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Costa-Dookhan KA, Leung SE, Cassin SE, Sockalingam S. Psychosocial Predictors of Response to Telephone-Based Cognitive Behavioural Therapy in Bariatric Surgery Patients. Can J Diabetes 2019; 44:236-240. [PMID: 31447318 DOI: 10.1016/j.jcjd.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 05/17/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Bariatric surgery is an empirically supported treatment for severe obesity; however, it does not directly target underlying behavioural and psychological factors that potentially contribute to obesity. Mounting evidence supports the efficacy of cognitive behavioural therapy (CBT) for improving eating psychopathology and psychological distress among bariatric patients, and telephone-based CBT (Tele-CBT) is a novel delivery method that increases treatment accessibility. METHODS This study aimed to identify demographic and clinical predictors of response to Tele-CBT among 79 patients who received Tele-CBT in 3 previous studies. Listwise deletion was applied, after which 58 patients were included in a multivariate linear regression adjusted for age, sex and education status, to evaluate patient rurality index (urban or nonurban), and baseline binge eating, emotional eating and depression symptoms, as predictors of tele-CBT response. RESULTS The predictors explained 31% of the observed variance [R2=0.312, F(4,57)=3.238, p<0.01]. Patient rurality index (beta=0.341, p<0.01) was the only statistically significant predictor of Tele-CBT response. CONCLUSIONS Given the limited psychosocial resources available in many bariatric surgery programs, the findings suggest that Tele-CBT may be particularly beneficial for patients residing in nonurban communities with limited access to other health-care services.
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Affiliation(s)
- Kenya A Costa-Dookhan
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto Institute of Medical Science, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Samantha E Leung
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Stephanie E Cassin
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada; Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Bariatric Surgery Program, Toronto Western Hospital, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto Institute of Medical Science, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
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Williams-Kerver GA, Steffen KJ, Mitchell JE. Eating Pathology After Bariatric Surgery: an Updated Review of the Recent Literature. Curr Psychiatry Rep 2019; 21:86. [PMID: 31410596 PMCID: PMC7953688 DOI: 10.1007/s11920-019-1071-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW The goal of this paper was to extend the prior literature on eating pathology following bariatric surgery by highlighting themes in data published over the past 3 years and identifying limitations and future directions for research. RECENT FINDINGS Changes in eating pathology after bariatric surgery remain consistent with previous research. Specifically, diagnostic prevalence rates and incidence of related behaviors generally decrease following surgery. However, some research supports that these factors increase and/or remit over time following surgery, and that they subsequently have a negative impact on weight loss outcomes. While recent findings have extended knowledge on eating pathology following bariatric surgery, the overall body of literature is still relatively limited. Additional research is needed, including work focusing on the standardization of eating pathology definitions, development/validation of standardized eating pathology instruments for bariatric surgery patients, and predictors of risk for continued or new onset eating pathology following surgery.
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Affiliation(s)
- Gail A Williams-Kerver
- Center for Biobehavioral Research, Sanford Research, 120 South 8th St., P.O. Box 2010, Fargo, ND, 58122, USA.
| | - Kristine J Steffen
- Center for Biobehavioral Research, Sanford Research, 120 South 8th St., P.O. Box 2010, Fargo, ND, 58122, USA
- Department of Pharmaceutical Science, College of Pharmacy, Nursing, and Alliances, North Dakota State University, Fargo, ND, USA
| | - James E Mitchell
- Center for Biobehavioral Research, Sanford Research, 120 South 8th St., P.O. Box 2010, Fargo, ND, 58122, USA
- University of North Dakota School of Medicine, Grand Forks, ND, USA
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Sockalingam S, Leung SE, Hawa R, Wnuk S, Parikh SV, Jackson T, Cassin SE. Telephone-based cognitive behavioural therapy for female patients 1-year post-bariatric surgery: A pilot study. Obes Res Clin Pract 2019; 13:499-504. [PMID: 31409544 DOI: 10.1016/j.orcp.2019.07.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 06/29/2019] [Accepted: 07/26/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Although bariatric surgery is a durable treatment for patients with severe obesity, it does not directly address behavioural and psychological factors that potentially contribute to weight regain post-surgery. Psychological interventions, such as cognitive behavioural therapy (CBT), can be challenging to access due to physical limitations and practical barriers. Telephone-based CBT (Tele-CBT) can improve eating psychopathology and psychological distress before and after surgery. Given the frequent occurrence/recurrence of problematic eating-related and psychological issues many patients face 1-year post-surgery, this open-trial pilot study aimed to evaluate the effectiveness of Tele-CBT delivered 1-year post-surgery as an adjunctive treatment to the usual standard of bariatric care. METHODS Patients (n=43) received six 1-h Tele-CBT sessions delivered weekly beginning at 1-year post-surgery. Patients completed questionnaire packages before and after the intervention to assess changes in binge eating (BES), emotional eating (EES), depression (PHQ-9), and anxiety (GAD-7). RESULTS Thirty-two patients completed Tele-CBT yielding a 74.4% completion rate. Participants reported significant improvements on the Binge Eating Scale (t(31)=3.794, p=0.001), Emotional Eating Scale (t(31)=3.508, p=0.001), Patient Health Questionnaire-9 Item Scale (z=-2.371, p=0.018), and Generalised Anxiety Disorder-7 Item Scale (z=-3.546, p<0.001) immediately following Tele-CBT. DISCUSSION The results demonstrate that Tele-CBT delivered 1-year post-surgery may improve binge eating, emotional eating, depression, and anxiety. Additional research is warranted to examine whether these changes translate into long-term improvements in bariatric surgery outcomes.
