Perceived Stress and Coping Strategies in Relation to Body Mass Index: Cross-Sectional Study of 12,045 Japanese Men and Women

BACKGROUND: Accumulated evidence suggests a weak positive relationship between psychosocial stress and body mass index (BMI), but little is known about stress coping strategies and BMI. OBJECTIVE: We aimed to examine if perceived stress and coping strategies are related to BMI, with any of their mutual interactions on BMI. METHODS: This cross-sectional study included 5,063 men and 6,982 women aged 40-69 years. A self-administered questionnaire ascertained perceived stress and 5 items of coping strategies (emotion expression, emotional support seeking, positive reappraisal, problem solving, and disengagement). Analyses were performed by gender with adjustment for age, socioeconomic status, and lifestyle factors. RESULTS: No significant associations were detected between perceived stress and BMI in either men (P (trend) = 0.09) or women (P (trend) = 0.58). In men, however, ‘disengagement’ showed an inverse association with BMI (P (trend) < 0.001), and ‘positive reappraisal’ and ‘problem solving’ revealed a positive association with BMI (P (trend) = 0.04 and 0.007, respectively) even after controlling for perceived stress. A possible interaction between perceived stress and ‘disengagement’ on BMI was found in men (P (interaction) = 0.027); the inverse association between ‘disengagement’ and BMI was more evident in higher levels of stress (β = −0.13, P (trend) = 0.21 in low; β = −0.22, P (trend) = 0.01 in medium; and β = −0.24, P (trend) = 0.06 in high). In men, ‘disengagement’ was inversely associated with overweight/obesity (odds ratio 0.79, 95% confidential interval 0.67-0.95), and “positive reappraisal” was positively associated with it (1.25, 1.02-1.54). CONCLUSIONS: Coping strategies may have an important role in developing overweight/obesity, particularly in men.