Psychosocial functioning in the obese before and after weight reduction: construct validity and responsiveness of the Obesity-related Problems scale

Long-term health and psychosocial outcomes from surgically induced weight loss: results obtained in patients not attending protocolled follow-up visits

OBJECTIVE

Obesity management is focused at weight loss to obtain health, psychological and social benefits. Outcomes from controlled trials, however, do not reflect the everyday routine practice. Therefore, we aimed to investigate the results from surgically induced weight loss in patients devoid of a protocol-wise follow-up, who were visited at home.

PATIENTS AND METHODS

Patients who underwent a vertical banded gastroplasty or a gastric bypass between 1980 and 1997 were eligible. Body weight and height were measured. Patients filled out questionnaires on health status (Nottingham Health Profile (NHP)), psychological symptoms (Symptom Check List (SCL-90-R)), personality traits (Dutch Personality Questionnaire (DPQ)) and eating behaviour (Dutch Eating Behaviour Questionnaire (DEBQ)).

RESULTS

Out of 451 operated patients the addresses of 313 subjects could be traced and 236 (75%) agreed to participate. They maintained a mean (s.d.) loss of 32.1 (22.6) kg and 45.2 (29.3) % of excess weight, 8.2 (4.5) years after the operation, about two-third of the largest weight loss they achieved after 17 months postoperatively. The NHP and SCL-90-R conformed to norm values in males except for energy, sleep and emotional reactions. Females differed from norm values in every aspect and even women achieving a BMI<30 kg/m(2) did not catch up to norm values. Weight loss was inversely related to physical immobility and pain. Personality traits (DPQ) showed a higher grievance and dominance and a lower rigidity and self-esteem compared to norm values. Females scored higher in inadequacy and lower in social inadequacy. Eating patterns (DEBQ) showed mainly emotional eating and restrained eating. Effect sizes of >/=0.8 s.d. were chosen to reflect the clinical relevance of statistically significant findings. Pain, disturbances in sleep, energy and mobility and emotional and restrained eating proved to be clinically relevant. In subjects operated >5 years ago, a higher sensitivity, a higher inadequacy and a lower social inadequacy were observed compared to more recently operated subjects. A more restrained eating pattern was related to an operation of recent date.

CONCLUSIONS

Surgically induced weight losses are satisfactory in the long-term, even in patients not attending a strict follow-up protocol. Health, psychological symptoms, personality traits and eating behaviour were related to weight loss and time lapse since the operation and did not return to reference normal-weight subject values.

Content comparison of health status measures for obesity based on the international classification of functioning, disability and health

OBJECTIVE

To compare the content covered by twelve obesity-specific health status measures using the International Classification of Functioning, Disability and Health (ICF).

DESIGN

Obesity-specific health status measures were identified and then linked to the ICF separately by two trained health professionals according to standardized guidelines. The degree of agreement between health professionals was calculated by means of the kappa (kappa) statistic. Bootstrapped confidence intervals (CI) were calculated. The obesity-specific health-status measures were compared on the component and category level of the ICF.

MEASUREMENTS

welve condition-specific health-status measures were identified and included in this study, namely the obesity-related problem scale, the obesity eating problems scale, the obesity-related coping and obesity-related distress questionnaire, the impact of weight on quality of life questionnaire (short version), the health-related quality of life questionnaire, the obesity adjustment survey (short form), the short specific quality of life scale, the obesity-related well-being questionnaire, the bariatric analysis and reporting outcome system, the bariatric quality of life index, the obesity and weight loss quality of life questionnaire and the weight-related symptom measure.

RESULTS

In the 280 items of the eight measures, a total of 413 concepts were identified and linked to the 87 different ICF categories. The measures varied strongly in the number of concepts contained and the number of ICF categories used to map these concepts. Items on body functions varied form 12% in the obesity-related problem scale to 95% in the weight-related symptom measure. The estimated kappa coefficients ranged between 0.79 (CI: 0.72, 0.86) at the component ICFs level and 0.97 (CI: 0.93, 1.0) at the third ICF's level.

