How Locus of Control Orientations Affects Individual Nutritional

Status: A Literature Review

Meliana Chandra

and Lailatul Muniroh

Department of Nutrition, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia

Research Group Center for Health & Nutrition Education, Counseling and Empowerment, Indonesia

Keywords: Locus of Control Orientation, Obesity, Health Behaviours.

Abstract: Obesity is a health problem which is determined by the accumulation of fat, leading to weight gain. The study

of obesity involves various disciplines, including psychology. Locus of control is a psychosocial concept that

refers to an individual’s belief in things that control events in their life; by their own control or external factors.

This study aimed to review literature examining the relationship between locus of control orientation and

individual’s nutritional status. This article was a narrative literature review comprising up to 50 relevant

sources about locus of control, health behaviors, and nutritional status issues, such as obesity, from various

regions. This review concluded that locus of control orientation is likely influences an individual’s

overnutrition status indirectly by influencing their health behaviours. Some studies also found that locus of

control orientation can impact food consumption, with individuals having an internal locus of control more

likely to consume healthier food such. In summary, locus of control orientation can be considered as one of

the crucial factors to regard in designing programs to reduce nutritional status problems in the future. Further

research is also required to improve the understanding of how psychosocial factors, such as locus of control

orientation, can influence nutritional status.

1 BACKGROUND

The Report of a World Health Organization

Consultation in 2000 named obesity as a global

epidemic. Obesity is a health problem involving

excessive fat accumulation in an individual’s body

caused by an imbalance of energy intake and

expenditure. Obesity can be considered a risk factor

for non-communicable degenerative diseases, which

are the most significant cause of death in humans

(Sofa, 2018).

The growth of the obesity epidemic can be

associated with many risk factors. Psychosocial is one

of the factors that can influence an individual’s eating

habits. The locus of control orientation is one of the

psychosocial factors referred to (Adnyani et al.,

2015). A person’s behavior executions can be

predicted due to locus of control. In the early

development of the theory, the locus of control

orientation was divided into two dimensions: internal

and external (Haskas, 2019). Individuals with internal

locus of control orientation believe that the

consequences of every action they do, no matter good

or bad, happen because of the factors within

themselves. In contrast, those with external locus of

control orientations assume that the factors outside of

their control significantly affect the results they get

(Nainggolan et al., 2018).

The development and severity of obesity are even

considered an epidemic in many developed countries,

and it is also starting to proliferate in many

developing countries such as Indonesia (Sahoo et al.,

2015). Obesity will have a significant impact on

humanity in the future. Hence, actions must be taken

to reduce and control the risk of health problems to

maintain and improve the global public health status.

This paper was written to conclude the relation

between locus of control orientation and an

individual’s nutritional status problem, such as

obesity, based on previous studies.

2 SUBJECTS AND METHOD

This article was a narrative literature review

comprising up to 50 relevant sources about locus of

control, health behaviors, and nutritional status

issues, such as obesity, from various regions.

Chandra, M. and Muniroh, L.

How Locus of Control Orientations Affects Individual Nutritional Status: A Literature Review.

DOI: 10.5220/0012898900004564

Paper published under CC license (CC BY-NC-ND 4.0)

In Proceedings of the 5th International Conference on Social Determinants of Health (ICSDH 2023), pages 70-74

ISBN: 978-989-758-727-6; ISSN: 2975-8297

3 RESULTS

3.1 Overnutrition

Overnutrition is a condition in which an individual’s

Body Mass Index (BMI) value, as the measure of

nutritional status, exceeds the normal range. One of

the overnutrition status characteristics is the

increasing body fat levels. An Indonesian person can

be classified as overnutrition if their BMI is ≥ 25.0

kg/m

(Ministry of Health of Republic of Indonesia,

2014). Overnutrition is divided into two classes,

namely overweight and obesity. A person can be

classified as obese if their BMI value is ≥ 27 kg/m2.

Generally, the causes of obesity relate to food intake,

metabolism, energy expenditure, and physical

activity. Socio-cultural factors, lack of knowledge,

peer pressure, uncontrolled eating habits, hunger,

emotional eating, snack consumption, sleep

deprivation, and impacts of drug therapy can cause

excessive food intake. Meanwhile, aging processes,

gender, and heredity can affect the slow mechanisms

of metabolism and low energy expenditure. Low

physical activity can be caused by muscle and joint

pain, the types of jobs a person occupies, chronic

fatigue, and emotional limitations (Blüher, 2019).

