Minnesota multiphasic personality inventory-2 restructured form (MMPI-2-RF) scale score differences in bariatric surgery candidates diagnosed with binge eating disorder versus BMI-matched controls

Should presurgical psychological evaluations still be a mandated requirement for metabolic and bariatric surgery? A critique of the literature and thoughts on future directions

For more than 30 years, clinical practice guidelines for the perioperative support of patients who undergo metabolic and bariatric surgery have recommended a formal psychological evaluation before surgery. However, the predictive utility of the evaluation in determining future outcomes has been mixed, leading to controversy regarding whether such evaluations should be required for all potential patients. This empirically based commentary will review the utility and value of the psychological evaluation in addition to the limitations in the extant literature that reduce predictive validity and provide recommendations on how to improve quality of the empirical literature and refinements to increase the utility of preoperative evaluations. Pre-metabolic and bariatric surgery psychological evaluation conducted by an appropriately trained clinician and properly reimbursed by the payor that includes time for psychological testing, integration of data, report writing, medical record review, and feedback to the patient and surgical team, should continue to be the standard of care as it benefits all stakeholders.

Personality dimensions, depression, and eating behavior in individuals seeking bariatric surgery: a cluster analysis

Introduction

Psychiatric comorbidity is frequent in bariatric surgery candidates. This study aimed to classify bariatric surgery patients according to patterns of preoperative measures of the severity of the eating disorder (ED), depression, and personality traits.

Methods

In the present cross-sectional study, 115 adult candidates for bariatric surgery (75 females, 65.22% of sample; mean age 37) were considered for analysis. Patients' sociodemographic and psychopathological variables were collected. K-Means clustering analysis was adopted to classify bariatric surgery candidates according to their preoperative Eating Disorder Inventory-2 (EDI-2) scores. In addition, we assessed depression and personality traits using the Beck Depression Inventory-2 (BDI-2) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2).

Results

Cluster analysis based on EDI-2 revealed two preoperative patterns: higher severity (n = 39), and low severity (n = 76). The more severe EDI-2 group had higher scores on the BDI-2 and presented higher scores on several MMPI-2 dimensions, particularly those related to anxiety (Psychasthenia, Anxiety, Fears, Obsessiveness), depression (Depression, including both content and clinical MMPI-2 subscales), externalizing symptoms (Anger, Cynicism, Type A Behavior), and social functioning (Social Introversion, Family Problems, Work Interference).

Discussion

Eating disorders symptoms in candidates for bariatric surgery are closely related to depression and different psychological conditions assessed with MMPI-2. These psychological variables should be evaluated preoperatively and targeted with more specific psychological interventions.

Additional Validation of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) Eating Concerns Scale

Maladaptive eating behaviors are typically associated with significant impairment in psychological functioning more broadly. The Minnesota Multiphasic Personality Inventory (MMPI) family of instruments has traditionally been the most frequently used psychological assessment of psychopathology by clinical psychologists. The most recent version, the MMPI-3, features a new Eating Concerns (EAT) scale that screens for the presence of problematic eating behaviors. The goals of the current study were (a) to independently replicate validity correlations reported from the college sample during EAT scale development, (b) to evaluate the utility of EAT scale item-level correlations with other substantive MMPI-3 scales, and (c) to evaluate the ability of the EAT items to predict specific frequency counts of dysfunctional eating behaviors. The current study examined the MMPI-3 assessment of dysfunctional eating behaviors among 188 undergraduate participants. Results indicated that the EAT scale is meaningfully associated with core symptom dimensions of maladaptive eating, including binging, vomiting, restricting, and concerns about weight and shape. In addition, this study identified meaningfully distinct patterns of correlations with personality and psychopathology constructs, and specific behavioral frequencies, across the five individual EAT scale items. These results contribute to the enhanced utility of this important screening scale in clinical settings.