CONCLUSION

The ICF proved highly useful for the content comparison of obesity-specific health-status measures. The results may provide clinicians and researchers with new insights when selecting health-status measures for clinical studies in obesity.

A comparison of maladaptive schemata in treatment-seeking obese adults and normal-weight control subjects

OBJECTIVES

The aims of this study were to determine whether treatment-seeking obese adults display a greater severity of maladaptive schemata than normal-weight adults and to investigate the possible correlates of maladaptive schemata among obese individuals.

METHODS

The sample included 52 obese adults participating in a weight loss treatment and 39 normal-weight adults. Participants in the obese and normal-weight control groups completed standardized self-report questionnaires designed to assess attitudes and behaviors regarding eating and weight (Questionnaire on Eating and Weight Patterns-Revised and Binge Eating Scale), maladaptive schemata (Young Schema Questionnaire-Short Version), mood disturbance (Profile of Mood States-Adolescents) and socially desirable responding (Balanced Inventory of Desirable Responding).

RESULTS

The obese patients reported a significantly greater severity of maladaptive schemata (after controlling for demographic variables and binge eating disorder status) than the normal-weight control subjects. In addition, within the obese group, there were significant positive correlations between the severity of maladaptive schema scores and both mood disturbance and problem eating scores.

CONCLUSION

The present findings suggest that obesity may be associated with a higher severity of maladaptive schemata, at least among those obese individuals who have sought treatment. Possible etiological and treatment implications of the findings are discussed.

[Corticotropic axis and chronic stress in abdominal obesity and metabolic syndrome]

Several indicators of corticotropic axis hyperactivity have been observed in common abdominal obesity, which is clinically similar to the obesity found in Cushing's syndrome. Corticotropic axis hyperactivity may be involved in the development and metabolic and cardiovascular complications of abdominal obesity. Several mechanisms may be responsible for this hormonal dysregulation: genetic, lifestyle, and nutritional factors, and chronic stress. We note the necessity of methodologically-impeccable clinical studies for an objective evaluation of the role of stress in obesity.

Psychobiological impact of a progressive weight loss program in obese men

Psychobiological effects associated with a progressive body weight loss may help to improve the understanding of psychological barriers to weight loss. We hypothesized that a moderate body weight loss (about 10% of initial body weight) is accompanied with some negative psychological impact. Four questionnaires [SF-36 Health Survey, Three-Factor Eating Questionnaire (TFEQ), Beck Depression Inventory (BDI) and Pittsburgh Sleep Quality Index (PSQI)] were administered at each phase of a body weight loss program that consisted of a supervised diet and exercise clinical intervention to 11 obese men (mean BMI = 33.4 kg/m(2), mean age = 38 yr). The three phases investigated were: 1) at the beginning of the intervention (baseline); 2) after 5 +/- 1 kg body weight loss (Phase 1); and 3) after 10 +/- 1 kg body weight loss (Phase 2). Using the SF-36 Health Survey, physical and mental health were shown to be significantly improved at Phase 1 (p < 0.05). The TFEQ showed that cognitive dietary restraint increased (p < 0.001), and both disinhibition (p < 0.05) and susceptibility to hunger (p < 0.05) were significantly reduced at both Phase 1 and 2 compared to baseline. Depression as measured by the BDI significantly increased at Phase 2 (p < 0.05) compared to baseline and Phase 1. However, the mean BDI scores observed remained below the cut-off point for likely clinical significance. Finally, the PSQI showed that sleep quality was significantly improved at Phase 1 compared to baseline (p < 0.01). Altogether, these results suggest that a substantial improvement in the psychobiological profile occurs with a 5-kg weight loss (Phase 1) but that with additional weight loss (Phase 2) a small, but significant increase in depression occurred and seems to be associated with the increase in rigid restraint of eating. However, prospective studies with a larger sample are needed to confirm and deepen these results.

