Binge eating and self-esteem predict body image dissatisfaction among obese men and women seeking bariatric surgery

Global self-esteem and degree of overweight/obesity: are they linked in the adult population? A systematic review and meta-analysis

OBJECTIVE

Self-esteem may be adversely affected in adults with overweight or obesity, particularly women and those showing higher BMIs, although there is no consensus in the literature. The objective of the current study, based on reported cross-sectional associations, was to clarify the relationship between global self-esteem and overweight/obesity in adults.

METHODS

Four databases were searched to identify eligible literature published prior to June 2024, and a systematic review was conducted of the 120 articles identified. Meta-analytic processing of 38 eligible articles at the study level and of the participant data obtained from 16 studies (n = 2,972) was conducted for quantitative synthesis. Potential moderators, such as gender, age, BMI, type of assessment, and treatment-seeking status, were tested.

RESULTS

The summary correlation between BMI and self-esteem across studies was r = -0.11, 95% CI [-0.17, -0.05], z = -3.70, p < .001. None of the tested moderators affected this association, although the meta-analysis of the individual participant data provided by the authors revealed a small effect of gender and a non-linear evolution of self-esteem linked to BMI.

CONCLUSION

The present study found a negative relationship between global self-esteem and overweight/obesity in adults, which suggests a negative, although weak, effect of excess weight on self-perception.

Recreational Physical Activity and the Mediterranean Diet: Their Effects on Obesity-Related Body Image Dissatisfaction and Eating Disorders

Obesity is a non-communicable disease that is associated with a number of serious physical and mental health conditions. The present study examines the effect of recreational physical activity and the Mediterranean diet on body image dissatisfaction and propensity for eating disorders. It is based on 1311 participants categorized by body mass index (BMI) into a normal ΒΜΙ group (NBG; N = 513), an overweight and obese ΒΜΙ group (OBG; N = 492), and a control group (CG; N = 309). All participants completed the Multidimensional Body-Self Relations Questionnaire-Appearance Scale (MBSRQ-AS), Rosenberg Self-esteem Scale (RSES), Eating Attitudes Test-26 (EAT-26), Mediterranean Diet Score (MedDietScore), and Fitness Evaluation and Fitness Orientation subscales from the original Multidimensional Body-Self Relations Questionnaire (MBSRQ). The results of the multiple regression analysis indicated that the overall prediction of the variables was statistically significant. A multivariate analysis of variance (MANOVA) demonstrated the existence of significant interactions between groups and gender across a range of scales. Despite higher body image dissatisfaction in the OBG group, they maintained positive self-esteem and did not exhibit eating disorder tendencies. Notably, women reported greater dissatisfaction than men across all three groups. Our findings have practical implications for public health promotion strategies, policymaking, future research, and clinical practice. Encouraging regular exercise and adherence to the Mediterranean diet could improve body satisfaction and reduce eating disorder risk. Policymakers can advocate for community-based policies promoting physical activity and healthy eating habits.

Sex differences in regional gray matter density in pre-adolescent binge eating disorder: a voxel-based morphometry study

BACKGROUND

Binge eating disorder (BED) is a pernicious psychiatric disorder which is linked with broad medical and psychiatric morbidity, and obesity. While BED may be characterized by altered cortical morphometry, no evidence to date examined possible sex-differences in regional gray matter characteristics among those with BED. This is especially important to consider in children, where BED symptoms often emerge coincident with rapid gray matter maturation.

METHODS

Pre-adolescent, 9-10-year old boys (N = 38) and girls (N = 33) with BED were extracted from the 3.0 baseline (Year 0) release of the Adolescent Brain Cognitive Development Study. We investigated sex differences in gray matter density (GMD) via voxel-based morphometry. Control sex differences were also assessed in age and body mass index and developmentally matched control children (boys N = 36; girls N = 38). Among children with BED, we additionally assessed the association between dorsolateral prefrontal (dlPFC) GMD and parent-reported behavioral approach and inhibition tendencies.

RESULTS

Girls with BED uniquely demonstrate diffuse clusters of greater GMD (p < 0.05, Threshold Free Cluster Enhancement corrected) in the (i) left dlPFC (p = 0.003), (ii) bilateral dmPFC (p = 0.004), (iii) bilateral primary motor and somatosensory cortex (p = 0.0003) and (iv) bilateral precuneus (p = 0.007). Brain-behavioral associations suggest a unique negative correlation between GMD in the left dlPFC and behavioral approach tendencies among girls with BED.

CONCLUSIONS

Early-onset BED may be characterized by regional sex differences in terms of its underlying gray matter morphometry.

Is Childhood Maltreatment Associated with Body Image Disturbances in Adulthood? A Systematic Review and Meta-Analysis

PURPOSE

We aimed to synthesize the evidence for an association between childhood maltreatment and body image disturbances in adulthood. Information on maltreatment subtypes and mediator variables was included to gain further insights into the mechanisms of the association. In addition, we aimed to examine the role of body image disturbances in the development of negative mental health outcomes associated with childhood maltreatment.

METHODS

Based on a comprehensive search strategy, eligible studies were identified in PubMed, Scopus, and Web of Science. The eligibility assessment was performed by two reviewers, and 132 articles were studied full-text. To reduce heterogeneity, only non-clinical samples were included in the meta-analysis. A meta-regression was computed to examine the influence of maltreatment subtype on body image disturbances.

RESULTS

Our results provide evidence for a robust association between childhood maltreatment and cognitive-affective body image, both in clinical and community samples. Included studies (N = 40) indicate that body image disturbances are especially pronounced in individuals suffering from Posttraumatic Stress Disorder (PTSD) after childhood maltreatment. The meta-analysis included 12 studies with a total of 15.481 participants, and indicates a small overall effect size (r = 0.21, 95% CI = [0.16, 0.26], p < .001). Meta-regression revealed no significant impact of maltreatment subtype in non-clinical samples.

CONCLUSION

Childhood maltreatment should be considered as a distal risk factor for the development of a negative cognitive-affective body image. We argue for future longitudinal studies which allow a better understanding of the pathways linking childhood maltreatment, body image disturbances and associated psychopathology.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40653-021-00379-5.

Factors associated with the improvement of body image dissatisfaction of female patients with overweight and obesity during cognitive behavioral therapy

BACKGROUND

Cognitive behavioral therapy (CBT) has become one of the most commonly used psychotherapeutic treatments for obesity. It stems from CBT for bulimia nervosa and binge eating disorder, which focuses on amelioration of the eating behavior and body image dissatisfaction (BID), but usually does not focus on weight loss. In contrast, CBT for obesity focuses on weight loss, as well as eating behavior and BID. It is at present unclear whether the improvement of BID during CBT for obesity is associated with improvement of factors other than weight loss.

OBJECTIVE

The purpose of this study was to determine whether improvement of BID during CBT for obesity was associated with improvement of factors other than weight loss.

