The effect of exercise added to diet in obesity treatment on psychological outcomes: A study on impulsivity, depression, hopelessness, and suicidal probability

Abstract

This study aimed to evaluate the effect of dietary intervention on psychological symptoms and to compare these changes between patients who exercised and those who did not. A total of 56 patients were included in the study. The mean age of the patients was 42 ± 11.4 years, and the mean body weight was 86.1 ± 13.9 kg. All patients underwent dietary intervention. Patients were also divided into two groups based on their exercise status: those who exercised and those who did not. Waist circumference, Beck Depression Inventory, Barratt Impulsivity Scale-11, Beck Hopelessness Scale, and Suicide Probability Scale scores were compared before and after the intervention. Waist circumference decreased significantly after the diet [from 94 cm to 86 cm; p<0.001]. Beck Depression Inventory [from 18 to 5.5; A significant decrease was observed in the Beck Hopelessness Scale scores [from 9.5 to 3.5; p<0.001]. The attention, motor, and non-planning subscales and the total score of the Barratt Impulsivity Scale decreased significantly. While a significant decrease was observed in the negative self-evaluation and hostility subscales of the Suicide Probability Scale, no significant change was found in hopelessness, suicidal ideation, and the total score. In the exercise subgroup analysis, waist circumference and depression scores decreased significantly in both groups. In the intergroup comparison, only the change score on the Beck Depression Inventory showed a significant difference. Dietary intervention was associated with significant improvements in depression, hopelessness, and impulsivity levels, along with a decrease in waist circumference. The additional contribution of exercise appears limited in this sample. The findings suggest that diet-based interventions can have positive effects on psychological well-being as well as physical health indicators.

Keywords

• Dietary intervention
• obesity
• body mass index
• depression
• exercise
• psychological well-being

Supporting Institution

There is no supporting institution.

Project Number

2022/09-16

Ethical Statement

The Non-Interventional Research Ethics Committee of Fırat University

References

1. Shah A, Davarci O, Chaftari P, Avenatti E. Obesity as a disease: a primer on clinical and physiological insights. Methodist Debakey Cardiovasc J. 2025;21(2):4-13.
2. Segal Y, Gunturu S. Psychological issues associated with obesity. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.
3. Wang Z, Cheng Y, Li Y, Han J, Yuan Z, Li Q, et al. The relationship between obesity and depression is partly dependent on metabolic health status: a nationwide inpatient sample database study. Front Endocrinol (Lausanne). 2022;13:880230.
4. Monsalve FA, Fernández-Tapia B, Arriagada OC, González DR, Delgado-López F. Obesity and depression: a pathophysiotoxic relationship. Int J Mol Sci. 2025;26(23):11590.
5. Dakanalis A, Mentzelou M, Papadopoulou SK, Papandreou D, Spanoudaki M, Vasios GK, et al. The association of emotional eating with overweight/obesity, depression, anxiety/stress, and dietary patterns: a review of the current clinical evidence. Nutrients. 2023;15(5):1173.
6. Ninla-Aesong P, Puangsri P, Kietdumrongwong P, Jongkrijak H, Noipha K. Being overweight and obese increases suicide risk, the severity of depression, and the inflammatory response in adolescents with major depressive disorders. Front Immunol. 2023;14:1197775.
7. Gemesi K, Winkler S, Schmidt-Tesch S, Schederecker F, Hauner H, Holzapfel C. Efficacy of an app-based multimodal lifestyle intervention on body weight in persons with obesity: results from a randomized controlled trial. Int J Obes (Lond). 2024;48(1):118-126.
8. Wang Y, Huang Z, Zhang Y, Guo Y. The impact of exercise and nutritional interventions on the mental health of obese college students. Int J Healthc Inf Syst Inform. 2025;20(1):1-18.