Maternal body mass index, duration of exclusive breastfeeding and children's developmental status at the age of 6 years

OBJECTIVE

To investigate whether the duration of exclusive breastfeeding and maternal body mass index (BMI) are associated with children's developmental status at the time of beginning elementary school.

DESIGN AND SUBJECTS

The subjects in the sample came from a longitudinal study on infant nutrition in Iceland. Food records were made once a month from birth to the age of 12 months, from which duration of exclusive breastfeeding could be determined. Mothers filled in The Icelandic developmental inventory for evaluation of motor and verbal development close to their children's sixth birthday (n = 85). Maternal self-reported weight and height was recorded. Information on socioeconomic factors was gathered by a questionnaire.

RESULTS

Duration of exclusive breastfeeding, in months, was positively related to children's motor component (B = 0.5+/-0.5, P = 0.054) and to the total developmental index (B = 1.0+/-0.5, P = 0.044) at 6 y, adjusting for gender and socioeconomic factors (maternal and paternal education, and family income). Children's learning score was negatively related to maternal BMI (B = -0.5+/-0.2, P=0.047). An inverse association also appeared between maternal BMI and two out of the three developmental composite scores, that is, verbal component and the total developmental index (B = -0.6+/-0.3, P=0.049) and (B = -0.4+/-0.2, P=0.057), respectively. In multiple regression the developmental indexes were most strongly independently associated with maternal BMI (negatively) and infants' birth weight (positively).

CONCLUSION

Maternal BMI and duration of breastfeeding were associated with verbal and motor development of 6-y-old children, independent of socioeconomic factors. Birth weight was also an independent determinant for developmental scores.

Development and validation of a French obesity-specific quality of life questionnaire: Quality Of Life, Obesity and Dietetics (QOLOD) rating scale

OBJECTIVE

To develop and validate a new health related quality of life (HRQOL) questionnaire specific to obesity and its management.

METHODS

This study was in two parts. The first (Study 1) consisted of the creation of a new tool derived from the American "Impact of Weight on Quality of Life Questionnaire" (IWQOL, 74 items) by adding to it a 17 items specific complementary module. This initial questionnaire (91 items) was reduced so as to obtain a questionnaire adapted to socio-cultural factors of obesity and dietary weight management in France. The objective of the second (Study 2) was to validate this final questionnaire by evaluating its psychometric properties: construction validity, internal reliability, concurrent validity in relation to a generic questionnaire, the SF-12, clinical validity by studying the effects of age, gender and body mass index (BMI), and reproducibility.

RESULTS

The results of Study 1, obtained in 128 obese patients (mean age: 42.5 12.1, BMI: 34.5 2.8 kg/m2, women: 83.6%) enabled reduction of the 91 questionnaire items to 36, grouped into 5 dimensions: physical impact, psycho-social impact, sex life, comfort with food and diet experience. Two hundred and twelve patients (mean age: 43.3 12.2, BMI: 35.8 7.4 kg/m2, women: 77.7%) were included in Study 2, among whom 75 filled out the questionnaire twice at a one week interval. Analyses enabled verification of the construction validity and internal reliability (Cronbach alpha > 0.7) of the questionnaire as well as its concurrent validity in relation to summarized SF-12 scores and its clinical validity. The "physical impact" dimension was significantly influenced by BMI and age, the dimensions "sex life" and "diet experience" by the factors gender and BMI, while "psycho-social impact" was influenced by the 3 factors cited. Its reproducibility was also deemed satisfactory (intra-class correlation coefficient > 0.8).

CONCLUSION

This new questionnaire, called the "Echelle Qualité de Vie, Obésité et Diététique (EQVOD)"/"Quality of Life, Obesity and Dietetics (QOLOD)" rating scale is sufficiently reliable and reproducible to be used in clinical practice. It is a simple tool adapted to socio-cultural factors of obesity in France, enabling taking into account of the effects of dietary management on the HRQOL of obese people.

