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Received: 5 December 2020    Accepted: 3 May 2021

DOI: 10.1111/ijcp.14320

ORIG INAL PAPER

Primary Care

The effect of diet and regular exercise on psychological

resilience in obese or overweight women

Cagla Ozdemir1  | Nurcan Akbas Gunes2

1
Kutahya Community Health Center,
Kutahya, Turkey
2
Department of Family Medicine, Faculty
of Medicine, Bolu Abant Izzet Baysal
University, Bolu, Turkey
Correspondence
Nurcan Akbas Gunes, Kılıçarslan
Neighborhood, Orhangazi Street, Number
21/B/6 Bolu, Turkey.
Email: drnurak@hotmail.com
Abstract
Aim: This study aimed to investigate the effects of diet and regular exercise on resil-
ience in obese or overweight women.
Methods: The study was conducted with the 109 patients who applied to the obesity
polyclinics. The patients were divided into three groups by their current disease con-
ditions and willingness; those who were willing to both diet and exercise (diet + ex-
ercise group) (n: 35), those who were willing to only diet (diet group) (n: 37) and
those who were not willing to recommended diet or exercise (control group) (n: 37).
The “Connor-­Davidson Resilience Scale” (CD-­RISC) was applied to all the participants
through face-­to-­face interviews. The CD-­RISC scale was repeated 8 weeks after the
first evaluation.
Results: There was a significant difference between the total score and subscores of
the scale in the intra-­group comparison before and after the intervention (P < .05).
When the groups were compared after the intervention, a significant difference was
found between the diet group and the control group as well as the exercise +diet
group and the control group (P < .05).
Conclusion: We found that diet and exercise practices increased psychological en-
durance in obese or overweight women. In addition, positive improvements were
also detected in psychological resilience subgroups such as perseverance and per-
sonal competence, tolerance to negative events and spiritual disposition.

1 |  I NTRO D U C TI O N
Obesity is a complex disease that is characterised by the over-­
accumulation of fat in adipose tissue and can affect people of all ages,
causing important hormonal and metabolic changes and psycho-­social
impacts.1 It is a global problem with an ever-­increasing prevalence.2
The World Health Organization (WHO) reported that the preva-
lence of obesity was 21%-­36% in our country, which was at the top
3,4
amongst European countries.
Obesity is associated with many chronic diseases. These dis-
eases include hypertension, insulin resistance, diabetes mellitus,
certain types of cancer and mental disorders. The studies clearly re-
vealed the relationship between obesity and mental problems such
as anxiety and depression in recent years.5-­7
Diet plans that help losing weight and obesity-­specific exercise
modalities reduce obesity-­
related complications and contribute to
maintaining general health.8 It is suggested that physical activity acti-
vates various immune-­modulating agents and affects the metabolism
of both physiologically and psychologically.9 Physical exercise has
been proven to show both an antidepressant and anxiolytic effect by
increasing blood flow, mitochondrial function and reducing adipose
tissue volume and cellular stress.10
The American Psychological Association has defined resilience as
“the process of adapting well in the face of adversity, trauma, tragedy,
threats or even significant source of stress.”11 It was found that resil-
ience has positive effects on physical and mental health as well as re-
duces negative effects caused by emotional stress. Resilience is thought
to serve as a stress buffer for cardiovascular and metabolic diseases.12