Obesity is a problem that occurs due to various

factors. Genetics is one of the factors that can cause

obesity. After the first single-gene defect that causes

monogenic obesity was found in 1997, researchers

found that more than 20 single-gene defects can lead

to autosomal obesity (O’Rahilly, 2009). The

mutations in these genes eventually cause the

leptin/melanocortin pathway in the central nervous

system to play a critical part in the regulation of an

individual’s energy balance, so the obesity resulting

from this appears to be caused by the increasing

appetite and reduced satiety (Herrera and Lindgren,

2010). The prediction from the Non-Communicable

Disease Risk Factor Collaboration (NCD-RisC)

institution also showed that the probability of obesity

based on gender is more significant in females, which

is 21% compared to 18% in males (Chooi et al.,

2019). This incidence can be associated with maternal

obesity in women during pregnancy (Huda et al.,

2010), changes in fat distribution in women

experiencing menopause, and the twofold

acceleration of lipoprotein metabolism compared to

men due to estrogen stimulation (Kanter and

Caballero, 2012).

Cultural factors can also lead to obesity by

influencing an individual’s view of their body image.

On an individual level, their views and preferences

toward their body shape can be the reason behind

weight gain occurrence. In some regions, such as the

Pacific Islands, plus-size people are considered more

attractive than those who are not (McCabe et al.,

2011). Social and environmental factors also have a

role in promoting the incidence of obesity. Lifestyle

changes caused by the increasing income in society,

especially those living in urban areas, along with the

growing influence of foreign culture due to the

development of information technology, have also led

to an increase in low-carbohydrates, low-fibers, and

high-fat diets (Aini, 2014). Together with the

decreasing intensity of physical activity due to

economic improvement, this can escalate energy

intake and reduce energy expenditure, thus leading to

a positive energy balance. When an individual’s

positive energy balance occurs for a long time,

excessive fat accumulation as an energy reserve can

occur, which leads to obesity (Selassie and Sinha,

2011).

3.2 Locus of Control

Locus of control is a psychosocial concept that refers

to an individual’s belief in things that control events

in their life (Morowatisharifabad et al., 2010). In the

theory’s early development, Julian Rotter proposed

this concept as a component of social learning theory.

The concept of locus of control is categorized into

two dimensions of orientation: internal and external

(Rotter, 2011). A person with an internal locus of

control orientation believes that the behavior they

perform determines the reinforcement or results they

obtain. In contrast, people with an external locus of

control orientation assume that the reinforcement or

results they receive are beyond their control, namely

by other people who are more powerful than them or

by accidental events (Malhotra, 2017). In other

words, people with an internal locus of control

orientation are confident that the environment around

them is responsive to their relatively permanent

characteristics. In contrast, people with an external

locus of control orientation are convinced that the

environment and external things they get seem out of

their control.

After Rotter proposed the concept, locus of

control has been studied on a broader scale in various

sub-disciplines of psychology (Zeigler-Hill and

Shackelford, 2020). The concept’s development

continues, proven by the development of different

domain-specific measurements with multiple uses of

locus of control, including the Multidimensional

Health Locus of Control (MHLC) Scale developed by

Kenneth A. Wallston and Barbara S. Wallston with

Gordon D. Kaplan and Shirley A. Maides in 1976

How Locus of Control Orientations Affects Individual Nutritional Status: A Literature Review

(Masters and Wallston, 2005). The development of

this MHLC instrument is used as a behavior predictor

related to individual health status after Hanna

Levenson in 1974 argued that locus of control is not

a unidimensional construct but multidimensional.

The concept of locus of control claimed by Levenson

categorizes the dimensions of locus of control into

three, namely internal control, powerful others, and

chances (Ross et al., 2015).

Differences in the locus of control orientation tend

to be affected by various aspects, such as

socioeconomic factors, childhood background,

education received, financial difficulties, and social

integration (Wardle, 2003). Each individual can have

different orientations with the varieties in the

underlying locus of control orientation tendencies.