Gender differences in the pathway of childhood trauma, impulsivity and adult eating behaviour: a cross-sectional study

Objective: The current cross-sectional study aimed to examine the association between childhood trauma, impulsivity, binge eating symptoms, and body mass index (BMI) in a sample of males and females. We also aimed to investigate the indirect association of childhood trauma with binge eating through impulsivity while controlling for BMI.Method: Participants were 410 young adults (mean age = 20.9 years, range 18-24; female = 73.9%) who completed online measures of childhood trauma, impulsivity, binge eating symptoms, and self-reported height and weight. Mediation models were tested using multi-group structural equation modelling.Results: Childhood trauma and impulsivity were associated with an increased risk of binge eating symptoms in females but not males, corroborating previous studies. There was a significant difference in the binge eating symptoms index between sexes, but not regarding the index of childhood trauma and impulsivity. Additionally, adverse childhood experiences were associated with impulsivity and the association of childhood trauma with binge eating was mediated by impulsivity in the female sample.Conclusions: Our results suggest sex-dependent patterns and risk factors that may impact binge eating symptoms. The implications of our results suggest that impulsivity might be a vulnerability factor for binge eating, especially for females.

Binge Eating Before and After Bariatric Surgery

PURPOSE OF REVIEW

The purpose is to review the state of the literature of binge eating in the context of bariatric surgery including prevalence, conceptualization, assessment, course, and related sequela throughout the perioperative continuum, particularly highlighting new advancements and future directions.

RECENT FINDINGS

Accurate assessment of binge eating in bariatric samples is essential for optimization of patient outcomes. Binge eating is less prevalent after bariatric surgery; however, prevalence rates increase over time. Most studies do not find a relationship between pre-operative binge eating and suboptimal weight outcomes after surgery. Refinement in understanding and conceptualization of post-operative binge eating is needed; new conceptualizations have proposed such a definition. Emerging constructs relevant to binge eating for bariatric patients include food addiction and food insecurity. Despite the introduction of formal diagnostic criteria for binge eating disorder, many uncertainties regarding the prevalence, course, and effects of binge eating currently exist; varied assessment methods continue to be a barrier to research on binge eating in bariatric surgery samples. Consensus on operational definitions for post-operative binge eating and best practices for assessment are areas for future consideration.

Examination of the Reliability and Validity of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) in a Preoperative Bariatric Surgery Sample

Presurgical psychological assessment of bariatric surgery candidates aims to identify psychosocial risk factors and provide treatment recommendations to facilitate optimal outcomes. Such assessment typically includes psychometric testing and a clinical interview. The Minnesota Multiphasic Personality Inventory (MMPI) has been commonly used as a broadband measure to assess a number of psychosocial domains in bariatric clinics. The newest version of the MMPI, the MMPI-3, was recently released. This study sought to (1) establish whether the MMPI-3 is comparable to the MMPI-2-RF in a sample of patients seeking bariatric surgery, (2) report reliability data for all MMPI-3 scale scores in this sample, and (3) explore associations between commonly used self-report symptom measures and substantive scales of the MMPI-3 to ascertain convergent and discriminant validity patterns. Six hundred and thirty-five presurgical patients completed the MMPI-3 in addition to the Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Alcohol Use Disorders Identification Test-Consumption (AUDIT-C), and Eating Disorder Examination-Questionnaire (EDE-Q). The majority (79.1%) of the sample was female, 65.5% was white, and 26.6% was Black. Scores on most of the MMPI-3 Emotional/Internalizing Dysfunction scales were meaningfully associated with the PHQ-9, GAD-7, and most EDE-Q subscales (except for Restraint). Meaningful discriminant patterns were observed as well. We conclude that the substantive scales of the MMPI-3 are reliable, comparable to their MMPI-2-RF counterparts, and evidence good convergent validity with extra-test measures assessing depression, anxiety, alcohol use, and eating disorder psychopathology in a preoperative bariatric sample.