Int J Clin Pract. 2021;00:e14320. wileyonlinelibrary.com/journal/ijcp |

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https://doi.org/10.1111/ijcp.14320
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2 of 7       OZDEMIR and AKBAS GUNES
There are numerous studies on the individual physiological
changes associated with diet and exercise or resilience.13,14 But,
there is a limited number of studies on the effects of diet and exer-
cise on resilience.15 Thus, this study aimed to investigate the effects
of diet and regular exercise on resilience in obese and overweight
women.
2 | M E TH O DS
The study was conducted with the patients who applied to the obe-
sity polyclinics. The sample size was calculated. The total sample
size was calculated as 105 (35 for each group) for the t-­test with the
effect size d  = 0.8; α  = 0.05 group distribution =1:1. Women who
were older than 18 years old, obese or overweight, at a sufficient
socio-­cultural level to understand the questionnaire or scales were
included in the study, while those with a mental disorder or a disease
contraindicated with recommended exercise were excluded from the
study. The study was completed with 109 patients. Ethics commit-
tee approval was obtained for the study (Kütahya Health Sciences
University). The height and weight of the patients were measured
to calculate BMI (body mass index). In the light of the obesity clas-
sification of the WHO, those with BMI of 25 kg/m2 and higher were
considered overweight, and those with 30 kg/m2 and higher were
considered obese.8
Diet and exercise were recommended to all patients. Some of the
patients chose to diet only. Some of them agreed to diet and exer-
cise. Some of them did not want to diet or exercise, but accepted to
participate in the study as a control group. The grouping in our study
was made according to these criteria [(diet group), (diet + exercise
group) and (control group)].
Age, sex, marital status, educational status, additional disease
of the patients and medications that they have used were recorded
in the sociodemographic form. The “Connor-­Davidson Resilience
Scale” (CD-­RISC) was applied to all the participants through face-­
to-­face interviews. Nutrition therapy to reduce daily calorie intake
and provide a weight loss of 0.5-­1.0 kg per week was recommended
by a dietician to the patients. The exercise was planned to be 60-­
min light-­or moderate-­brisk walking for 3 days a week. The patients’
adherence to diet and exercise plans was controlled by phone calls.
The CD-­RISC scale was repeated 8 weeks after the first evaluation
(Figure 1).
2.1 | Evaluation methods
2.1.1 | Connor-­Davidson Resilience Scale
Connor-­
Davidson Resilience Scale (CD-­
RISC) was developed by
Connor and Davidson to determine the resilience levels of individu-
als.16,17 Five-­point Likert scale with 25 questions consisted of three
sub-­scales: perseverance and personal competence (items 1,5,10-­
12, 15-­19, 21-­25), tolerance of negative affect (items 4, 6, 7, 8, 13,
What’s known
• Obesity can affect people of all ages, causing important
hormonal and metabolic changes and psycho-­
social
impacts.
• Diet and exercise, as a treatment method requiring no
additional cost, play an important role in the treatment
of obesity.
What is new
• It was observed that diet or regular exercise has im-
proved the resilience of obese or overweight women
based on perseverance and personal competence, toler-
ance of negative affect and spirituality.
14) and spirituality (items 2, 3,9, 20). The items of the scale were
scored between 0 and 4, ranging from “never” (0 points) to “almost
always” (4 points). The maximum score that can be obtained from
the scale was 100, with higher scores indicating greater psychologi-
cal resilience.
2.2 | Statistical analysis
The conformity of the variables to normal distribution was ex-
amined by visual (histogram and probability plots) and analytical
methods (Shapiro-­W ilk test). The descriptive statistics were given
as mean and standard deviation for the normally distributed data,
median and minimum-­maximum value for the non-­n ormally dis-
tributed data, and number and percentage for the nominal data.
The normally distributed variables were analysed with the inde-
pendent samples t test, one-­way ANOVA test and paired samples
t-­
test. The non-­
n ormally distributed variables were compared
using the “Mann Whitney U test” between two groups and the
“Kruskal Wallis test” between three groups. The nominal data
were evaluated using the Chi-­s quare test/ Fisher's exact test be-
tween two groups. In the statistical analyses performed in this
study, the comparisons with a P-­value <.05 were considered sta-
tistically significant.
3 | R E S U LT S
In the study, the mean age was 43.7 ± 8.4 years for the diet group,
42.5 ± 11.7 years for the exercise + diet group and 40.8 ± 9.2 years
for the control group. No statistically significant difference was
found in terms of age between the groups (P  > .05). The socio-­
demographic characteristics of the patients are shown in Table 1.
There was a significant difference between the total score and
subscores of the scale in the intra-­group comparison before and
OZDEMIR and AKBAS GUNES
F I G U R E 1   Distribution of CD-­RISC scores in after-­intervention groups
after the intervention (P  < .05). However, there was no significant
difference in the control group before and after the intervention
(P  > .05). The intra-­group relationship between the scale's total
scores and subscores before and after the intervention are sum-
marised in Table 2.
In our study, no statistically significant difference was found in
terms of CD-­RISC total score and subscores in the comparison of the
groups before the intervention (P < .05) (Table 3).
When the groups were compared after the intervention, a sig-
nificant difference was found between the diet group and the con-
trol group as well as the exercise + diet group and the control group
(P < .05). However, there was no significant difference between the
diet group and the exercise + diet group (P > .05). The inter-­group
relationship between the scale's total scores and subscores after the
intervention are summarised in Table 4.
4 | D I S CU S S I O N
Obesity, which has a multifaceted biological basis that includes
genetic susceptibility, biological factors, eating habits, energy ex-
penditures and adipose tissue functions, and appears as a result
of high-­calorie food consumption and insufficient physical activ-
ity, has been associated with several diseases. Recently, it has been
recognised that mental disorders are included in these diseases.18-­21
Obese individuals are more exposed to stressful life events and thus
show higher emotional stress levels. Moreover, it has been reported
that emotional resilience in adolescents is preventative against obe-
sity. 22 Therefore, the approaches aiming to enhance emotional resil-
ience may contribute to combating obesity. Regular physical activity,
which is recommended in obesity treatment, provides positive out-
comes in several obesity-­related diseases such as cardiovascular dis-
eases. 23 It is also known that regular physical activity helps to relieve
mental disorder symptoms such as anxiety and depression as well
as enhances physical and psychological aspects of life quality.10,24,25
|
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Physical exercise both increases psychological resilience and sup-
ports weight loss in obese or overweight individuals. Thus, physical
exercise contributes both psychologically and physiologically.
In our study, it was observed that only diet or diet + regular ex-
ercise programme enhanced the psychological resilience, which was
evaluated by the CD-­RISC scale.
Although all patients were interviewed by phone, there was no
change in psychological resilience in the control group. Calling pa-
tients may have affected their resilience. However, in the control
group, it was observed that the telephone conversation had no ef-
fect on psychological resilience. Psychological resilience was more
pronounced in the intervention groups than in the control group.
Our findings show that diet and regular exercise affect psychological
resilience in obese or overweight individuals. Patients' compliance
with the recommendations reveals this effect.
Multifaceted pathologies of obesity are an important factor
that brings obesity forward amongst other health issues. Obesity
is associated with more calorie intake and insufficient physical
activity, as well as psychopathologies such as depression, anxiety
disorder, lost sense of self, substance abuse, abuse and stigmati-
sation. 26 Although physical activity and exercise programmes are
key treatments, they require patient compliance and continuity. It
can be thought that obese individuals with better coping capabil-
ity and psychological resilience will show better compliance with
treatment. In our study, it was observed that diet and exercise are
associated with psychological resilience, so it can be suggested
that psychological resilience enhancement can mediate obesity
treatment. Moreover, other approaches targeting psychological
resilience enhancement may be effective in obesity treatment.
However, these questions can only be answered by more compre-
hensive prospective studies.
There are a limited number of studies investigating BMI,
physical activity and psychological resilience.12,27,28 However, to
our knowledge, there are no studies examining the relationship
between regular exercise and diet, and psychological resilience.
4 of 7      | OZDEMIR and AKBAS GUNES

