Our results revealed that despite controlling for covariates, including traditional cardiovascular risk factors and BMI, sense of control was inversely associated with VAT. Our previous research has found that BMI does not necessarily correlate with VAT when stratified by race/ethnicity . This difference is particularly important since VAT is more metabolically active than other forms of adipose tissue and contributes to metabolic abnormalities associated with weight gain [1–10]. Nonetheless, as expected, BMI was positively associated with VAT measures in our study. Subcutaneous adipose tissue (SAT) was not assessed in the present study for its known direct correlation to BMI and waist conference and being less metabolically active, which is outside the scope of the present study. BMI was assessed as a confounder in our study as it may also be a surrogate measure of unhealthy behaviors. Conversely, it may also function as a mediator in the pathway leading from low sense of control to poor lifestyle and elevated VAT. However, analyses did not find BMI to function as a mediating factor. Another consideration to mention is whether chronic conditions, such as hypertension or diabetes, truly functions as confounders in the present study or rather as final outcomes in the pathway. We chose to assess these chronic conditions as confounders due to the complex and dynamic relationship between VAT and chronic conditions. Chronic disease states, such as elevated sugar, can lead to excessive metabolic burden attenuating the development of VAT or triggering metabolic or inflammatory pathways leading to physiologic dysfunction such as elevated blood pressures and downstream adverse health outcomes. Nonetheless, we presented results with and without chronic conditions in the adjusted regression models and determined it did not alter the association between sense of control and VAT. Our results lend to the importance that one's sense of control or mastery has health consequences that are objectively measured. An increase level of understanding of the pathways by which this occurs continue to be an important area of further research, especially studies that identify factors that are amenable to intervention and improved health outcomes.
Our results align well with other published research in that sense of control is associated with health behaviors and conditions that are normally associated with adiposity [23–25]. High sense of control has been found to be protective in the development of diabetes mellitus among adults , while lower levels have been associated with a blunted ability to deal with life stressors possibly leading to poor health behavior decisions . In fact, the relationship between sense of control and VAT is most likely a result of having difficulty in changing poor health behaviors or leading one to make unhealthy choices, which in turn harbors the potential to perpetuate the observation of disparate health outcomes. Low sense of control or mastery has previously been shown to be associated with unhealthy food choices , low levels of physical performance , and smoking . The multi-factorial attributes of economics, environmental factors, internalizing factors, and social pressures all perpetuate unhealthy behaviors and poorer health. The key to sustainable improved health is not only interventions that impact at the individual level, but also numerous changes associated with the social determinants of health, for example safer communities, policy changes, and financial stability.
There are several limitations to the study that must be considered. While sense of control is related to locus of control, self mastery, and self efficacy, it must be realized that these are related but distinct constructs. Also, the sense of control measure used in this study assessed general control of life choices and was not specific to health. Since the study was conducted in North Texas, USA, generalizability to other locations remains undetermined. In addition, the crude measures for diet and physical activity may not capture the full assessment of each variable. However, the significant findings demonstrated in the simple regression models provide expected associations between these variable and VAT, hence, reassuring the final conclusions of our study. Finally, the cross-sectional nature of the data precludes any causal assumptions.