Gut-brain mechanisms underlying changes in disordered eating behaviour after bariatric surgery: a review

Bariatric surgery results in long-term weight loss and an improved metabolic phenotype due to changes in the gut-brain axis regulating appetite and glycaemia. Neuroendocrine alterations associated with bariatric surgery may also influence hedonic aspects of eating by inducing changes in taste preferences and central reward reactivity towards palatable food. However, the impact of bariatric surgery on disordered eating behaviours (e.g.: binge eating, loss-of-control eating, emotional eating and 'addictive eating'), which are commonly present in people with obesity are not well understood. Increasing evidence suggests gut-derived signals, such as appetitive hormones, bile acid profiles, microbiota concentrations and associated neuromodulatory metabolites, can influence pathways in the brain implicated in food intake, including brain areas involved in sensorimotor, reward-motivational, emotional-arousal and executive control components of food intake. As disordered eating prevalence is a key mediator of weight-loss success and patient well-being after bariatric surgery, understanding how changes in the gut-brain axis contribute to disordered eating incidence and severity after bariatric surgery is crucial to better improve treatment outcomes in people with obesity.

Eating disorders and subsequent risk of substance use disorders involving illicit drugs: a Danish nationwide register-based cohort study

PURPOSE

No study has investigated the ongoing risk of substance use disorders involving illicit drugs (ISUD) after first eating disorder (ED) and whether the pattern of risk differs according to types of ED and ISUD. Therefore, we aimed to longitudinally assess the risk of a subsequent diagnosis of any ISUD (pooled category) and specific ISUD after a first-time diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or unspecified ED (USED).

METHODS

A retrospective cohort study using data from Danish nationwide registers identified 20,759 ED patients and 83,038 matched controls (1:4 ratio). Risk of any ISUD diagnosis after first ED diagnosis was estimated by generating hazard ratios (HR). Logistic regression was applied to assess associations between each ED and specific ISUD.

RESULTS

Patients with AN, BN, and USED (without a prior ISUD diagnosis) exhibited an increased relative risk of a subsequent diagnosis of any ISUD compared with respective controls, and the elevated risk persisted over 10 years (AN, adjusted HRs ranging from 1.60 [99% CI 1.15-2.24] to 5.16 [3.14-8.47]; BN, 2.35 [1.46-3.79] to 14.24 [6.88-29.47]; USED, 2.86 [1.35-3.79] to 8.56 [3.31-29.47]). The highest estimates were observed during the first year of follow-up. Each ED type was associated with an increased likelihood of all types of ISUD. AN and USED were most strongly associated with sedatives/hypnotics, BN with other illegal substances (e.g., ecstasy and hallucinogens).

CONCLUSIONS

ED patients have a considerable risk for subsequent ISUD. Prevention efforts and treatment targeting ISUD are likely required to improve ED treatment prognosis.

Does receiving an eating disorder diagnosis increase the risk of a subsequent alcohol use disorder? A Danish nationwide register-based cohort study

BACKGROUND AND AIM

No large-scale, longitudinal clinical study has examined whether patients with different types of eating disorders (ED) have an increased risk of a subsequent alcohol use disorder (AUD). This study aimed to assess the ongoing risk of receiving a diagnosis of AUD following a first-time diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or unspecified ED (USED).

DESIGN

Retrospective cohort study.

SETTING

Danish nationwide registries, January 1994 to December 2018.

PARTICIPANTS

A total of 20 759 ED patients and 83 036 controls were followed from the date of first ED diagnosis (index date) until the date of first AUD diagnosis, death, emigration, or the end of the study. Controls were selected in a 1:4 ratio and matched on month and year of birth, gender and ethnicity.

MEASUREMENTS

We obtained data on ED (AN, BN, USED; exposure) and AUD (abuse/dependence; outcome) diagnoses as well as sociodemographics and other psychiatric diagnoses. Time to AUD was generated from the index date. Risk of AUD after the index date was assessed among those without a prior AUD diagnosis while adjusting for sociodemographics and prior psychiatric diagnoses.

FINDINGS

Compared with controls, an increased relative risk of AUD after the index date was observed in AN patients throughout the study lasting 15 + years (adjusted hazard ratios [HRs] ranging from 2.49 [99% CI = 1.46, 4.25] to 6.83 [2.84, 16.41]), in BN patients during the first year of follow-up and from 2 years onward (2.72 [1.66, 4.44] to 17.44 [6.01, 50.63]), and in USED patients during the first year and 2-15 years of follow-up (2.52 [1.54, 4.14] to 14.17 [5.86, 34.27]). In all three groups, estimates were highest during the first year, particularly among BN patients.