TA B L E 1   Distribution of
Diet group Diet + exercise Control group
sociodemographic features
(n = 37) group (n = 35) (n = 37) P
†
Age (Mean ± SD)   43.7 ± 8.4 42.5 ± 11.7 40.8 ± 9.2 .445
†
BMI   32.2 ± 4.6 32.2 ± 5.8 28.9 ± 7.1 .052
Marital status† 
Married (n (%)) 33 (89.2) 32 (91.4) 27 (75) .322a 
Single (n (%)) 4 (10.8) 3 (8.6) 9 (25) .021b 
.091c 
Working statusc 
Working (n (%)) 6 (16.2) 4 (11.4) 29 (80.6) .021b 
Not working (n (%)) 31 (83.8) 31 (88.6) 7 (19.4)
b
Income rate  
Under 2000 TL 16 (43.2) 8 (22.9) 6 (16.7) .212a 
(n (%)) .001b 
2000 TL and above 21 (56.8) 27 (77.1) 30 (83.3) .087 c 
(n (%))
Chronic diseasec 
Yes (n (%)) 11 (29.7) 10 (27.6) 11 (39.3) .091a 
No (n (%)) 26 (70.3) 27 (72.4) 17 (60.7) .154b 
.357 c 
a
Diet group vs diet + exercise group.
b
Diet group vs control group.
c
Diet + exercise group vs control group analysis.
†
One-­way ANOVA test.
††
Chi-­square test/Fisher's exact test.
Bold/italic indicates P values <.05 are statistically significant.