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Affiliation(s)
- Sanjeev Sockalingam
- Centre for Mental Health, University Health Network, Canada; Bariatric Surgery Program, Toronto Western Hospital, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Education, Centre for Addiction and Mental Health, Canada.
| | - Samantha E Leung
- Centre for Mental Health, University Health Network, Canada; Bariatric Surgery Program, Toronto Western Hospital, Canada
| | - Raed Hawa
- Centre for Mental Health, University Health Network, Canada; Bariatric Surgery Program, Toronto Western Hospital, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Susan Wnuk
- Centre for Mental Health, University Health Network, Canada; Bariatric Surgery Program, Toronto Western Hospital, Canada; Department of Psychiatry, University of Toronto, Canada
| | - Sagar V Parikh
- Department of Psychiatry, University of Toronto, Canada; Department of Psychiatry, University of Michigan, Ann Arbor, United States
| | - Timothy Jackson
- Bariatric Surgery Program, Toronto Western Hospital, Canada; Division of General Surgery, University Health Network, University of Toronto, Canada
| | - Stephanie E Cassin
- Centre for Mental Health, University Health Network, Canada; Department of Psychiatry, University of Toronto, Canada; Department of Psychology, Ryerson University, Canada.
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Prospective Study of Attachment as a Predictor of Binge Eating, Emotional Eating and Weight Loss Two Years after Bariatric Surgery. Nutrients 2019; 11:nu11071625. [PMID: 31319502 PMCID: PMC6683092 DOI: 10.3390/nu11071625] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/10/2019] [Accepted: 07/15/2019] [Indexed: 12/16/2022] Open
Abstract
Bariatric surgery remains the most effective treatment for severe obesity, though post-surgical outcomes are variable with respect to long-term weight loss and eating-related psychopathology. Attachment style is an important variable affecting eating psychopathology among individuals with obesity. To date, studies examining eating psychopathology and attachment style in bariatric surgery populations have been limited to pre-surgery samples and cross-sectional study design. The current prospective study sought to determine whether attachment insecurity is associated with binge eating, emotional eating, and weight loss outcomes at 2-years post-surgery. Patients (n = 108) completed questionnaires on attachment style (ECR-16), binge eating (BES), emotional eating (EES), depression (PHQ-9), and anxiety (GAD-7). Multivariate linear regression analyses were conducted to examine the association between attachment insecurity and 2-years post-surgery disordered eating and percent total weight loss. Female gender was found to be a significant predictor of binge eating (p = 0.007) and emotional eating (p = 0.023) at 2-years post-surgery. Avoidant attachment (p = 0.009) was also found to be a significant predictor of binge eating at 2-years post-surgery. To our knowledge, this study is the first to explore attachment style as a predictor of long-term post-operative eating pathology and weight outcomes in bariatric surgery patients.