CONCLUSIONS

Patients with anorexia nervosa, bulimia nervosa, or unspecified eating disorders appear to have an increased ongoing risk of receiving a diagnosis of alcohol use disorder following their first eating disorder diagnosis compared with controls.

Associations among psychopathology and eating disorder symptoms and behaviors in post-bariatric surgery patients

PURPOSE

A considerable number of post-bariatric surgery patients report problematic eating behaviors (PEBs) and/or eating disorders (EDs). Examining psychosocial variables associated with ED symptoms may identify targets for postoperative interventions to reduce these behaviors and improve surgical outcomes.

METHODS

A total of 161 participants completed the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and the Eating Disorder Examination-Questionnaire (EDE-Q). Participants were classified into ED risk or no ED risk groups and subjective binge eating (SBE) or no SBE groups. Independent-sample t tests were computed to examine mean differences in total weight loss (%TWL) and MMPI-2-RF scale scores between the ED groups. Relative Risk Ratios (RRRs) were computed to determine which MMPI-2-RF scales were associated with increased risk of ED group membership.

RESULTS

The ED risk group lost significantly less weight (19.36% TWL) than the no ED risk group (25.18% TWL). The SBE group lost significantly less weight (17.98% TWL) than the no SBE group (25.57% TWL). Participants in the ED groups scored significantly higher on internalizing and externalizing MMPI-2-RF scales than the no ED groups. These scales were associated with increased risk (1.55-2.55 times the risk) of being classified into the ED groups.

CONCLUSIONS

Patients who experienced postoperative ED symptoms lost significantly less weight than patients without ED symptoms. Postoperative ED symptoms are related to, and may be impacted by, higher levels of internalizing and externalizing dysfunction after surgery. Postoperative assessment of and interventions targeting psychosocial dysfunction could decrease ED symptoms.

LEVEL OF EVIDENCE

III: Evidence obtained from well-designed cohort or case-control analytic studies.

Predictive Role of Body Image in Bulimic Behaviors Among Obese Patients Qualified for Bariatric Surgery

Bulimic behavior and the associated experience of one's own body are of great importance in the course of surgical treatment for obesity. This study determined the predictive role of multidimensional body image on bulimic-type eating behaviors among individuals scheduled for the surgical treatment of obesity. This study was conducted in a clinical setting on a group of 100 obese patients who were treated at the Centre for the Surgical Treatment of Obesity at the University Hospital in Krakow (Poland) and were qualified for bariatric surgery. Body image was examined with Cash's Multidimensional Body-Self Relations Questionnaire (MBSRQ) and bulimic behavior with David M. Garner's Eating Attitudes Test (EAT-26). Part A of the EAT-26 focused only on the bulimia and food preoccupation scale. Part B included sex, age, and body mass index (BMI) in the predictive model. A stepwise multiple regression analysis was conducted to assess psychological predictors of eating behavior. For binary variables, a logistic regression analysis was conducted for the whole group and for the women's group alone. Owing to the small sample size of men, regression analyses were not conducted. Higher values were observed in the Appearance Orientation dimension among women when compared to men. Appearance evaluation and age were found to be significant predictors for bulimic behaviors in the whole group. In regression models for behavior in the last 6 months, the predictors were found to be Health Evaluation and Appearance Orientation for laxative use, and Overweight Preoccupation for vomiting for weight control. Health-promoting behaviors in obesity treatment were conditioned as follows: for exercise, the predictors were sex and Fitness Orientation and for weight loss, they were Overweight Preoccupation and Body Areas Satisfaction. Our study shows that different bulimic behaviors are variously conditioned by body image dimensions, some of which are predictors of behaviors that are risk factors for obesity and poor outcomes of bariatric treatment, whereas others increase the chance of pro-health behaviors among obese individuals.