METHODS

One hundred and sixty-five women (BMI 31.8 ± 5.2 kg/m², age 49.3 ± 10.5 years) with overweight or obesity completed a 7-month CBT-based weight loss intervention. BID, depression, anxiety, binge eating, and perfectionism were assessed at both baseline and the end of the intervention through the use of psychological questionnaires.

RESULTS

Percent total weight loss, baseline BID, baseline binge eating disorder (BED), change in depression (Δdepression), Δstate anxiety, Δtrait anxiety, Δbinge eating, and Δperfectionism were significantly correlated with ΔBID. Multiple regression analysis showed that baseline BID, baseline BED, percent total weight loss, Δbinge eating, and Δdepression were independently associated with ΔBID.

CONCLUSION

Improvement of binge eating, and improvement of depression, as well as weight loss, were independently associated with amelioration of BID.

CLINICAL TRIAL REGISTRATION

[https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000008052], identifier [UMIN000006803] and [https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R0000 55850], identifier [UMIN000049041].

Binge eating among young adults: association with sociodemographic factors, nutritional intake, dietary n-6:n-3 ratio and impulsivity

Binge eating behaviour (BE) is the major symptom of binge eating disorder (BED). This study aimed to compare the nutritional intake in the presence or absence of BE, with a particular focus on dietary n-6:n-3 ratio, to assess the association between BE and impulsivity and the mediating effect of BMI on this association. A total of 450 university students (age 18-28 years) participated. The self-administered questionnaires were a semi-quantitative FFQ and the UPPS-P Impulsive Behavior Scale and the binge eating scale. The average BE score was 11·6 (se 7·388), and 20 % of the total participants scored above the cut-off of 17, thus presenting BE with 95 % CI of 16·3, 23·7 %. Our study revealed that greater BMI, higher total energy intake, greater negative urgency and positive urgency scores were significantly associated with BE. Participants with high value of dietary n-6:n-3 ratio were 1·335 more at risk to present a BE compared with those with a lower value of this ratio (P = 0·017). The relationship between BE score and UPPS domains score was not mediated by the BMI. This is the first study reporting a link between high dietary n-6:n-3 ratio and BE as well as the fact that BE was linked to both, negative and positive urgencies, and that the association between BE and impulsivity was not mediated by BMI. These findings can help to deal more efficiently with people suffering from BE, a symptom that can precede the development of BED.

Body appreciation and appearance evaluation in individuals with obesity compared to individuals with normal-weight: findings from a representative German population sample

PURPOSE

Body image has been identified as an important factor in mental health in individuals with obesity. Previous studies have focused on negative body image and research of positive body image-particularly in obesity-is still in its infancy. The current study explored the positive body image facet body appreciation and the negative facet appearance evaluation in different BMI groups as well as men and women.

METHODS

A total of 1003 participants of the general German public above the age of 18 years completed measures on body appreciation and appearance evaluation.

RESULTS

Significantly lower body appreciation was observed in male participants with obesity compared to normal-weight participants. In women, the BMI groups did not differ significantly in body appreciation. BMI was negatively associated with appearance evaluation in both genders. While men and women did not differ in body appreciation, men reported lower appearance evaluation scores compared to women.

CONCLUSION

The present study is one of few that investigated positive body image in individuals with obesity compared to individuals with normal weight. The findings underscore the potential of body appreciation as a resource in treatment of body image concerns in individuals with obesity. Further implications for future research are discussed.

LEVEL OF EVIDENCE

III, case-control analytic study.

The effect of cognitive symptoms in binge eating disorder on depression and self-esteem: a cross-sectional study

PURPOSE

To compare individuals with class II and III obesity with and without binge eating disorder (BED) in terms of sociodemographic characteristics, depressive symptoms, self-esteem, eating behaviors, and cognitive variables thought to be involved in the pathophysiology of the disease.

METHODS

The participants were selected from volunteer patients with body mass index ≥ 35 applying to the Ondokuz Mayıs University Medical Faculty, Turkey, for bariatric surgery between 01.07.2016 and 31.05.2019. The Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES), and Eating Disorder Examination Questionnaire (EDE-Q) were administered to all participants.

RESULTS

Binge eating disorder (BED) was determined in 95 (34%) of the 278 individuals applying for bariatric surgery. The frequency of previous psychiatric diseases was higher in the BED group than in the non-BED group. BDI, RSES, total EDE-Q, weight concern, shape concern, and eating concern EDE-Q subscale scores were also higher in the BED group. Correlation analysis revealed positive low correlation between depression scores and total EDE-Q scores and all subscales scores, with the exception of restraint. Positive low correlation was determined between decreased self-esteem and body weight and shape concern. At multivariate regression analysis, cognitive variables explained 28.6% of variance in depressive symptoms in the BED group, and 21.5% of variance in self-esteem.

CONCLUSION

The study results showed elevation in cognitive factors in patients with BED compared to the controls. Among these variables, eating and weight concern were shown to be associated with depressive symptoms, while eating concern was linked to self-esteem.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Patient Motivations and Goals for Bariatric Surgery: A Mixed Methods Study

BACKGROUND

Existing research has primarily focused on weight as the outcome of interest for bariatric surgery; however, patients frequently report other lifestyle and interpersonal surgery motivations and goals. Understanding the spectrum of bariatric surgery goals and motivations has important implications for enhancing patient-centered care and surgery outcomes.

OBJECTIVES

The current study characterized the nature of bariatric patient motivations and goals for surgery, described the extent to which motivations matched goals, and examined whether men and women differed in the specific motivations/goals described.

SETTING

Teaching hospital, United States METHODS: Data were obtained via retrospective chart review of bariatric patient responses to the clinic's standard open-ended questions about motivations and goals for bariatric surgery. A mixed method approach was used, including content analysis, to identify themes and χ²/t test analyses to test gender differences.

RESULTS

Surgery motivations and outcome goals were reflected by 8 overarching and overlapping themes. The most common motivations were related to general health and quality of life. The most common goals were to improve health/longevity and mobility. Over a quarter of patients showed no overlap between motivations and goals. Few gender differences were observed.

CONCLUSION

Findings underscore the importance of goals beyond weight loss, as well as the utility of helping patients shape their goals in accordance with goal-setting theories.

Psychological characteristics of patients seeking bariatric treatment versus those seeking medical treatment for obesity: is bariatric surgery a last best hope?

PURPOSE

Bariatric surgery (BS) is considered the most effective treatment for severe obesity. Nevertheless, long-term studies have identified some concerning issues, such as increased postoperative rates of suicide and substance use disorders. Some investigators have postulated that these postoperative issues might result from differences in psychological characteristics between patients with obesity seeking BS and those seeking non-surgical (medical) care. The aim of this study was to explore the psychological differences between patients seeking BS and those seeking non-surgical care.

METHODS

151 patients seeking BS (BS group) and 95 patients seeking medical care (non-surgery group) completed questionnaires measuring depression, anxiety, self-esteem, body dissatisfaction, hopelessness and weight-loss expectations (WLE).