TA B L E 2   Change in CD-­RISC scores

Before the After the Effect
after the intervention
intervention intervention P size

Diet group (n = 37)

Total scorea  76 (22-­100) 90 (26-­100) <.001 0.773
Tenacity and personal 48 (12-­60) 55 (12-­60) <.001 0.760
competencea 
Tolerance of negative affect a  14 (5-­21) 21 (5-­24) <.001 0.764
a
Tendency towards spirituality   13 (2-­16) 14 (3-­16) <.001 0.681
Diet + exercise group (n = 35)
Total scorea  73 (27-­100) 80 (27-­100) <.001 0.626
Tenacity and personal 46 (13-­60) 51 (13-­60) <.001 0.593
competencea 
Tolerance of negative affect a  14 (3-­24) 18 (3-­24) <.001 0.620
Tendency towards spiritualitya  11 (6-­16) 13 (6-­16) .001 0.540
Control group (n = 37)
Total scorea  64 (24-­100) 66 (25-­94) .513 0.107
Tenacity and personal 40 (8-­60) 44 (10-­60) .438 0.127
competencea 
Tolerance of negative affect a  12 (2-­21) 14 (4-­22) .531 0.093
Tendency towards spiritualitya  9 (2-­15) 10 (2-­15) .877 0.025

Abbreviation: CD-­RISC, Connor-­Davidson Resilience Scale.

a
Median (min-­max).
Bold/italic indicates P values <.05 are statistically significant.
OZDEMIR and AKBAS GUNES |
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TA B L E 3   Analysis of CD-­RISC scores

Diet group Diet + exercise Control group
between pre-­intervention groups
(n = 37) group (n = 35) (n = 37) P

Total score (Median 76 (22-­100) 73 (27-­100) 64 (24-­100) .146

(min-­max))
Tenacity and personal 48 (12-­60) 46 (13-­60) 40 (8-­60) .149
competence (Median
(min-­max))
Tolerance of negative 14 (5-­21) 14 (3-­24) 12 (2-­21) .541
affect (Median
(min-­max))
Tendency towards 13 (2-­16) 11 (6-­16) 9 (2-­15) .081
spirituality (Median
(min-­max))

TA B L E 4   Analysis of CD-­RISC scores

Diet group Diet + exercise Control group
between groups after the intervention
(n = 37) group (n = 35) (n = 37) P

Total score (Median 90 (26-­100) 80 (27-­100) 66 (25-­94) .312a 

(min-­max)) .011b 
.007c 
Tenacity and personal 55 (12-­60) 51 (13-­60) 44 (10-­60) .272a 
competence (Median .001b 
(min-­max)) .011c 
Tolerance of negative 21 (5-­24) 18 (3-­24) 14 (4-­22) .195a 
affect (Median .021b 
(min-­max)) .017c 
Tendency towards 14 (3-­16) 13 (6-­16) 10 (2-­15) .054a 
spirituality (Median .031b 
(min-­max)) .027c 
a
Diet group vs diet + exercise group.
b
Diet group vs control group.
c
Diet + exercise group vs control group analysis.
Bold/italic indicates P values <.05 are statistically significant.