Measurement of Eating Pathology Using the Minnesota Multiphasic Personality Inventory-3 (MMPI-3)

Eating disorders are prevalent among college student populations. Although previous iterations of the instrument did not include specific measurement of eating pathology, the Minnesota multiphasic personality inventory-3 (MMPI-3) now includes a specific scale (i.e., Eating Concerns [EAT]) to assess problematic eating behaviors. The current study examined the MMPI-3 assessment of eating pathology among 249 undergraduate women. A pattern emerged where symptoms of internalizing psychopathology on the MMPI-3 were generally associated with symptoms of eating disorder. However, the newly included EAT scale demonstrated the strongest associations with most areas of eating dysfunction. Further, hierarchical regression analyses suggested that the EAT scale added substantial incremental predictive utility (up to 23%) over other MMPI-3 scales combined in assessing eating pathology. Classification accuracy statistics yielded high sensitivity and specificity coefficients when predicting eating disorder risk at an EAT scale score cutoff of 75 T or higher. These findings support the use of the MMPI-3 in assessing eating pathology in college women, although its performance with men and with women not of college age remains to be studied.

Psychosocial Functioning of Bariatric Surgery Patients 6-Years Postoperative

INTRODUCTION

Mental health professionals routinely assess psychosocial risk factors prior to bariatric surgery to help identify factors that may impede surgical outcomes. Data regarding longer-term psychosocial functioning postoperatively are needed.

PURPOSE

Assess the psychosocial functioning of patients who obtained bariatric surgery approximately 6 years ago.

METHODS

A total of 161 patients consented to participate in the outcome study. Participants were compensated for their time and participation. Participants were weighed by the research/clinical staff and asked to complete a battery of self-report measures, including the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Other measures targeted adherence, eating behaviors/body image, alcohol use, and quality of life.

RESULTS

Postoperative MMPI-2-RF scores indicate psychosocial functioning is largely similar to previously published pre-surgical functioning data. Six-year weight loss outcomes were lower than previous studies reported for a similar postoperative time period (mean %total weight loss = 22.98%; standard deviation = 11.71), though quality of life scores were relatively high. Postoperative MMPI-2-RF scale scores were associated with poorer psychosocial functioning, reduced adherence, greater eating behaviors/body image concerns, greater alcohol use severity, lower quality of life, and less overall weight loss.

CONCLUSIONS

Psychological dysfunction 6 years after surgery is associated with various adverse outcomes. Ongoing, postoperative treatment may result in better long-term functioning for patients.

Food Addiction and Binge Eating During One Year Following Sleeve Gastrectomy: Prevalence and Implications for Postoperative Outcomes

BACKGROUND

Food addiction and binge eating are common among individuals with obesity. However, a paucity of studies prospectively examined the prevalence and implications of food addiction before and post-bariatric surgery. We aimed to examine the prevalence of food addiction and binge eating before and after sleeve gastrectomy (SG) and to assess their associations with behavioral and weight loss outcomes.

METHODS

We followed at 3 (M3), 6 (M6), and 12 (M12) months postoperative, 54 women who underwent SG. Data collected including anthropometrics, nutritional intake, food tolerance, and physical activity measures. The Yale Food Addiction Scale and the Binge Eating Scale were used to characterize food addiction and binge eating, respectively.

RESULTS

The mean baseline age and BMI were 32.1 ± 11.1 years and 44.9 ± 4.9 kg/m², respectively. Pre-surgery, food addiction, and binge eating were identified in 40.7% and 48.1% of patients, respectively. The prevalence of food addiction decreased significantly up to M6, but increased to 29.3% at M12. The prevalence of binge eating decreased significantly through the follow-up up to 17.4% at M12. Those who met criteria for food addiction at M12 achieved significantly lower excess weight loss at M12 compared with those not meeting this criterion (P = 0.005). Food addiction scores at M12 negatively correlated with weekly physical activity (r = - 0.559; P < 0.001) and food tolerance scores (r = - 0.428; P = 0.005).