9. Hossain MN, Lee J, Choi H, Kwak YS, Kim J. The impact of exercise on depression: how moving makes your brain and body feel better. Phys Act Nutr. 2024;28(2):43.
10. Akın E, Berkem M. İntihar girişiminde bulunan ergenlerde öfke ve dürtüsellik. Marmara Med J. 2012;25(3):148-152.
11. Gulec H, Tamam L, Gulec M, Turhan M, Karakus G, Zengin M, et al. Barratt Durtusellik Olcegi-11 (BIS-11)'in Turkce uyarlamasinin psikometrik ozellikleri. Klinik Psikofarmakol Bulteni. 2008;18:251-258.
12. Cull JG, Gill WS. Suicide Probability Scale. Los Angeles: Western Psychological Services; 1982.
13. Atlı Z, Eskin M, Dereboy Ç. İntihar Olasılığı Ölçeğinin (İOÖ) klinik örneklemde geçerlik ve güvenirliği. Klinik Psikiyatri Derg. 2009;12(3):111-124.
14. Beck AT, Weissman A, Lester D, Trexler L. The measurement of pessimism: the hopelessness scale. J Consult Clin Psychol. 1974;42(6):861-865.
15. Durak A, Palabıyıkoğlu R. Beck Umutsuzluk Ölçeği geçerlilik çalışması. Kriz Derg. 1994;2(2):311-319.
16. Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561-571.
17. Hisli N. Beck Depresyon Envanteri'nin geçerliliği üzerine bir çalışma. Turk Psikol Derg. 1988;6(22):118-126.
18. AlAmmar WA, Albeesh FH, Khattab RY. Food and mood: the corresponsive effect. Curr Nutr Rep. 2020;9(3):296-308.
19. Jacka FN, O'Neil A, Opie R, Itsiopoulos C, Cotton S, Mohebbi M, et al. A randomised controlled trial of dietary improvement for adults with major depression (the 'SMILES' trial). BMC Med. 2017;15(1):23.
20. Patil S, Mehdi SS, Mehdi S. The gut-brain axis and mental health: how diet shapes our cognitive and emotional well-being. Cureus. 2025;17(7):e88420.
21. Bizzozero-Peroni B, Martínez-Vizcaíno V, Fernández-Rodríguez R, Jiménez-López E, Núñez de Arenas-Arroyo S, Saz-Lara A, et al. The impact of the Mediterranean diet on alleviating depressive symptoms in adults: a systematic review and meta-analysis of randomized controlled trials. Nutr Rev. 2025;83(1):29-39.
22. van Zonneveld SM, van den Oever EJ, Haarman BCM, Grandjean EM, Nuninga JO, van de Rest O, et al. An anti-inflammatory diet and its potential benefit for individuals with mental disorders and neurodegenerative diseases: a narrative review. Nutrients. 2024;16(16):2646.
23. Tong F, Zhang Y, Jiao Y. The efficacy of cognitive behavioral therapy on reducing suicidal symptoms among adults: a systematic review and meta-analysis. Front Psychol. 2025;16:1672957.
24. Emiroğlu E, Aktaç Ş. Food-related impulsivity in the triangle of obesity, eating behaviors and diet. Black Sea J Health Sci. 2023;6(1):178-184.
25. Zeng J, Wang H. The impact of high-intensity exercise on patients with depression: a systematic review and meta-analysis of randomized controlled trials. Front Public Health. 2025;13:1616925.
26. Berardelli I, Corigliano V, Hawkins M, Comparelli A, Erbuto D, Pompili M. Lifestyle interventions and prevention of suicide. Front Psychiatry. 2018;9:567.
27. Andrade LS, Almeida IS, Mochizuki L, Sousa CV, Falk Neto JH, Kennedy MD, Quagliotti Durigan JL, Mota YL. What is the exercise intensity of Pilates? An analysis of the energy expenditure, blood lactate, and intensity of apparatus and mat Pilates sessions. J Bodyw Mov Ther. 2021;26:36-42.
28. Tian S, Liang Z, Qui F, Yu Y, Wang C, Zhang M, Wang X. Optimal exercise modality and dose to improve depressive symptoms in adults with major depressive disorder: a systematic review and Bayesian model-based network meta-analysis of RCTs. J Psychiatr Res. 2024;176:384-392.
29. Wang Y, Sun J, Zhang Y, Wang J, Lu S. Association of reallocating time between physical activity and sedentary behavior on the risk of depression: a systematic review and meta-analysis. Front Psychol. 2025;16:1505061.