RESULTS

There were no differences between the BS and non-surgery groups in depression, anxiety or self-esteem. Body dissatisfaction and WLE were greater in the BS group than in the non-surgery group. Contrary to our hypothesis, the non-surgery group showed higher levels of hopelessness than the BS group. Correlation analyses revealed very similar associations between psychological characteristics for both groups. Hierarchical regression and moderation analyses identified self-esteem as the factor most predictive of hopelessness in both groups.

CONCLUSIONS

We found few differences in psychological characteristics between groups. The lower level of hopelessness in the BS group might be seen as a form of protection leading up to surgery but may result from the patient's view of BS as their "last best hope". Further studies are needed to understand the evolution of these psychological characteristics after surgery and their possible effects on postoperative outcomes.

LEVEL OF EVIDENCE

Level III, case-control analytic studies.

Revisiting the relationship between body dissatisfaction and eating disorder symptoms in Chinese adolescents: the mediating roles of regulatory emotional self-efficacy and depression symptoms

PURPOSE

Even though many studies have investigated the relationship between body dissatisfaction and eating disorder symptoms, the relationship is still far from being clear, especially about what factors that could potentially mediate such relationship. This study aimed to examine the direct pathway in the relationship between body dissatisfaction and eating disorder symptoms, and possible mediation pathways between the two via regulatory emotional self-efficacy and depression symptoms.

METHODS

A sample of 654 adolescents from central China completed questionnaires for a set of study variables. Modeling analysis was conducted that examined the direct pathway between body dissatisfaction and eating disorder symptoms, and the mediating roles of regulatory emotional self-efficacy and depression symptoms between these two constructs. Multi-group modeling analysis was conducted to assess model invariance across gender and age groups.

RESULTS

The results showed that, in addition to the direct pathway between body dissatisfaction and eating disturbances, regulatory emotional self-efficacy and depression symptoms partially mediated the relationship between these two constructs. Results of multi-group invariance analysis showed that the mediation model was consistent across gender and age groups.

DISCUSSION

These results indicated that management of regulatory emotional self-efficacy and appropriate intervention for depression could potentially buffer against the negative impact of body dissatisfaction on eating disorder symptoms. Finally, some potential clinical implications are discussed, and possible preventions for eating disorder symptoms are suggested.

LEVEL OF EVIDENCE

V, Cross-sectional descriptive study.

Prevalence and Correlates of Body Image Dissatisfaction in Patients with Multiple Sclerosis

Background

Body image dissatisfaction (BID) strongly predicts undesirable outcomes, including disordered eating, depression, and low self-esteem. People with multiple sclerosis (MS) may have higher BID due to changes in mobility and functioning and high rates of depression; however, little research has explored BID in people with MS. Identifying factors predicting BID in people with MS would help providers become more aware of BID and its possible negative outcomes.

Methods

The sample included 151 adult patients with MS receiving care at the Cleveland Clinic Mellen Center for MS. The Body Shape Questionnaire was administered, and demographic information was collected from medical records. Data on MS-specific variables were collected via computerized testing. A one-sample t test, an independent-samples t test, and a hierarchical linear regression were conducted.

Results

Average scores on BID were not significantly different from the population mean. Patients with moderate/marked concern were more likely to be female and had higher body mass index values, Patient Health Questionnaire-9 scores, and Quality of Life in Neurological Disorders Stigma T-scores. There were no age differences. No MS-specific variables significantly predicted BID.

Conclusions

People with MS show approximately the same levels of BID as the general population. Higher BID was associated with being female and with higher body mass index, depression, and stigma. No MS-specific variables predicted higher BID after controlling for significant variables. Given the evidence in the literature of the negative effects of BID on health behaviors and mood, it is important to explore whether other factors affect BID in people with MS.

Childhood Emotional Maltreatment and Problematic Social Media Use Among Adolescents: The Mediating Role of Body Image Dissatisfaction

Preliminary evidence suggests that childhood maltreatment is associated with higher problematic social media use (PSMU). It has also been established that childhood emotional maltreatment (CEM) is associated with body image dissatisfaction (BID). However, the direct and indirect impacts of CEM on PSMU via BID remain untested. The present study examined these direct and indirect relationships among a sample of 385 adolescents (mean age 15.62 years, range 14–18 years). Results indicated that female adolescents had higher levels of CEM, BID, and PSMU compared to males. Structural equation modeling indicated that CEM was indirectly associated with PSMU via BID among males. However, only BID was positively associated with PSMU among females. The findings are in accordance with theoretical models suggesting that individuals’ core characteristics including early childhood experiences and psychopathological factors are associated with different types of specific internet-use disorders.

Altered Processing and Integration of Multisensory Bodily Representations and Signals in Eating Disorders: A Possible Path Toward the Understanding of Their Underlying Causes

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM V) eating problems are the clinical core of eating disorders (EDs). However, the importance of shape and weight overvaluation symptoms in these disorders underlines the critical role of the experience of the body in the etiology of EDs. This article suggests that the transdiagnostic centrality of these symptoms in individuals with EDs may reflect a deficit in the processing and integration of multisensory bodily representations and signals. Multisensory body integration is a critical cognitive and perceptual process, allowing the individual to protect and extend her/his boundaries at both the homeostatic and psychological levels. To achieve this goal the brain integrates sensory data arriving from real-time multiple sensory modalities and internal bodily information with predictions made using the stored information about the body from conceptual, perceptual, and episodic memory. In this view the emotional, visual, tactile, proprioceptive and interoceptive deficits reported by many authors in individuals with EDs may reflect a broader impairment in multisensory body integration that affects the individual's abilities: (a) to identify the relevant interoceptive signals that predict potential pleasant (or aversive) consequences; and (b) to modify/correct the autobiographical allocentric (observer view) memories of body related events (self-objectified memories). Based on this view, the article also proposes a strategy, based on new technologies (i.e., virtual reality and brain/body stimulation), for using crossmodal associations to reactivate and correct the multisensory body integration processes.

Short-term changes in affective, behavioral, and cognitive components of body image after bariatric surgery

BACKGROUND

Many bariatric surgery candidates report body image concerns before surgery. Research has reported post-surgical improvements in body satisfaction, which may be associated with weight loss. However, research has failed to comprehensively examine changes in affective, behavioral, and cognitive body image.

OBJECTIVES

This research examined (1) short-term changes in affective, behavioral, and cognitive components of body image from pre-surgery to 1- and 6-months after bariatric surgery, and (2) the association between percent weight loss and these changes.

SETTING

Participants were recruited from a private hospital in the midwestern United States.

METHODS

Eighty-eight females (original N = 123; lost to follow-up: n = 15 at 1-month and n = 20 at 6-months post-surgery) completed a questionnaire battery, including the Body Attitudes Questionnaire, Body Checking Questionnaire, Body Image Avoidance Questionnaire, and Body Shape Questionnaire, and weights were obtained from patients' medical records before and at 1- and 6-months post-surgery.

