospina G, Morales-Romero J, Romo-González T (2017) Self-regulation of eating and physical activity is lower in obese female college students as compared to their normal weight counterparts. Eat Weight Disord 22(2):311-319. doi: 10.1007/s40519-016-0338-9

4. Formiguera X, Canto'n A (2004) Obesity: epidemiology and clinical aspects. Best Pract Res Clin Gastroenterol. 18(6):1125-1146.

5. IDF Diabetes Atlas-8 th Edition, IDF, 2017

6. Satman I, Yilmaz T, Sengul A, Salman S, Salman F, Uygur S, et al (2002) The TURDEP Group. Population-based study of diabetes and risk characteristics in Turkey: results of the Turkish diabetes epidemiology study (TURDEP). Diabetes Care. 25:1551–6.

7. Satman I, Omer B, Tutuncu Y, Kalaca S, Gedik S, Dinccag N, et al (2013) TURDEP-II Study Group Twelve-year trends in the prevalence and risk factors of diabetes and prediabetes in Turkish adults. Eur J Epidemiol 28(2):169-80 doi: 10.1007/s10654-013-9771-5

8. Kelly NR, Tanofsky-Kraff M, Vannucci A, Ranzenhofer LM, Altschul AM, Schvey NA, Yanovski JA (2016) Emotion dysregulation and loss-ofcontrol ating in children and adolescents. Health Psychol 35:1110-1119.
doi: 10.1037/hea0000389.

9. Stunkard A, Messick S (1985) The three-factor eating questionnaire to measure dietary restraint, disinhibition and hunger. J Psychosom Res 29(1):71-83.

10. Herman CP, Mack D (1975) Restrained and unrestrained eating. J Pers 43(4): 647–660.

11. Cohen S, Kamarck T, Mermelstein R (1983) A global measure of perceived stress. J Health Soc Behav 24(4): 385–396.

12. Braet C, Van Strien T (1997) Assessment of emotional, externally induced and restrained eating behaviour in nine to twelve-year-old obese and non-obese children. Behav Res Ther 35(9):863–873.

13. Kaplan HI, Kaplan HS (1957) The psychosomatic concept of obesity. J Nerv Ment Dis 125(2):181–201.

14. Bruch H (1964) Psychological aspects of overeating and obesity. Psychosomatics, 5(5): 269–274.

15. World Health Organization, 7th Global Conference on Health Promotion Health literacy and health behaviour Available from: chp/track2/en/. Access: 12 June 2017

16. Sorensen K (2012) Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health. 2(1):80. doi: 10.1186/1471-2458-12-80.

17. HLS-EU CONSORTIUM (2012): Comparative report of health literacy in eight EU member states. The European Health Literacy Survey HLS-EU, online publication: HTTP://WWW.HEALTH-LITERACY.EU

18. World Health Organization, BMI Classification.

19. Karlsson J, Persson L-O, Sjöström L, Sullivan M (2000) Psychometric properties and factor structure of the three-factor eating questionnaire (TFEQ) in obese men and women. Results from the Swedish obese subjects (SOS) study. Int J Obes 24(12):1715–25.

20. Kıraç D (2015). A new method for investigating obesity-related eating habits "Three-factor nutrition questionnaire”. Clinical and Experimental Health Sciences 5(3):162-9.

21. T. C. Ministry of Health. Turkey Health Literacy Scale Reliability and Validity, 2016.

22. Lindström J, Tuomilehto J (2003) The diabetes risk score: a practical tool to predict type 2 diabetes risk. Diabetes Care 26(3):725–31.

23. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatric Association, Inc.

24. Kelly NR, Shomaker LB, Pickworth CK, Grygorenko MV, Radin RM, Vannucci A, Yanovski JA (2015) Depressed affect and dietary restraint in adolescent boys' and girls' eating in the absence of hunger. Appetite 91:343-350.

25. Tanofsky-Kraff M, Shomaker LB, Stern EA, Miller R, Sebring N, DellaValle D, Yanovski JA (2012) Children's binge eating and development of metabolic syndrome. Int J Obes 36: 956-962.

26. Vannucci A, Tanofsky-Kraff M, Crosby RD, Ranzenhofer LM, Shomaker LB, Field SE, Yanovski JA (2013) Latent profile analysis to determine the typology of disinhibited eating behaviors in children and adolescents. J Consult Clin Psychol 81:494-507.

27. Van de Laar FA, van de Lisdonk EH, Lucassen PLBJ, Stafleu A, Mulder J, van den Hoogen HJM et al (2006) Eating behaviour and adherence to diet in patients with type 2 diabetes mellitus. Diabet Med 23(7):788–794.

28. Wilfley D, Berkowitz R, Goebel-Fabbri A, Hirst K, Ievers-Landis C, Lipman TH, Van Buren D (2011) Binge eating, mood, and quality of life in youth with type 2 diabetes: Baseline data from the TODAY study. Diabetes Care
34: 858-860.

29. Godfrey KM, Gallo LC, Afari N (2015) Mindfulness-based interventions for binge eating: A systematic review and meta-analysis. J Behav Med 38:348-362. doi: 10.1007/s10865-014-9610-5.

30. Godsey J (2013) The role of mindfulness based interventions in the treatment of obesity and eating disorders: An integrative review. Complement Ther Med 21:430-439. doi: 10.1016/j.ctim.2013.06.003.