CONCLUSIONS

The reduction in food addiction observed at M6 was not maintained at M12. Food addiction at M12 was associated with poorer weight loss, eating, and lifestyle behaviors. Clinical practice should focus on the psychological aspects associated with obesity.

Binge Eating Disorder and Related Features in Bariatric Surgery Candidates

OBJECTIVE

The present study sought to: 1) assess the prevalence of Binge Eating Disorder (BED) and abnormal eating behaviors in bariatric surgery candidates; 2) compare patients with and without BED as regards to eating disturbances, psychological characteristics, and health status; 3) individuate which factors were significantly related to binge eating severity.

METHODS

Sixty-three preoperative patients (17 males and 46 females) were screened by means of an ad hoc socio-demographic schedule, the Rosenberg Self-Esteem Scale, the Eating Disorders Inventory-3, the Binge Eating Scale, and the General Health Questionnaire-28. BED diagnosis was performed through a clinical interview.

RESULTS

BED and disordered eating, such as episodes of binge eating, sense of lack of control over eating and inappropriate compensatory behaviors, appear common in patients undergoing weight loss surgery. Significant differences between BED and non-BED subjects in relation to eating disturbances and psychological characteristics emerged. Multiple regression analysis revealed that only emotional dys-regulation significantly predicted binge eating vulnerability.

CONCLUSION

The recognition of factors involved in the development and maintenance of disordered eating in bariatric patients may support the choice of particular therapeutic strategies and improve bariatric surgery outcome. Further studies on this issue would be useful.

Food-Related Impulsivity in Obesity and Binge Eating Disorder-A Systematic Update of the Evidence

The specific eating pattern of Binge Eating Disorder (BED) patients has provoked the assumption that BED might represent a phenotype within the obesity spectrum that is characterized by increased impulsivity. Following the guidelines of the PRISMA statement (preferred reporting items for systematic reviews and meta-analyses), we here provide a systematic update on the evidence on food-related impulsivity in obese individuals, with and without BED, as well as normal-weight individuals. We separately analyzed potential group differences in the impulsivity components of reward sensitivity and rash-spontaneous behavior. Our search resulted in twenty experimental studies with high methodological quality. The synthesis of the latest evidence consolidates conclusions drawn in our initial systematic review that BED represents a distinct phenotype within the obesity spectrum that is characterized by increased impulsivity. Rash-spontaneous behavior in general, and specifically towards food, is increased in BED, while food-specific reward sensitivity is also increased in obese individuals without BED, but potentially to a lesser degree. A major next step for research entails the investigation of sub-domains and temporal components of inhibitory control in BED and obesity. Based on the evidence of impaired inhibitory control in BED, affected patients might profit from interventions that address impulsive behavior.

Psychological Aspects of Bariatric Surgery as a Treatment for Obesity

PURPOSE OF REVIEW

Little is known about the psychological effects on life after bariatric surgery despite the high prevalence of psychological disorders in candidates seeking this procedure. Our review discusses the literature around the psychological impact of bariatric surgery, exploring whether the procedure addresses underlying psychological conditions that can lead to morbid obesity and the effect on eating behaviour postoperatively.

RECENT FINDINGS

Findings show that despite undisputed significant weight loss and improvements in comorbidities, current literature suggests some persisting disorder in psychological outcomes like depression and body image for patients at longer term follow-up, compared to control groups. Lack of postoperative psychological monitoring and theoretical mapping limits our understanding of reasons behind these findings. Reframing bariatric approaches to morbid obesity to incorporate psychological experience postoperatively would facilitate understanding of psychological aspects of bariatric surgery and how this surgical treatment maps onto the disease trajectory of obesity.

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.

Graze eating among bariatric surgery candidates: prevalence and psychosocial correlates

BACKGROUND

Graze eating is defined as repetitive, unplanned eating of small amounts of food throughout the day. Little consensuses exist regarding whether graze eating, like binge eating disorder (BED), is characterized by feelings of loss of control (LOC). Furthermore, little is known about how patients who graze eat with and without LOC differ psychologically.

OBJECTIVES

The present study seeks to better characterize graze eating by examining differences between graze eating with LOC (+LOC) and without LOC (-LOC) among presurgical bariatric patients.