RESULTS

Results indicated significant decreases in body dissatisfaction, feelings of fatness, and body image avoidance at 1- and 6-months after bariatric surgery, with the greatest magnitude of change occurring for body image avoidance. Change in feelings of fatness was significantly correlated with percent weight loss at 6-months, but not 1-month, post-surgery.

CONCLUSIONS

These findings highlight the importance of examining short-term changes in body image from a multidimensional perspective in the effort to improve postsurgical outcomes. Unique contributions include the findings regarding the behavioral component of body image, as body image avoidance emerges as a particularly salient concern that changes over time among bariatric surgery candidates.

Evaluation of disordered eating tendencies in young adults

PURPOSE

It was aimed to determine the prevalence of high disordered eating tendencies and its relationship with food addiction, emotional eating and self esteem in participants at 18 and 33 years age group.

METHODS

This study was planned as a cross-sectional study and conducted with 1359 young adult volunteers (M = 386, F = 973) with an average age of 22.4 ± 2.84 years. Eating Attitudes Test-26 (EAT-26), Yale Food Addiction Scale (YFAS), Emotional Appetite Questionnaire (EMAQ) and Rosenberg Self-Esteem Scale (RSES) were used. EAT-26 score above 20 was considered as eating disorders risk cutoff.

RESULTS

Participants with disordered eating tendencies have higher rates (22.4%) of food addiction compared to participants without high disordered eating tendencies (7.2%). There is no difference for EMAQ and YFAS scores; however, there is a significant difference for RSES and EAT-26 scores according to gender. A positive association of EAT-26 with YFAS and EMAQ-negative scores and a negative association of EAT-26 with RSES and EMAQ-positive were found.

DISCUSSION

There is association among EAT-26, YFAS, and Rosenberg Self-Esteem Scale, and Emotional Appetite Questionnaire scores. This study provides information for future studies about high disordered eating tendencies, food addiction and mood that are thought to be important in young adults.

LEVEL OF EVIDENCE

Level V (cross-sectional descriptive study).

Body mass index, depression, and suicidality: The role of self-esteem in bariatric surgery candidates

BACKGROUND

Previous research suggests a relationship between weight and depression/suicidality, although few studies have examined the mechanisms underlying this association. This study examined the mediating role of self-esteem in the relationship between BMI and depression/suicidality, as well as the moderating role of gender in the mediated pathways.

METHODS

As part of a screening process in consideration for bariatric surgery, 3,101 adults (81.4% female, 18.6% male) were assessed one time. Five univariate mediation and five univariate moderated-mediation models were hypothesized and analyzed. For the mediation models, we entered five outcome variables separately: 1) severity of depressed mood, 2) diagnosis of Major Depressive Disorder, 3) lifetime history of suicide attempts, 4) suicidal ideation at the time of evaluation, and 5) severity of suicidality, BMI as the independent variable, and self-esteem as the mediator. For the moderated-mediated models, gender was examined as a moderator to examine whether self-esteem was a stronger mediator for one gender, compared to the other.

RESULTS

Findings supported the mediating role of self-esteem across all five outcomes. Further, the mediated effect was moderated by gender, such that the mediation effect was stronger for males, compared to females.

LIMITATIONS

The majority of the sample consisted of White females, limiting broad applicability of findings. All variables were assessed simultaneously, at baseline, limiting the ability to make causal attributions.

CONCLUSIONS

Study findings suggest that self-esteem may help explain the relationship between BMI and depression/suicidality, particularly for men. Thus, interventions targeting self-esteem may be useful for improving psychological outcomes among those presenting for bariatric surgery.

Cirurgia bariátrica e transtornos alimentares: uma revisão integrativa

RESUMO Objetivo Realizar revisão sobre transtornos alimentares e comportamentos alimentares transtornados relacionados à cirurgia bariátrica. Métodos Revisão integrativa da literatura nas bases de dados PubMed, Lilacs, Bireme, portal SciELO com descritores indexados com critérios de inclusão: oferecer dado sobre a presença ou frequência de transtorno alimentar e/ou comportamentos alimentares disfuncionais previamente e/ou após a cirurgia. Resultados Foram selecionados 150 estudos (14 nacionais e 136 internacionais): 80,6% eram com avaliação de pacientes pré-/pós-cirúrgicos; 12% eram estudos de caso e 7,3% eram estudos de revisão. Diferentes instrumentos foram usados para avaliação, principalmente o Questionnaire on Eating and Weight Patterns, a Binge Eating Scale e Eating Disorders Examination Questionnaire. A compulsão alimentar foi o comportamento mais avaliado, com frequências/prevalências variando de 2% a 94%; no caso do transtorno da compulsão alimentar as frequências/prevalências variaram de 3% a 61%. Houve também a descrição de anorexia e bulimia nervosa, síndrome da alimentação noturna e comportamento beliscador. Alguns estudos apontam melhora dos sintomas no pós-cirúrgico e/ou seguimento enquanto outros apontam surgimento ou piora dos problemas. Conclusão Apesar da variabilidade entre métodos e achados, comportamentos alimentares disfuncionais são muito frequentes em candidatos à cirurgia bariátrica e podem ainda surgir ou piorar após a intervenção cirúrgica. Profissionais de saúde devem considerar de maneira mais cuidadosa tais problemas neste público, dadas às consequências para o resultado cirúrgico e qualidade de vida.

Life After Bariatric Surgery: Perceptions of Male Patients and Their Intimate Relationships

This study explores the experiences of 20 men who have had bariatric surgery, focusing on their couple or marital relationships. The researcher concentrates on men's perspectives regarding relationship satisfaction, sexual intimacy, and social support after surgical intervention. Phenomenology and family systems theory were used to guide the study from which emerged three themes: (a) Unintended consequences (unpredicted problems occurring within intimate relationships); (b) Intimacy as bittersweet (experiencing increasing levels of intimacy, while still desiring more); and (c) Inconsistent social support (experiencing instances where social support is provided, while simultaneously experiencing other areas where social support is not provided). The study includes a rich description of the data, critical analysis, and discussion of clinical implications for therapists and other healthcare professionals.

Psychosocial presentation of female bariatric surgery patients after multiple revisional surgeries: A qualitative study

Bariatric surgery is currently the most viable and cost-effective treatment for obesity. This study aimed to understand, from a female patient’s perspective, what contributed to not achieving or maintaining excess weight loss from a primary laparoscopic adjustable gastric band surgery, leading to subsequent multiple revisional bariatric surgeries. The purposive sample of participants ( N = 17 females) were over 18 years, had a primary failed laparoscopic adjustable gastric band and had more than three revisional procedures. Participants were individually interviewed and data were analysed from a grounded theory methodology to build a causal model with the core category of unrealistic expectations of bariatric surgery and other important conceptual categories.