Despite the methodological variances, the existing studies sup-
port our findings. The study conducted by Stewart-­Knox et al27
in 2012 recorded the BMI, waist circumference values and so-
ciodemographic characteristics as well as questioned the physi-
29
cal activity and nutritional habits of individuals. Psychological
evaluation was performed using the “Psychological Resilience
Scale." The study has found that a sedentary lifestyle affects BMI
and individuals with high BMI have less psychological resilience.
Similarly, it was determined that physical activity is effective on
waist circumference size and inversely proportional to psycholog-
ical resilience. The results of our study were in agreement with
these results. However, no physical intervention has been applied
and the physical activity level has been questioned via a question-
naire in this study. In the study conducted by Lehrer et al12 in 2019,
the participants were evaluated via the Perceived Stress Scale and
Brief-­Resilience Scale. Cardiometabolic risk factors that include
glucose, lipid parameters, blood pressure and waist circumference
have been evaluated, and the Metabolic Syndrome Severity Score
was calculated. The study has found that psychological resilience
has a negative correlation with the perceived stress and sever-
ity of the metabolic syndrome. It was seen that patient-­reported
physical activity duration is associated with psychological resil-
ience. In Turkey, in a study conducted by Secer et al28 in 2019,
the participants were evaluated via the “International Physical
Activity Questionnaire” and the “Psychological Resilience Scale.”
The study found a positive correlation between physical activ-
ity and psychological resilience. A correlation was also found
between BMI and psychological resilience. However, unlike our
study, individuals with normal or low BMI were evaluated in the
relevant study. The physical activity was evaluated via a question-
naire. The results should be interpreted carefully because of the
methodological variance between the studies.
Enhancement of psychological resilience was observed in both
diet and diet + exercise groups. However, the psychological resil-
ience enhancement observed in the diet + exercise group was similar
to the individuals who were recommended diet only. Even if the pa-
tients are told how to diet and exercise, it may not be done properly.
This may have affected our results. Exercise status was evaluated in
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6 of 7       OZDEMIR and AKBAS GUNES
both diet and exercise groups. It was not taken into account in other
groups.
Our study had some limitations. Treatment compliance rates
have not been evaluated. Also, our study evaluated the short-­term
effectiveness of diet and exercise treatment. Our study has not in-
vestigated the long-­term effect of diet and exercise interventions on
psychological resilience.
5 |  CO N C LU S I O N
As a result, we found that diet and exercise practices increased psy-
chological resilience in obese or overweight women. In addition,
positive improvements were also detected in psychological resil-
ience subgroups such as perseverance and personal competence,
tolerance to negative events and spiritual disposition. These effects
can be revealed more clearly with long-­term studies involving larger
groups in the future.
AC K N OW L E D G E M E N T
None.
D I S C LO S U R E
All authors declare that they have no conflicts of interest.
AU T H O R C O N T R I B U T I O N S
Cagla Ozdemir: Conceptualisation, Methodology, Formal analysis,
Investigation, Writing -­original draft, Visualisation. Nurcan Akbas
Gunes: Conceptualisation, Investigation, Writing -­review & editing,
Software.
I N FO R M E D C O N S E N T
Informed consent was obtained from all individual participants.
R E S E A R C H I N VO LV I N G H U M A N PA R T I C I PA N T S
This study with a case-­control study design was approved by the
Ethics Committee of Kütahya Health Sciences University.
ORCID
Cagla Ozdemir  https://orcid.org/0000-0002-9766-1918
Nurcan Akbas Gunes  https://orcid.org/0000-0001-8688-5839
REFERENCES
1. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and
trends in overweight among US children and adolescents, 1999–­
2000. JAMA. 2002;288:1728-­1732.
2. Pednekar M, Jóźwiak J, Kolsteren P, et al. Worldwide trends in
body-­mass index, underweight, overweight, and obesity from 1975
to 2016: a pooled analysis of 2416 population-­based measurement
studies in 128· 9 million children, adolescents, and adults. Lancet.
2017;390:2627-­2642.
3. Timmis A, Townsend N, Gale C, et al. European Society of
Cardiology: cardiovascular disease statistics 2019 (executive sum-
mary). Eur Heart J. 2020;6:7-­9.
4. World Health Organization. WHO fact sheet on overweight and
obesity; 2020. https://www.who.int/news-­room/fact-­sheet​s/detai​l/​
obesi​t y-­and-­overw​eight. Accessed December 1, 2020.
5. Lykouras L, Michopoulos J. Anxiety disorders and obesity.
Psychiatriki. 2011;22:307-­313.
6. Segura-­Garcia C, Caroleo M, Rania M, et al. Binge Eating Disorder
and Bipolar Spectrum disorders in obesity: psychopathological and
eating behaviors differences according to comorbidities. J Affect
Disord. 2017;208:424-­430.
7. Jantaratnotai N, Mosikanon K, Lee Y, McIntyre RS. The interface of
depression and obesity. Obes Res Clin Pract. 2017;11:1-­10.
8. TEMD Obezite, Lipid Metabolizması, Hipertansiyon Çalışma Grubu.
Obezite tanı ve tedavi kılavuzu. Ankara, Turkey: Miki Matbaacılık;
2019:63-­76.
9. Hamer M. The relative influences of fitness and fatness on inflam-
matory factors. Prev Med. 2007;44:3-­11.
10. Simonen RL, Rankinen T, Pérusse L, et al. A dopamine D2 recep-
tor gene polymorphism and physical activity in two family studies.
Physiol Behav. 2003;78:751-­757.
11. Southwick SM, Bonanno GA, Masten AS, Panter-­Brick C, Yehuda
R. Resilience definitions, theory, and challenges: interdisciplinary
perspectives. Eur J Psychotraumatol. 2014;5:25338.
12. Lehrer HM, Steinhardt MA, Dubois SK, Laudenslager ML. Perceived
stress, psychological resilience, hair cortisol concentration, and
metabolic syndrome severity: a moderated mediation model.
Psychoneuroendocrinology. 2020;113:104510.
13. Mouchacca J, Abbott GR, Ball K. Associations between psycholog-
ical stress, eating, physical activity, sedentary behaviours and body
weight among women: a longitudinal study. BMC Public Health.
2013;13:828.
14. Felix AS, Lehman A, Nolan TS, et al. Stress, resilience, and car-
diovascular disease risk among black women: results from the
Women’s Health Initiative. Circ Cardiovasc Qual Outcomes.
2019;12:e005284.
15. Tekin A, Tekin G, Calisir M, Bayrakdaroğlu S. Düzenli aerobik egzer-
siz programinin üniversiteli obez kiz öğrencilerin fiziksel, motorik ve
psiko-­sosyal parametrelerine etkisi. Spor ve Performans Araştırmaları
Dergisi. 2015;6:19-­29.
16. Connor KM, Davidson JR. Development of a new resilience scale:
the Connor-­Davidson resilience scale (CD-­RISC). Depress Anxiety.
2003;18:76-­82.
17. Karaırmak Ö. Establishing the psychometric qualities of the
Connor-­Davidson Resilience Scale (CD-­RISC) using exploratory and
confirmatory factor analysis in a trauma survivor sample. Psychiatry
Res. 2010;179:350-­356.
18. Haslam D, James W. Obesity. Lancet. 2005;366:1197-­1209.
19. Garaulet M, Ordovas J, Madrid J. The chronobiology, etiology and
pathophysiology of obesity. Int J Obes (Lond). 2010;34:1667-­1683.
20. Rosenkilde M, Auerbach P, Reichkendler MH, et al. Body fat loss and
compensatory mechanisms in response to different doses of aero-
bic exercise—­a randomized controlled trial in overweight sedentary
males. Am J Physiol Regul Integr Comp Physiol. 2012;303:R571-­R579.
21. Rajan T, Menon V. Psychiatric disorders and obesity: a review of
association studies. J Postgrad Med. 2017;63:182.
22. Foster BA, Weinstein K. Moderating effects of components of re-
silience on obesity across income strata in the national survey of
children's health. Acad Pediatr. 2019;19:58-­66.
23. Kodama S, Saito K, Tanaka S, et al. Cardiorespiratory fitness as a
quantitative predictor of all-­ c ause mortality and cardiovascu-
lar events in healthy men and women: a meta-­ analysis. JAMA.
2009;301:2024-­2035.
24. Herring MP, O’Connor PJ, Dishman RK. The effect of exercise train-
ing on anxiety symptoms among patients: a systematic review. Arch
Intern Med. 2010;170:321-­331.
OZDEMIR and AKBAS GUNES |
      7 of 7