These orientation differences ultimately promote the

execution of health behaviors, leading to diverse

outcomes of an individual’s health indicators,

including nutritional status.

4 DISCUSSION

The escalating incidence of overnutrition can be

linked to various risk factors. H.L. Blum’s Classical

Theory classifies the factors affecting health status

into behaviors, environment, health services, and

heredity (Saraswati et al., 2021). Behavioral factors

conducted by an individual can also be influenced by

their locus of control orientation. Locus of control

orientation is considered a measurable psychosocial

factor related to the performance of an individual’s

health behaviors (Adhanty et al., 2021). Locus of

control orientation is a critical characteristic whose

relation with the incidence of overnutrition should be

observed since it can indicate whether a person is

confident that the environment and their life choices

are within control (Neymotin and Nemzer, 2014).

In general, internal locus of control orientation

can be associated with positive outcomes, such as

more outstanding academic achievement (Findley

and Cooper, 1983), better mental health (Gallagher et

al., 2014), and improved physical condition. This can

happen since individuals with an internal locus of

control orientation consider that their every action is

vital to the realization of events in their life, so they

are more likely to manifest positive behaviors such as

exercising, not smoking, and maintaining healthy

eating habits (Wallston and Wallston, 1978).

The theory is supported by the research results

from Cobb-Clark et al. (2014) on household members

in Australia from 2003 to 2010, demonstrating that

individuals with an internal locus of control tend to

pay more attention to their health by doing more

exercise and consuming healthier foods, such as by

ingesting more various types of vegetables, fruits, and

low-fat milk in men and regularly eating vegetables

and avoiding fatty foods in women. In addition, a

study conducted by Bellini et al., (2011) on children

and adolescents with celiac disease in Italy also

showed that individuals with an internal locus of

control orientation tend to be more compliant with a

gluten-free diet than those with an external

orientation. This study proved that locus of control is

a beneficial early warning system to identify which

individuals are most likely to disobey the

predetermined diet related to their health problems.

Aside from influencing individual health-related

behaviors, locus of control orientation can also affect

stress levels (Paranjpe, 2014). This can be related to

a person’s ability to deal with the stressors they

receive. A previous study on groups of workers

proved that people with an internal locus of control

orientation helped reduce the adverse effects of their

workload (Gray-Stanley et al., 2010).

Stress can be defined as a non-specific response

the body gives to a command (Selye, 1956). The

characteristic of stress is that it causes individuals to

feel uncomfortable since there is an imbalance

between orders, both from within and from outside of

themselves, which are obtained by the limits of the

ability they think when they have to carry out these

orders. Stress can cause various changes in an

individual’s behavior, including eating patterns

(Choi, 2020). A report claimed that individuals with

higher stress levels tend to have the urge to adopt

unhealthy eating patterns, such as consuming lots of

snacks (Sogari et al., 2018).

This can be associated with an increasing appetite

due to fluctuations in hormonal changes when an

individual experiences stress since stress can affect

glucocorticoid secretion. Glucocorticoids stimulate

appetite and the production of insulin, a hormone that

can affect nutrient intake (Dallman, 2010). This

theory is proved by the research conducted by

Mouchacca et al. (2013) on 1,382 women aged 18 to

46 years in Victoria, Australia, which concluded that

stress levels are associated with intensified fast food

consumption. Furthermore, the research conducted

by Al Jaber et al. (2019) on students of the Medical

Study Program at the Islamic University of Al-Imam

Muhammed Ibnu Saud revealed that when the

students’ stress levels increase, their execution of bad

eating habits will also escalate, as evidenced by the

high consumption of unhealthy foods such as fast

foods which are high in calories.

ICSDH 2023 - The International Conference on Social Determinants of Health

5 CONCLUSION

Previous studies have proven that locus of control

orientation can indirectly affect an individual’s

nutritional status, including the execution of

overnutrition prevention, by encouraging the person

to perform healthy behaviors. In addition, locus of

control orientation can also affect stress levels related

to regulating appetite-affecting hormones. Based on

this, locus of control orientation can be considered as

one of the crucial factors to regard in designing

programs to reduce nutritional status problems in the

future. Further research is also required to improve

the understanding of how psychosocial factors, such

as locus of control orientation, can influence

nutritional status.

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ICSDH 2023 - The International Conference on Social Determinants of Health