Personal Descriptions of Life Before and After Bariatric Surgery From Overweight or Obese Men

Bariatric surgery is now a common weight loss solution for morbidly obese men where meaningful weight reduction and improvements in quality of life have been identified postsurgery. As the majority of surgical candidates are female, there exists a paucity of literature relating to the experience of males undergoing bariatric surgery. In this study, a qualitative descriptive-exploratory design was used to explore body image descriptions, adaptation of a new lifestyle, new boundaries postsurgery, and any barriers seeking consultation for surgery. Six males who had undergone bariatric surgery were recruited in Australia. Data were collected and analyzed using NVivo between May and October 2014. The themes emerging from the data included living in an obese body, life before surgery, decision making for surgery, and life after surgery. The participants collectively reported that life before surgery was challenging. They described the changes the surgery had made in their lives including positive changes to their health, body image, social lives, and self-esteem. Some participants preferred not to tell others their intentions for surgery due to perceived stigma. The men in this study also described a lack of information available to them depicting male perspectives, a possible barrier for men seeking weight loss surgery options. Implications for practice highlighted in these results relate to a greater need for accessible information specific to men based on real-life experiences.

Adult and childhood weight influence body image and depression through weight stigmatization

The goal of this study was to examine lifetime weight stigmatization as a mediator of the relationships among current body mass index, childhood overweight, depression, and body dissatisfaction. Participants were 299 female undergraduates (mean age = 20.52, standard deviation = 2.57; mean body mass index = 23.29, standard deviation = 4.51). Weight stigmatization significantly mediated the relationships between body mass index and body dissatisfaction, body mass index and depressive symptoms, and childhood overweight and depressive symptoms. The model accounted for 44.7 percent of the variance in depressive symptoms and 28.2 percent of the variance in body image dissatisfaction. Findings indicated that a decrease in weight stigmatization may predict better mental health.

Weight-based bullying and compromised peer relationships in young adult bariatric patients

The experience of weight-based bullying in young adult bariatric patients has not yet been examined. Thirteen young adults (age, 18-24) that were seeking or had undergone bariatric surgery participated in semi-structured in-depth interviews. A thematic analysis informed by grounded theory principles was conducted. Analysis revealed the following three major themes: (1) being the biggest kid, (2) coping through avoidance, and (3) compromised peer and intimate relationships. Victims of weight-based bullying often avoid and withdraw socially in response to persistent verbal abuse. The decision to pursue bariatric surgery at a relatively young age adds another dimension of difficulty when navigating peer relationships.

Are Iranian obese women candidate for bariatric surgery different cognitively, emotionally and behaviorally from their normal weight counterparts?

OBJECTIVE

The purpose of the present study was to examine the cognitive, emotional and behavioral differences between obese and normal weight women.

METHODS

The participants consisted of 60 obese women (BMI ≥ 35, Mean age 35.83) who were candidates for bariatric surgery and 60 normal weight women (BMI ≤ 24.90, Mean age 33.38) who were selected through convenient sampling method. The two groups were matched with respect to age and education. Measures included the Young Schema Questionnaire-Short Form, Difficulties in Emotion Regulation Scale (DERS) and the Binge Eating Scale. Independent sample t test and Mann-Whitney U tests were conducted to compare the two groups' scores on early maladaptive schemas, DER and binge eating.

RESULTS

Results indicated that obese women candidate for bariatric surgery scored significantly higher on emotional deprivation, mistrust, failure, dependency, enmeshment, self-sacrifice, especially abandonment, social isolation, vulnerability, self-control and subjugation schemas, but not on shame, entitlement, emotional inhibition and unrelenting standards. Obese women also displayed higher scores on three subscales of DERS, i.e., goal, impulse and strategies. BE scores were significantly higher in obese women than normal weight ones.

CONCLUSION

The findings showed that obese women candidates for bariatric surgery suffered from more cognitive, emotional and behavioral vulnerability compared to women with normal weight. Addressing these vulnerabilities among obese women could improve outcomes of weight loss surgeries and cognitive behavioral interventions so that weight regain is minimized and better outcomes are achieved.

Psychological predictors of body image concerns 3 months after bariatric surgery

BACKGROUND

Although studies have associated postoperative weight loss with improvement in body image dissatisfaction, some individuals continue to report body image concerns after bariatric surgery. These concerns are linked to increased depressive symptoms and decreased self-esteem in bariatric populations.

OBJECTIVE

This study sought to explore preoperative factors that may predict early body image concerns 3 months after bariatric surgery.

SETTING

Academic medical center.

METHOD

Data were analyzed from 229 patients evaluated for bariatric surgery who completed a 3-month postoperative psychology appointment and the Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form (MMPI-2-RF). Scales measuring depression, persecution, self-doubt, and inadequacy were examined. Medical records were reviewed for demographic characteristics, psychotropic medication usage, history of psychological treatment, and current or lifetime depression diagnosis.

RESULTS

Patients who preoperatively scored higher on demoralization (F [1, 227] = 35.40, P< .001), low positive emotions (F [1, 227] = 4.18, P< .05), ideas of persecution (F [1, 227] = 15.24, P< .001), self-doubt (F [1, 227] = 27.47, P< .001), and inefficacy (F [1, 227] = 21.34, P< .001) were significantly more likely to report body image concerns 3 months after bariatric surgery. Similarly, body image concerns were more common in patients with a preoperative depression diagnosis (χ(2) = 8.76, P<.01), current psychotropic medication usage (χ(2) = 7.13, P<.01), and history of outpatient therapy (χ(2) = 8.34, P<.01) and psychotropic medication (χ(2) = 9.66, P< .001).

CONCLUSION

Bariatric surgery candidates with psychopathology and other psychological risk factors are more likely to report body image concerns early after bariatric surgery. Future research is warranted to determine whether this association remains further out from surgery.

Body image concerns in obese women seeking bariatric surgery

Purpose

– The purpose of this paper is to assess multidimensional body image concerns in a sample of obese women seeking bariatric surgery at an outpatient hospital clinic in Hamilton, Ontario, Canada.

Design/methodology/approach

– A sample of obese adult women seeking bariatric surgery at an outpatient medical clinic in Hamilton, Ontario, Canada (n=148) completed various self-report measures of body image concerns, including body image dysphoria, body image quality of life, body image investment, and appearance satisfaction. Participant scores were compared to normative data. Correlations between body image concern measures and body mass index (BMI) were examined.

Findings

– Participants endorsed more body image dysphoria, more negative body image quality of life, and less appearance satisfaction than normative samples. BMI was not correlated with body image concern scores.

Practical implications

– Interventions aimed at reducing body image disturbance in obese women should target multiple components of body image concern. Decisions about who should receive interventions should not be based on BMI status.

Originality/value

– The majority of research on body image concerns focuses exclusively on evaluative constructs such as body image dissatisfaction. The current study examined affective, cognitive, and behavioural body image constructs. A better understanding of the multidimensional nature of body image concerns in obese women seeking bariatric surgery informs the development of effective, targeted interventions.

[Body perception and bariatric surgery: the ideal and the possible]

BACKGROUND

Bariatric surgery helps significantly in weight loss. Little is known whether the change in body shape and size is enough to meet the expectations created preoperatively.