SETTING

A large, Midwestern academic medical center.

METHODS

The sample consisted of 288 adult bariatric surgery candidates (mean age 45.8, standard deviation [SD] 12.57) who underwent a presurgical psychological evaluation. Graze eating, BED, and other mental health diagnoses were evaluated using a semistructured interview. Participants were also administered the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and binge eating scale (BES). Data were collected using a retrospective chart review.

RESULTS

Among the 33% (n = 95) of the sample who reported preoperative graze eating, 32% (n = 30) also endorsed LOC. Graze eating, particularly with LOC, was associated with Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) diagnoses of anxiety disorders and BED, and multiple measures of internalizing dysfunction on the MMPI-2-RF.

CONCLUSIONS

Bariatric surgery candidates who graze eat experience a greater degree of overall distress and psychopathology including anxiety and depression. The minority who experience grazing+LOC appear to have even greater risk of psychopathology. Moreover, there appears to be significant overlap with BED. Future research should explore whether these 2 maladaptive eating patterns benefit from similar treatment.

Temperament and personality in eating disorders

PURPOSE OF REVIEW

In the last decades, three main different personality domains have been investigated in the field of eating disorders: personality traits, temperament, and personality disorders. The use of a wide range of instruments and the presence of many different approaches in the definition of personality dimensions make it difficult to summarize the emerging results from different studies. The aim of this narrative review is to critically highlight and discuss all interesting developments in this field, as reflected in the recent literature.

RECENT FINDINGS

The study of personality and temperament in eating disorders seems to be in line with the recently suggested dimensional approach, which highlights the importance of symptoms aggregation, rather than the categorical diagnoses. Recent literature seems to confirm that specific personality and temperamental profiles can be drawn for patients with eating disorders, which can discriminate different eating disorders' diagnoses/symptoms.

SUMMARY

These observations have relevant clinical implications as treatment of eating disorders is largely based on psychotherapeutic interventions. However, large longitudinal studies are needed to better clarify the suggested relationships and to identify more defined therapeutic strategies.

The epidemiology and genetics of binge eating disorder (BED)

This narrative review provides an overview of the epidemiology of binge eating disorder (BED), highlighting the medical history of this disorder and its entry as an independent condition in the Feeding and Eating Disorders section of the recently published Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Estimates of prevalence are provided, as well as recognition that the female to male ratio is lower in BED than in other eating disorders. Evidence is also provided of the most common comorbidities of BED, including mood and anxiety disorders and a range of addiction disorders. In addition, discussion of the viewpoint that BED itself may be an addiction - at least in severe cases - is presented. Although the genetic study of BED is still in its infancy, current research is reviewed with a focus on certain neurotransmitter genes that regulate brain reward mechanisms. To date, a focal point of this research has been on the dopamine and the μ-opioid receptor genes. Preliminary evidence suggests that a predisposing risk factor for BED may be a heightened sensitivity to reward, which could manifest as a strong dopamine signal in the brain's striatal region. Caution is encouraged, however, in the interpretation of current findings, since samples are relatively small in much of the research. To date, no genome-wide association studies have focused exclusively on BED.

The eating-related behaviours, disorders and expectations of candidates for bariatric surgery

It is important that clinicians and researchers understand the possible eating-related difficulties experienced by pre-bariatric surgery candidates, as well as their expectations of how their eating and hunger will change after surgery. This review examines English-language publications related to the eating-related behaviours, disorders and expectations of bariatric candidates. Seventy-five articles related to binge eating disorder, grazing, night eating syndrome, emotional eating, food cravings and addiction, and pre-surgical expectations of post-surgical eating in this population were critically reviewed. A variety of often problematic eating behaviours appear more common in bariatric candidates than in non-obese populations. The literature suggests that 4-45% of candidates may have binge eating disorder, 20-60% may graze, 2-42% may have night eating syndrome, 38-59% may engage in emotional eating and 17-54% may fit criteria for food addiction. Binge eating may also be more prevalent in bariatric candidates than in similarly obese non-surgical individuals. Expectations of surgery are high, with pre-surgical candidates believing their bariatric procedure will virtually guarantee significantly improved eating behaviours. Study replications are needed, and further investigation into prevalence, impacts and candidate characteristics related to disordered eating behaviours, as well as candidates' expectations of eating after surgery, will be important. Further comparisons of bariatric candidates to similarly obese non-bariatric populations will be important to understand eating-related characteristics of candidates beyond those related to their weight. Future research may be improved by the use of validated measures, replicable methodologies, minimization of data collected in circumstances where respondents may been motivated to 'fake good', use of prospective data and consistent definitions of key terminology.