Effectiveness of home-centered care through telemedicine applications for overweight and obese patients: a randomized controlled trial

OBJECTIVE

To determine if home-centered monitoring through telemedicine has an impact on clinical characteristics, metabolic profile and quality of life in overweight and obese patients.

DESIGN

Randomized controlled trial, 6-month duration.

SETTING

Tertiary care academic hospital.

SUBJECTS

A total of 122 patients were eligible to participate as they met the inclusion criteria of increased body mass index (BMI>25 kg/m(2)), age>18 and <70 y and ability to operate electronic microdevices.

INTERVENTIONS

All patients in the control group (n=77) received standard hospital care. Patients in the intervention group (n=45), additionally, measured three times a week, for 6 months, their blood pressure and body weight and transmitted them to an automated call center. These values were not shared with the patients' physician or dietician.

MAIN OUTCOME MEASURES

Clinical (body weight, BMI, blood pressure), laboratory (fasting plasma glucose, triglycerides, HDL-cholesterol, total cholesterol) and quality of life parameters (SF-36((R)), Visual Analog Scale of European Quality-5 Dimensions, Obesity Assessment Survey). Data were analyzed in an intention-to-treat-way (last observation carried forward).

RESULTS

Drop-out rate was similar in the control and intervention groups: 12 vs 11 percent, respectively, P=NS. There were no significant differences at baseline between intervention and control groups in all main outcome parameters. There were significant decreases for patients in the intervention group in body weight (from 101.6+/-22.4 to 89.2+/-14.7 kg, P=0.002, P=0.05 vs controls at 6 months), total cholesterol (from 247.6+/-42.0 to 220.7+/-42.6 mg/dl, P=0.002, P=0.05 vs controls at 6 months) and triglycerides (from 148.4+/-35.0 to 122.3+/-31.4 mg/dl, P=0.001, P=0.01 vs controls at 6 months). Intervention group patients made a total of 1997 phone contacts. The number of phone contacts was correlated positively with Social Functioning (SF), Vitality (VT) and Mental Health (MH) scores of SF-36((R)) at baseline (r=0.48, r=0.41, r=0.41, respectively, P=0.05) but not with weight loss.

CONCLUSIONS

Home-centered, intense treatment through the use of telemedicine can be effective in improving short-term obesity outcomes.

Hypolipidemic effects of crude extract of adlay seed (Coix lachrymajobi var. mayuen) in obesity rat fed high fat diet: relations of TNF-alpha and leptin mRNA expressions and serum lipid levels

To find out whether the expressions of these adipocyte markers are influenced by oriental medicine, obesity rats induced by high fat diet (HFD) for 8 weeks were injected with 50 mg/100 g body weight adlay seed crude extract (ACE), daily for 4 weeks. The results are summarized as follows: HFD + ACE group significantly reduced food intakes and body weights. Weights of epididymal and peritoneal fat were dramatically increased in HFD groups compared with those of normal diet (ND) group but significantly decreased more in HFD + ACE group than those of HFD + saline group (sham). Those of brown adipocytes were increased in HFD + ACE group compared to ND and sham groups but there was no significant difference. The sizes in white adipose tissue (WAT) by microscope were markedly larger in HFD groups than ND group but considerably reduced in HFD + ACE group compared with sham group. The levels of triglyceride, total-cholesterol and leptin in blood serum were significantly decreased in HFD + ACE group compared to those of sham group. Leptin and TNF-alpha mRNA expressions in WAT of rats were remarkably increased more in sham group than in those of ND group. Those of HFD + ACE group were significantly decreased compared with those of sham group, especially. TNF-alpha mRNA expression in HFD + ACE group was declined more than that of ND group. In conclusion, treatments of ACE modulated expressions of leptin and TNF-alpha and reduced body weights, food intake, fat size, adipose tissue mass and serum hyperlipidemia in obesity rat fed HFD. Accordingly, the oriental medicine extract, adlay seed crude extract, can be considered for obesity therapies controlling.