AIM

To evaluate the different perceptions of body size and shape before and after bariatric surgery.

METHOD

A total of 423 patients were evaluated by Nine-figure Outline Scale. Of these, 32% were pre-surgery (PreS), 20% were evaluated between 10 and 12 months after surgery (PO-1), 13% between 18 and 24 months (PO-2), 15% between 30 and 36 months (PO-3) and 20% after 42 months of operation (PO-4). Groups were compared using one-way analysis of variance.

RESULTS

When choosing figures that represented a man and a woman of normal size, no differences were observed between groups. Regarding the choice of figures representing the own size, differences were observed between groups PreS and all other groups (p<0.001), and PreS chosen larger figures. In choosing figures that represented a size that believed they could achieve, PreS differed from the PO-1, PO-2 and PO-3 (p <0.001), showing a tendency to choose larger silhouettes after surgery. When choosing figures that represented a size that would like to have PO-4 differed from PO-1 and PO-2 (p <0.05), showing that in the PO-4 there was a tendency to choose larger figures.

CONCLUSION

The body perception seems to comply with own body size, even after weight loss. As longer postoperative period, the participants were more aware of the real possibilities of weight loss. There were signs of dissatisfaction with the body size and shape, mainly in the PO-1 and PO-2, which can lead to frustration and little use of the benefits of the surgery for health and quality of life.

Measurement of disordered eating in bariatric surgery candidates: a systematic review of the literature

Symptoms of disordered eating are common among patients seeking bariatric surgery, and assessment of eating pathology is typical in pre-surgical evaluations. A systematic review was conducted to evaluate the definitions, diagnostic criteria and measures used to assess disordered eating in adults seeking bariatric surgery. The review identified 147 articles featuring 34 questionnaires and 45 interviews used in pre-surgical assessments. The Questionnaire on Eating and Weight Patterns Revised and the Structured Clinical Interview for DSM were the most frequently used questionnaire and interview respectively. Variations to pre-surgical diagnostic criteria included changes to the frequency and duration criteria for binge eating, and inconsistent use of disordered eating definitions (e.g., grazing). Results demonstrate a paucity of measures designed specifically for an obese sample, and only 24% of questionnaires and 4% of interviews used had any reported psychometric evaluation in bariatric surgery candidates. The psychometric data available suggest that interview assessments are critical for accurately identifying binge episodes and other diagnostic information, while self-report questionnaires may be valuable for providing additional information of clinical utility (e.g., severity of eating, shape and weight-related concerns). Findings highlight the need for consensus on disordered eating diagnostic criteria and psychometric evaluation of measures to determine whether existing measures provide a valid assessment of disordered eating in this population. Consistent diagnosis and the use of validated measures will facilitate accurate identification of disordered eating in the pre-surgical population to enable assessment of suitability for surgery and appropriate targeting of treatment for disordered eating to optimise treatment success.

Psychosocial factors associated with binge eating among overweight and obese male veterans

The study's primary objective is to compare psychosocial characteristics of overweight/obese male Veterans who report binge eating with those who do not report binge eating. Participants include 111 overweight/obese male Veterans who completed questionnaires assessing binge eating, depression, stress, body image, self-efficacy for healthy eating and physical activity, and barriers to physical activity. Of the study sample, 25.2% are classified as binge eaters. Binge eating status is not significantly associated with age, race/ethnicity, weight, or BMI. Binge eating is associated with higher scores on measures of depression, barriers to exercise, self-classified weight, and lower self-efficacy for both healthy eating and exercise, but is not associated with body satisfaction or recent stress. Findings suggest that a sizable minority of overweight/obese male Veterans engage in binge eating. Depressive symptoms, self-efficacy, and perceived barriers all significantly predicted binge eating. These findings have implications both for identification of overweight/obese men at risk for binge eating disorder as well as for weight loss treatment in the Veteran population.

Sex differences in the physiology of eating

Hypothalamic-pituitary-gonadal (HPG) axis function fundamentally affects the physiology of eating. We review sex differences in the physiological and pathophysiological controls of amounts eaten in rats, mice, monkeys, and humans. These controls result from interactions among genetic effects, organizational effects of reproductive hormones (i.e., permanent early developmental effects), and activational effects of these hormones (i.e., effects dependent on hormone levels). Male-female sex differences in the physiology of eating involve both organizational and activational effects of androgens and estrogens. An activational effect of estrogens decreases eating 1) during the periovulatory period of the ovarian cycle in rats, mice, monkeys, and women and 2) tonically between puberty and reproductive senescence or ovariectomy in rats and monkeys, sometimes in mice, and possibly in women. Estrogens acting on estrogen receptor-α (ERα) in the caudal medial nucleus of the solitary tract appear to mediate these effects in rats. Androgens, prolactin, and other reproductive hormones also affect eating in rats. Sex differences in eating are mediated by alterations in orosensory capacity and hedonics, gastric mechanoreception, ghrelin, CCK, glucagon-like peptide-1 (GLP-1), glucagon, insulin, amylin, apolipoprotein A-IV, fatty-acid oxidation, and leptin. The control of eating by central neurochemical signaling via serotonin, MSH, neuropeptide Y, Agouti-related peptide (AgRP), melanin-concentrating hormone, and dopamine is modulated by HPG function. Finally, sex differences in the physiology of eating may contribute to human obesity, anorexia nervosa, and binge eating. The variety and physiological importance of what has been learned so far warrant intensifying basic, translational, and clinical research on sex differences in eating.

Binge eating behavior among a national sample of overweight and obese veterans

Despite the high prevalence of overweight and obesity in US military veterans, binge eating has not been examined in this population. Using a secondary data analysis approach, we examined the prevalence and correlates of self-reported binge eating among 45,477 overweight or obese veterans receiving care in Veterans Health Administration (VHA) facilities. Participants completed a 23-item survey that assessed demographics, weight history, physical and mental health comorbidities, and eating habits during routine medical clinic visits. Chi square and logistic regression analyses were used to examine relationships among binge eating and demographic variables and medical and psychiatric comorbidities. Nearly three-quarters of the sample reported any binge eating. Binge-eaters were more likely to report higher BMI,depression, anxiety, and type 2 diabetes (p<.0001). After controlling for potentially confounding variables, male veterans were significantly more likely to report any binge eating than female veterans (p<.001). These results have important implications for modifying weight management programs and highlight the need for assessment and treatment to address binge eating, particularly among men and patients with type 2 diabetes [corrected].

Understanding everyday life of morbidly obese adults-habits and body image

BACKGROUND

Morbid obesity is a progressive, chronic condition associated with failed attempts at change and repeated relapses.

AIM

There seems to be little previous research into the understanding of the everyday life of morbidly obese adults. We wanted to gain more knowledge about characteristics of eating habits and body image as well as motivational forces for change.

