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Lobo I, da Luz FQ, Hay P, Gaeta TL, Teixeira PC, Cordás TA, Sainsbury A, Salis Z. Is binge eating associated with poor weight loss outcomes in people with a high body weight? A systematic review with meta-analyses. Eat Weight Disord 2023; 28:89. [PMID: 37889364 PMCID: PMC10611631 DOI: 10.1007/s40519-023-01613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 10/15/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVES This systematic review aimed to compare the weight change in people with or without binge eating who underwent various weight loss treatments. METHODS We searched for studies in PubMed, American Psychological Association, and Embase from inception to January 2022. The studies selected included assessment of binge eating and body weight before and after weight loss treatment in people of any age. The meta-analyses were conducted using Comprehensive Meta-Analysis (CMA). We used Egger's regression test, the funnel plot, and the Trim and Fill test to assess the risk of publication bias. RESULTS Thirty-four studies were included in the systematic review, with a total of 10.184 participants. The included studies were divided into three categories according to types of weight loss treatments, namely, (1) bariatric surgery; (2) pharmacotherapy isolated or combined with behavioral interventions; and (3) behavioral and/or nutritional interventions. The meta-analyses showed no significant difference in weight loss between people with or without binge eating engaged in weight loss treatments, with an overall effect size of - 0.117 (95% CI - 0.405 to 0.171; P = 0.426). CONCLUSIONS Our findings showed no difference in weight loss in people with or without pre-treatment binge eating who received various weight loss treatments. Weight loss treatments should not be withheld on the basis that they will not be effective in people with pre-treatment binge eating, albeit their safety and longer term impacts are unclear. LEVEL OF EVIDENCE Level I, at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.
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Affiliation(s)
- Isabella Lobo
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Felipe Q da Luz
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Phillipa Hay
- School of Medicine, Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
| | - Tamiris L Gaeta
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Paula Costa Teixeira
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Táki Athanássios Cordás
- Faculty of Medicine, Institute of Psychiatry, Eating Disorders Program (AMBULIM), University of São Paulo, São Paulo, SP, Brazil
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia
| | - Zubeyir Salis
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia.
- Faculty of Medicine, School of Public Health, Centre for Big Data Research in Health, University of New South Wales, Kensington, NSW, Australia.
- Division of Rheumatology, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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Lüscher A, Vionnet N, Amiguet M, Chartoumpekis D, Mantziari S, Frantz J, Favre L. Impact of Preoperative Psychiatric Profile in Bariatric Surgery on Long-term Weight Outcome. Obes Surg 2023; 33:2072-2082. [PMID: 37145292 PMCID: PMC10289928 DOI: 10.1007/s11695-023-06595-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 04/06/2023] [Accepted: 04/10/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Conflicting results have been reported regarding the predictive value of preoperative psychological assessment and weight outcome after bariatric surgery. This might be attributed to different factors affecting early weight loss and long-term weight loss. Herein, we investigated whether preoperative psychiatric profile was associated with preoperative BMI and with both early (1 year) and long-term (5 years) weight loss after Roux-en-Y gastric bypass (RYGB). METHODS Prospective observational cohort study of patients undergoing RYGB between 2013 and 2019. Symptoms related to anxiety, depression, eating disorder, and alcohol use disorders were assessed by employing validated, specific psychometric tests (STAI-S/T, BDI-II, BITE, AUDIT-C) prior to surgery. Pre-operative BMI, early weight loss (1 year), and long-term weight evolution (up to 5 years) were registered. RESULTS Two hundred thirty six patients (81% women) were included in the present study. Linear longitudinal mixed model showed a significant effect of preoperative high anxiety (STAI-S) on long-term weight outcome, after controlling for gender, age and type 2 diabetes. Patient with high preoperative anxiety score regained weight faster than those experiencing low anxiety (each year percent excess BMI loss (%EBMIL) - 4.02%, ± 1.72, p = 0.021). No other pre-operative psychiatric symptoms have been shown to have an impact on long-term weight loss. In addition, no significant association was found between any of the pre-operative psychiatric variables and pre-operative BMI, or early weight loss (%EBMIL) at 1-year post-RYGB. CONCLUSION Herein we identified high anxiety score (STAI-S) as a predictor for long-term weight regain. Thus, long-term psychiatric surveillance of these patients and the development of tailored management tools could serve as a means to prevent weight regain.
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Affiliation(s)
- Anouk Lüscher
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nathalie Vionnet
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Michael Amiguet
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Dionysios Chartoumpekis
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
| | - Styliani Mantziari
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Service of Visceral Surgery, Lausanne University Hospital, Lausanne, Switzerland
| | - Johanna Frantz
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland
- Liaison Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Lucie Favre
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.
- Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital, Lausanne, Switzerland.