Validity of Minnesota Multiphasic Personality Inventory – 2 – Restructured Form (MMPI-2-RF) scores as a function of gender, ethnicity, and age of bariatric surgery candidates

BACKGROUND

Presurgical psychological screening is used to identify factors that may impact postoperative adherence and surgical outcomes in bariatric surgery candidates. Minnesota Multiphasic Personality Inventory - 2 Restructured Form (MMPI-2-RF) findings have demonstrated utility for this task.

OBJECTIVES

To explore whether there are clinically meaningful gender, ethnicity, or age differences in presurgical MMPI-2-RF scores and the validity of these scores in bariatric surgery candidates.

METHODS

The sample was composed of 872 men and 2337 women. Ethnicity/race groups included 2,204 Caucasian, 744 African American, and 96 Hispanic individuals. A sample of 165 were not included in the ethnicity/race analyses because they were of another descent. Ages groups included 18-35 year olds (n = 454), 36-49 year olds (n = 1154), 50-64 year olds, (n = 1246), and 65 years old or older (n = 355). Validity data, obtained via a retrospective chart review, were available for a subset patients (n = 1,268) who were similarly distributed. Step-down hierarchical regression analyses were conducted to assess for differential validity.

RESULTS

Bariatric surgery candidates produced comparable MMPI-2-RF scores in all subsamples, indicating that the test norms generalize across demographic groups. Validity findings were also generally comparable, indicating that MMPI-2-RF scores have the same interpretive implications in demographically diverse subgroups of bariatric surgery candidates.

CONCLUSIONS

The MMPI-2-RF can assist in presurgical psychological screening of demographically diverse bariatric surgery candidates.

Replication and evaluation of a proposed two-factor Binge Eating Scale (BES) structure in a sample of bariatric surgery candidates

BACKGROUND

The Binge Eating Scale (BES) is a widely-used self-report measure of binge eating severity. Hood et al. reported a 2-factor structure for the BES in a sample of bariatric surgery candidates, with factors labeled feelings/cognitions and behavioral manifestations. The present study aims to replicate and extend the factor structure obtained by Hood et al. by testing the utility of a bifactor model that removes binge eating severity variance, which the total BES score purports to assess, in another sample of bariatric surgery candidates.

METHODS

Bariatric surgery candidates (n = 517; 71.2% women; mean body mass index = 49.50 kg/m(2); SD = 10.17) were sampled. Twenty-four percent met DSM-IV-TR diagnostic criteria for binge eating disorder.

RESULTS

Consistent with previous research, a 2-factor structure for the BES was supported; however, the 2 factors were substantially correlated (r = .89). A bifactor model significantly improved model fit, supporting the presence of a higher-order severity factor accounting for a significant amount of variance. This factor was primarily marked by binge eating severity as demonstrated by associations with number of objective binge eating episodes and DSM-IV-TR diagnosis. In the bifactor model, the feelings/cognitions factor was modestly associated with self-reported mood psychopathology. However, contrary to expectations, the behavioral manifestation factor was not associated with empirically derived behavioral problems.

CONCLUSIONS

The current findings partially converge with those of Hood et al. However, the use of the BES as a 2-factor measure is not recommended at this point because of lack of incremental validity demonstrated by the behavioral manifestation factor. Continued use of the BES as a unidimensional measure of binge eating severity, in conjunction with a comprehensive clinical interview, can provide useful guidance for presurgical treatment recommendations.