METHODS

A qualitative approach was chosen in order to gain insight into how morbidly obese adults experience everyday life. Qualitative interviews are well suited to provide insight into themes from the interviewee's life story from the subjects' own perspectives. To gain insight into such processes, a narrative approach that allowed the informants to give voice to their ways of doing, thinking and feeling in daily life, was adopted. The informants comprised seven women and four men aged of 26-56 years, recruited from a population of obese individuals who had participated in a weight reduction course. A hermeneutic approach was used where the research question was the basis for a reflective interpretation.

RESULTS

The following meaning-units were identified: to be perceived as overweight; and to see oneself as overweight. Ingrained habits: the struggle between knowing and doing; acting without knowing; and eating is soothing.

CONCLUSIONS

Seeing oneself as an obese person is a gradual process that implied experiencing oneself as different from significant others, such as (slim) siblings and friends. To experience a gap between knowing and doing concerning food habits in everyday life indicates that informants value they have a choice. This is an important insight to consider when framing interventions to support this vulnerable group.

Rumination and body dissatisfaction interact to predict concurrent binge eating

Based upon the escape theory (Baumeister, 1991; Heatherton & Baumeister, 1991) and the emotional cascade model (Selby, Anestis, & Joiner, 2008), it was hypothesized that body dissatisfaction and rumination tendencies would interact to predict concurrent binge eating symptoms. This hypothesis was tested in a sample of 780 undergraduate students. The results conformed to prediction, in that individuals with high levels of body dissatisfaction were most likely to report binge eating behavior when they also had a tendency to ruminate. This interaction had a significant association with binge eating, above and beyond variance accounted for by participant sex, depression symptoms, and body mass index. Moreover, there was evidence of specificity for the model, as the interaction did not predict concurrent problematic drinking. Our findings suggest compatibility between the escape theory and emotional cascade models, and identify two factors that, in combination, may render individuals particularly vulnerable to binge eating.

Assessment tools in obesity - psychological measures, diet, activity, and body composition

The global increase in the prevalence of obesity has led to an increased need for measurement tools for research, management and treatment of the obese person. The physical size limitations imposed by obesity, variations in body composition from that of normal weight, and a complex psychopathology all pose tremendous challenges to the assessment of an obese person. There is little published research regarding what tools can be used with confidence. This review is designed to provide researchers and clinicians with a guide to the current and emerging measurement tools specifically associated with obesity research and practice. Section 1 addresses psychological measures of well being. Sections 2, 3, and 4 focus on the assessment of food intake, activity, and body composition. All sections address basic challenges involved in the study and management of obesity, and highlight methodological issues associated with the use of common assessment tools. The best available methods for use in the obese both in research and clinical practice are recommended.

Deficits in emotion regulation mediate the relationship between childhood abuse and later eating disorder symptoms

The present study examined the relationship of child maltreatment to both emotion dysregulation and subsequent eating pathology. In an effort to extend previous research, the authors examined the unique impact of childhood emotional abuse (CEA) on emotion dysregulation and eating disorder (ED) symptoms while controlling for the effects of sexual and physical abuse. Structural equation modeling was utilized to simultaneously examine the effects of all three abuse types on multiple dependent variables as well as examine whether deficits in emotion regulation mediated the relationship between abuse and eating pathology. Results from a survey of 1,254 female college students revealed significant paths from abuse subtypes to specific eating disorder symptoms, with CEA evidencing the strongest association with ED symptoms. Additionally, emotion dysregulation was positively associated with ED symptoms, and mediated the effects of emotional abuse on symptoms. Findings support previous research on the enduring effects of emotional abuse as well as highlight the importance of the assessment of CEA in the treatment of ED symptoms.

Predicting problematic Internet use in men and women: the contributions of psychological distress, coping style, and body esteem

Problematic Internet use (PIU) is becoming a prevalent and serious problem among college students. Rates of PIU are higher in men, which may be due to psychological variables, such as comorbid psychological disorders and beliefs about one's body. We examined the ability of psychological distress, coping style, and body esteem to predict levels of PIU in men and women in a sample of 425 undergraduate students (46.8 percent male; mean age = 19.0, SD = 1.7). For men, phobic anxiety, wishful thinking, and overweight preoccupation were significant predictors of increased PIU. For women, depression, keeping to oneself, and decreased tension reduction were associated with increased PIU. The findings suggest that men and women may have different psychological reasons for excessive Internet use, including different types of psychological distress and coping styles. Unlike women, men may use the Internet because of weight concerns.

Comprehensive review of obesity and psychological considerations for treatment

Although obesity is considered to be a medical condition, psychosocial variables influence its development, course, and treatment. To date, obesity research focuses heavily on the associated physical problems and the identification of effective treatments. While an array of behavioral, pharmacological and surgical treatments has been developed, their ability to demonstrate long-term weight losses is not convincing. Thus, there has been a shift towards the identification of psychological and social factors that may assist in the prediction of successful treatments, most notably in the surgical treatment of obesity. As a result, less emphasis has been placed on post-treatment psychosocial influences. As the treatment of obesity becomes increasing multidimensional, the need for attention to psychosocial factors and the involvement of mental health providers increases. For the allied or mental health provider, a comprehensive understanding of obesity's physical, psychological and social basis is vital to ensure proper assessment or treatment, as it is warranted.

The relationship between binge eating and weight status on depression, anxiety, and body image among a diverse college sample: a focus on Bi/Multiracial women

Binge eating is associated with a host of adverse outcomes, but little is known about sex and racial differences among those who binge eat. The present study examined sex and racial group differences in binge eating based on weight status within a college-student population. It was hypothesized that White women would endorse higher rates of binge eating, depression, anxiety, and body image dissatisfaction than other groups. Participants completed a web-based survey assessing depression, anxiety, body image, weight history, physical activity, smoking, and body mass index. Participants included White, Black, and Bi/Multiracial college students. Findings highlighted sex and racial differences based on binge eating and weight status. Notably, Bi/Multiracial women who endorsed binge eating behavior and who were overweight reported greater levels of anxiety than all other groups and greater levels of depression than White women and White men. Additionally, Bi/Multiracial women and White women who endorsed binge eating behavior and who were overweight reported greater body image dissatisfaction relative to Black women and White men. Future research should further explore the nature and impact of sex and race differences on binge eating.

[Evolution of psychopathological alterations in patients with morbid obesity after bariatric surgery]

BACKGROUND AND OBJECTIVE

The aims of this study were to know the prevalence of the psychopathological alterations among patients with morbid obesity (MO) candidates for bariatric surgery in our centre, to analyze its predictive value on the surgical outcome and to study the evolution after weight stabilization was achieved.

PATIENTS AND METHODS

One hundred and forty five patients of the University Hospital Foundation Alcorcón (122 women) candidates for bariatric surgery (108 finally operated) were included in the study. A clinical interview was carried and several scales of psychopathology were applied before and after surgery: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigation Test Edinburg (BITE), and Body Shape Questionnaire (BSQ). A comparison of means between the initial and final scores of the psychometric tests and a logistic regression analysis to identify the predictive variables of positive evolution after surgery (defined as percentage of lost overweight> 50% and final IMC <35) were performed.