31.Elfhag K, Linné Y (2005) Gender differences in associations of eating pathology between mothers and their adolescent offspring. Obes Res 13:1070-1076.

32.Anglé S, Engblom J, Eriksson T, Kautiainen S, Saha M, Lindfors P, Lehtinen M, Rimpelä A (2009) Three factor eating questionnaire-R18 as a measure of cognitive restraint, uncontrolled eating and emotional eating in a sample of young Finnish females. Int J Behav Nutr Phys Act 17(6):41 doi: 10.1186/1479-5868-6-41.

33. Tuomilehto J, Lindstrom J, Eriksson et al (2001) Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 344(18):1343–1350.
34. Knowler WC, Barrett-Connor E, Fowler SE et al (2002). Diabetes prevention program research group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346(6):393–403.
35. Tokunaga-Nakawatase Y, Nishigaki M, Taru C et al (2014) Computer-supported indirect-form lifestyle-modification support program using Lifestyle Intervention Support Software for Diabetes Prevention (LISS-DP) for people with a family history of type 2 diabetes in a medical checkup setting: a randomized controlled trial. Prim Care Diabetes 8(3):207–214. doi: 10.1016/j.pcd.2014.01.007.
36. Ritchie GE, Kenge AP, Joshi R et al (2011) Comparison of near-patient capillary glucose measurement and a risk assessment questionnaire in screening for type 2 diabetes in a high-risk population in rural India. Diabetes Care 34(1): 44–49. doi: 10.2337/dc10-1270.
37. Ramachandran C, Snehalatha S, Mary B et al (2006) The Indian Diabetes Prevention Programme shows that lifestyle modification and metformin prevent type 2 diabetes in Asian Indian subjects with impaired glucose tolerance (IDPP-1). Diabetologia 49:289–297.
38. Collins J, Ryan L, Truby H (2013) A systematic review of the factors associated with interest in predictive genetic testing for obesity, type II diabetes and heart disease. J Hum Nutr Diet 27(5):479–488. doi: 10.1111/jhn.12179.
39. Naranjo AA, Rodríguez AY, Llera RE, Aroche R (2013) Diabetes risk in a Cuban primary care setting in persons with no known glucose abnormalities, MEDICC Rev 15(2):16–19.

40. Bayındır CA, Metin Karaaslan M, Koçan S, Pekmezci H, Baydur SS, Kırbaş A, Ayaz T (2016) Prevalence and screening for risk factors of type 2 diabetes in Rize, Nourtheast Turkey: findings from a population-based study. Prim Care Diabetes 10(1):10-8 doi: 10.1016/j.pcd.2015.06.002.

41. Hidvegi T, Hetyesi K, Biro L, Jermendy GG (2001) Education level and clustering of clinical characteristics of Metabolic Syndrome. Diabetes Care 24(11):2013–2015.

42. Daher AM, AlMashoor SAH, Than W (2015) Glycaemic control and quality of life among ethnically diverse Malaysian diabetic patients, Qual Life Res 24(4):951–958 doi: 10.1007/s11136-014-0830-5.

43. Sezera, Relationship of Health Literacy to Healthy Lifestyle Behaviors, Public Health Nursing Department. Marmara University: Institute of Health Sciences; 2012

44. Filiz Yıldırım AK. Sağlık Okuryazarlığı. 2015; Available from: Access: 5 May 2017

45. Speirs KE (2012) Health literacy and nutrition behaviors among low-income adults. J Health Care Poor Underserved 23(3):1082-91. doi: 10.1353/hpu.2012.0113.

46. von Wagner C (2007) Functional health literacy and health-promoting behaviour in a national sample of British adults. J Epidemiol Community Health. 61(12):1086-90.

47. Zoellner J (2011) Health literacy is associated with healthy eating index scores and sugar-sweetened beverage intake: findings from the rural Lower Mississippi Delta. J Am Diet Assoc 111(7):1012-20. doi: 10.1016/j.jada.2011.04.010.
48. Nutbeam D, McGill B, Premkumar P (2018) Improving health literacy in community populations: a review of progress. Health Promot Int.33(5):901-911. doi: 10.1093/heapro/dax015.
49. Peterson FL, Cooper RJ, Laird JA (2001) Enhancing Teacher Health Literacy in School Health Promotion A Vision for the New Millennium. J School Health 71(4):138-44.

50. Lam LT, Yang L (2014) Is low health literacy associated with overweight and obesity in adolescents: an epidemiology study in a 12-16 years old population. Nanning, China, 2012. Arch. Public. Health. 72(1):11. doi: 10.1186/2049-3258-72-11.

51. Thomacos N, Keleher H (2009) Health literacy and Vulnerable Groups: What Works? Department of Health Social Science, Monash University, Melbourne

52. Faruqi N, Spooner C, Joshi C, Lloyd J, Dennis S, Stocks N, et al (2015) Primary health care-level interventions targeting health literacy and their effect on weight loss: a systematic review. BMC Obes 17(2):1–6. doi: 10.1186/s40608-015-0035-7

53. Al-Ruthia YS, Balkhi B, AlGhadeer S, Mansy W, AlSanawi H, AlGasem R, AlMutairi L, Sales I (2017) Relationship between health literacy and body mass index among Arab women with polycystic ovary syndrome. 25(7):1015-1018. doi: 10.1016/j.jsps.2017.04.003