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Wilkinson LL, Rowe AC, Millings A. Disorganized attachment predicts body mass index via uncontrolled eating. Int J Obes (Lond) 2019; 44:438-446. [PMID: 31164726 DOI: 10.1038/s41366-019-0378-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/16/2019] [Accepted: 04/01/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND/OBJECTIVES Previous research has demonstrated relationships between attachment orientations (expectations of ourselves and others in interpersonal relationships), eating behaviours and obesity. However, such research has been limited to investigations of 'organised' forms of attachment orientations (reflecting coherent and predictable patterns of behaviour). Theoretically, aberrant eating behaviours and body mass index, should also be related to 'disorganized attachment.' SUBJECTS Here we test these relationships for the first time in a general population. Secondary data analyses of a pre-existing dataset were conducted (N = 537). METHODS USED Questionnaire measures of organised (avoidant and anxious) and disorganized attachment were included alongside eating behaviour measures (emotional eating, uncontrolled eating and cognitive restraint) and body mass index (BMI). RESULTS Parallel multiple mediation analysis (PROCESS) showed that uncontrolled eating (but not emotional eating or cognitive restraint) significantly mediated a relationship between disorganized attachment and body mass index (significant indirect relationship; LLCI = 0.02 ULCI = 0.16) when both attachment anxiety and avoidance were included as covariates. CONCLUSIONS We suggest that the mechanism underpinning this indirect relationship is a form of maladaptive affect regulation, but that the behavioural motivators differ from those observed in anxiously attached individuals. Rather than eating being a premeditated strategy used by individuals high in disorganized attachment to manage emotion, opportunities to eat are simply taken as they present themselves. Professionals engaged in addressing eating problems and weight management should consider attachment orientations in their patient assessments and be mindful that attachment disorganized individuals are especially likely to engage in uncontrolled eating behaviours that are associated with a higher BMI.
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Affiliation(s)
| | - Angela C Rowe
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Abigail Millings
- Department of Psychology, University of Sheffield, Sheffield, UK
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Abstract
PURPOSE OF REVIEW The purpose of this review was to examine different forms of disordered eating among individuals with excess weight, including their rates, correlates, and psychosocial treatments. RECENT FINDINGS Binge eating/binge eating disorder, loss of control eating, emotional eating, and food addiction are all fairly prevalent among individuals with excess weight. They appear to share many of the same correlates, including broader eating disorder psychopathology, body/shape/weight concerns, depression, anxiety, and low self-esteem. Behavioral, cognitive-behavioral, and third-wave (e.g., acceptance, mindfulness) therapies appear effective in improving binge eating, loss of control eating, emotional eating, associated features (e.g., weight and shape concerns), and psychological distress (e.g., depression). Certain forms of disordered eating are elevated among individuals with excess weight, and psychosocial interventions have been found effective in improving symptomatology. Empirical research examining the efficacy of treatments for food addiction is lacking, and greatly needed given both its rate and controversy.
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Affiliation(s)
- Bethany A Nightingale
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
| | - Stephanie E Cassin
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada.
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Mental Health, University Health Network, Toronto, ON, Canada.
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Employment Outcomes 2 Years After Bariatric Surgery: Relationship to Quality of Life and Psychosocial Predictors. Obes Surg 2019; 29:2854-2861. [DOI: 10.1007/s11695-019-03905-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Gero D, Tzafos S, Milos G, Gerber PA, Vetter D, Bueter M. Predictors of a Healthy Eating Disorder Examination-Questionnaire (EDE-Q) Score 1 Year After Bariatric Surgery. Obes Surg 2019; 29:928-934. [DOI: 10.1007/s11695-018-3596-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Raheb-Rauckis C, Jarosz P. A reconceptualization of the definition of binge eating for African American women: A concept analysis. Nurs Forum 2018; 54:60-67. [PMID: 30380136 DOI: 10.1111/nuf.12298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/13/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022]
Abstract
AIM The aim of this analysis is to develop a better understanding of the concept of binge-eating behavior among African American women (AAW). BACKGROUND Obesity is a major public health concern that is disproportionately prevalent among AAW. Among the factors that contribute to obesity development, binge eating may be of significant concern to AAW. DESIGN A critical analysis and synthesis of the empirical literature using Walker and Avant's model for concept analysis. The databases MEDLINE, Cumulative Index to Nursing Health Literature (CINAHL) Complete, PsycINFO, and PsycARTICLES were used. Keywords included binge eating AND African American women or Black women race or ethnicity or minority. RESULTS Binge eating is a behavior that exists on a continuum that involves the overconsumption of food, with or without loss of control (LOC), whereas binge eating with LOC is related to increased impairment and severity. While the main attribute of binge eating involves the consumption of a large amount of food, the LOC component of binge eating definition may not be culturally relevant criteria to include as a requirement, as it may exclude AAW in diagnostics and subsequent treatment as well as overlook the health implications of binge eating regardless of LOC endorsement. CONCLUSION Including LOC in defining binge-eating behavior among AAW is significant, but should not be necessitated. This concept analysis illustrates the complexities related to binge-eating behavior among AAW, enumerating the characteristics of binge eating that may be unique to certain populations. The definition for binge eating among AAW developed from this concept analysis needs to be further explored in future studies.
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Affiliation(s)
| | - Patricia Jarosz
- Goldfarb School of Nursing at Barnes-Jewish College, St Louis, Missouri
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