RESULTS

An improvement in the scores of BDI, BAI and in the subscales of EDI, Impulse to the thinness (EDI-DT) and corporal Dissatisfaction (EDI-BD) was observed. The differences were not significant for the rest of the psychometric tests. The multivariate analysis identified 3 predictive factors for postsurgical evolution: BDI (OR 0.91, IC95% 0.82-1.02), BIS (OR 1.08, IC 95% 1.0-1.16) y EDI-DT (OR 1.18, IC 95% 1.0-1.39).

CONCLUSIONS

In our study, the scales of depression, anxiety, impulse to thinness and corporal dissatisfaction improved in patients with MO after bariatric surgery. Some baseline psychometric variables may predict a favourable postsurgical evolution of these patients.

The relationship between weight loss and psychosocial functioning among bariatric surgery patients

BACKGROUND

Success after bariatric surgery should also reflect improvement in psychosocial functioning. The objective of this study was to assess the relationships between both mental health and eating disorders and weight loss in morbidly obese patients 2 years after gastric bypass.

METHODS

Forty-three obese women (mean age, 39.3 +/- 1.4 years; mean body mass index, 44.7 +/- 0.4 kg/m2) were evaluated before and 1 and 2 years after gastric bypass. The Beck Depression Inventory and the Hospital Anxiety and Depression Scale were used for depression and anxiety evaluation and the Eating Disorder Inventory for eating disorder assessment.

RESULTS

Decreases in depression (P <.01), anxiety (P <.05), and eating disorder (P <.01) scores were measured 2 years after surgery. Both excess weight loss and change in body mass index were associated with improvements in all measured psychologic outcomes 2 years after surgery.

CONCLUSIONS

The importance of weight loss is in relation to mental health 2 years after bariatric surgery. Psychologic outcomes and eating disorders did not predict weight loss 2 years after gastric bypass. However, these factors improved significantly after weight loss.

Obesity: attitudes of undergraduate student nurses and registered nurses

AIM

To investigate undergraduate student nurses' and registered nurses' attitudes towards obese persons and towards the management of obese patients.

BACKGROUND

Obesity is a global public health problem. Escalating rates of overweight and obesity are also taking a toll in Asian countries that have historically had much lower rates. Despite the growing prevalence of obesity worldwide, studies show that nurses and other health professionals hold negative attitudes towards obese people, which may affect the care of obese patients.

DESIGN

Cross-sectional study.

METHODS

A self-administered questionnaire was completed by 352 undergraduate student nurses and 198 registered nurses. The questionnaire consisted of the Fat Phobia Scale, the Attitudes Toward Obese Adult Patients Scale and a demographic profile. Data were analysed using descriptive statistics and student's t-tests.

RESULTS

Overall mean scores on the Fat Phobia Scale (3.53 SD 0.47) indicated average levels of fat phobia and mean scores on the Attitudes Toward Obese Adult Patients scale (2.64 SD 0.51) indicated neutral attitudes towards obese patients. Registered nurses had significantly higher levels of fat phobia and more negative attitudes than did student nurses. The majority of participants perceived that obese people liked food, overate, and were shapeless, slow and unattractive. Additionally, over one-half of participants believed that obese adults should be put on a diet while in hospital.

CONCLUSIONS

Results of this study show that both registered nurses and student nurses have negative perceptions of obesity and are unlikely to attribute positive characteristics to obese individuals. That registered nurses hold more negative attitudes towards obese person is cause for concern.

RELEVANCE TO CLINICAL PRACTICE

Given the increasing prevalence of obesity and the disproportionate number of obese persons affected by many health conditions, current and future nurses should have positive professional attitudes towards obese individuals. Obesity needs to be more adequately addressed, both in basic nursing education programs and in continuing professional education for practising nurses.

The relation between body size perception and change in body mass index over 13 years: the Coronary Artery Risk Development in Young Adults (CARDIA) study

The authors assessed associations of body size perception and weight change over 13 years in black men and women and white men and women from the Coronary Artery Risk Development in Young Adults (CARDIA) Study (1992-2005). The perceptions of self and ideal body size were measured by using the Stunkard 9-figure scale at the year 7 examination (1992-1993). Figures were classified into underweight, normal weight, overweight, and obese. Self-ideal discrepancy yielded 4 body size satisfaction categories. Body mass index (BMI) (measured at years 7, 10, 15, and 20) was the dependent variable in gender-specific adjusted multiple regression models stratified by year 7 BMI. Obese women who perceived themselves as obese lost 0.09 BMI units annually, while those who perceived themselves as normal weight gained 0.31 units annually (P = 0.0005); obese women who considered their body size much too large had less annual weight gain than did those who considered their body size a bit too large (0.21 vs. 0.38 BMI units; P = 0.009). Obese women with overweight ideal body size gained less weight annually than did those with normal weight ideal body size (0.12 vs. 0.27 BMI units; P = 0.04). Results for men showed fewer and weaker associations. When obese women perceive themselves as obese and feel that their body size is too large, they gain less weight over time.

Sexual identity development and self-esteem as predictors of body image in a racially diverse sample of gay men

The current study examined the relationship between sexual identity development and body image, as well as the potential mediating effect of self-esteem, in a community sample of gay men. A diverse group of participants (N = 172), recruited through listservs and flyers, completed an online survey. Regression analyses were conducted to assess the relationships between identity development and self-esteem, identity development and body image, self-esteem and body image, and the mediating role of self-esteem. As predicted, significant relationships were identified between each pair of variables, and self-esteem was found to be a mediator when the sample was considered as a whole. When participants of color were compared to those who were White, however, between-group differences emerged; identity stage did not predict self-esteem or body image for participants of color, nor did the mediated relationship exist. Self-esteem did predict body image in both groups. The sociocultural context of these findings is considered.

Psychometric evaluation of the eating disorder examination-questionnaire for bariatric surgery candidates

OBJECTIVE

Despite increasing use of the Eating Disorder Examination-Questionnaire (EDE-Q) in bariatric surgery patients, little is known about the utility and psychometric performance of this self-report measure in this clinical group. The primary purpose of the current study was to evaluate the factor structure and construct validity of the EDE-Q in a large series of bariatric surgery candidates.

METHODS AND PROCEDURES

Participants were 337 obese bariatric surgery candidates. Participants completed the EDE-Q and a battery of behavioral and psychological measures.

RESULTS

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) produced a 12-item, 4-factor structure of the EDE-Q. The four factors, interpreted as Dietary Restraint, Eating Disturbance, Appearance Concerns, and Shape/Weight Overvaluation, were found to be internally consistent and converged with other relevant measures of psychopathology.

DISCUSSION

Factor analysis of the EDE-Q in bariatric surgery candidates did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE-Q in this and other diverse populations and consider means of improving this measure's ability to best assess eating-related pathology in bariatric surgery patients.