25. Martin CK, Church TS, Thompson AM, et al. Exercise dose and quality of 29. Simpson E, O'Connor J, Livingstone M, et al. Health and lifestyle
life: a randomized controlled trial. Arch Intern Med. 2009;169:269-­278. characteristics of older European adults: the ZENITH study. Eur J
26. Sarwer DB, Polonsky HM. The psychosocial burden of obesity. Clin Nutr. 2005;59:S13-­S21.
Endocrinol Metab Clin North Am. 2016;45:677-­688.
27. Stewart-­Knox B, Duffy ME, Bunting B, et al. Associations between
obesity (BMI and waist circumference) and socio-­demographic fac-
How to cite this article: Ozdemir C, Akbas Gunes N. The
tors, physical activity, dietary habits, life events, resilience, mood,
effect of diet and regular exercise on psychological resilience
perceived stress and hopelessness in healthy older Europeans. BMC
Public Health. 2012;12:424. in obese or overweight women. Int J Clin Pract.
28. Seçer E. Üniversite öğrencilerinin fiziksel aktivite düzeyleri ile psikolojik 2021;00:e14320. https://doi.org/10.1111/ijcp.14320
dayanıklılıkları arasındaki ilişki. Erzincan Binali Yıldırım Üniversitesi,
Sağlık Bilimler Enstitüsü; 2019.