- Centre Hospitalier Universitaire Vaudois, CHUV, Division of Endocrinology, Diabetology and Metabolism, Lausanne University Hospital, Rue St Martin 3, CH-1003, Lausanne, Switzerland.
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Barbuti M, Carignani G, Weiss F, Calderone A, Fierabracci P, Salvetti G, Menculini G, Tortorella A, Santini F, Perugi G. Eating disorders and emotional dysregulation are associated with insufficient weight loss after bariatric surgery: a 1-year observational follow-up study. Eat Weight Disord 2023; 28:49. [PMID: 37266717 DOI: 10.1007/s40519-023-01574-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/14/2023] [Indexed: 06/03/2023] Open
Abstract
PURPOSE Subjects with obesity, especially those seeking bariatric surgery, exhibit high rates of mental disorders and marked psychopathological traits. The primary objective of this prospective, non-interventional study was to investigate whether the presence of different psychiatric disorders, attention deficit/hyperactivity disorder (ADHD) symptomatology and emotional dysregulation influenced weight loss at 1-year follow-up after surgery. METHODS Subjects consecutively referred for pre-surgical evaluation at the Obesity Center of Pisa University Hospital were recruited. Psychiatric diagnoses were made through the Mini-International Neuropsychiatric Interview (MINI) and ADHD symptomatology was assessed with the Wender-Reimherr Adult Attention Deficit Disorder Scale (WRAADDS). Emotional dysregulation was investigated through the WRAADDS and self-report questionnaires. After surgery, weight and obesity-related comorbidities were monitored during follow-up. RESULTS Of the 99 participants recruited, 76 underwent surgery and 65 could be reevaluated 1 year after surgery. Subjects with insufficient weight loss (excess body mass index loss ≤ 53%, n = 15) had more frequent lifetime binge eating disorder (BED) and BED-mood disorders comorbidity than subjects with favorable post-surgical outcome. Additionally, they scored higher on both physician-administered and self-report scales assessing emotional dysregulation, which represents a nuclear symptom of ADHD in adults. At the logistic regression analysis, older age, higher preoperative excess body mass index and greater affective instability were predictors of reduced weight loss at 1-year follow-up. CONCLUSION Emotional dysregulation seems to be associated with a worse outcome after bariatric surgery. Further studies with larger samples and longer follow-up are needed to confirm the influence of different psychiatric disorders and psychopathological traits on post-surgical outcome. LEVEL OF EVIDENCE V, prospective descriptive study.
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Affiliation(s)
- Margherita Barbuti
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Giulia Carignani
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Francesco Weiss
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy
| | - Alba Calderone
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Paola Fierabracci
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Guido Salvetti
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Giulia Menculini
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Alfonso Tortorella
- Section of Psychiatry, Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Ferruccio Santini
- 1st Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Via Paradisa, 2, 56124, Pisa, Italy
| | - Giulio Perugi
- 2nd Psychiatry Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italy.
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Parker JJ, Rolle CE, Shivacharan RS, Barbosa DAN, Feng A, Huang Y, Kakusa BW, Prieto T, Jaffe RA, Williams NR, Halpern CH. Appetitive Mapping of the Human Nucleus Accumbens. Biol Psychiatry 2023; 93:e15-e19. [PMID: 36509559 DOI: 10.1016/j.biopsych.2022.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/09/2022] [Accepted: 09/16/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Jonathon J Parker
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Cammie E Rolle
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Rajat S Shivacharan
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Daniel A N Barbosa
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
| | - Austin Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Yuhao Huang
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Bina W Kakusa
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California
| | - Tom Prieto
- Department of Neurology, Stanford University School of Medicine, Stanford, California
| | - Richard A Jaffe
- Department of Anesthesia, Stanford University School of Medicine, Stanford, California
| | - Nolan R Williams
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Casey H Halpern
- Department of Neurosurgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania; Department of Surgery, Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
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Aguiar PV, Dionisio WÁDS, Souza EADC, Vantini D, Campanholi R, Pinto TCC, Ximenes RCC. Binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery. Eat Weight Disord 2023; 28:12. [PMID: 36800040 PMCID: PMC9938051 DOI: 10.1007/s40519-023-01533-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 12/17/2022] [Indexed: 02/18/2023] Open
Abstract
PURPOSE The aim of the present study was to determine possible associations between binge eating, depressive symptoms and suicidal ideation in obese candidates for bariatric surgery. METHODS A cross-sectional study was conducted with 254 obese patients recruited from the general surgery service for bariatric procedures at the hospital affiliated with the Federal University of Pernambuco, Brazil. Evaluations were performed using the Binge Eating Scale (BES), Beck Depression Inventory, Beck Scale for Suicidal Ideation (BSSI) and a questionnaire addressing sociodemographic characteristics. RESULTS Most patients were women (82%), 48% had a moderate binge eating disorder, 42% a severe binge eating disorder, 32% had symptoms suggestive of mild, moderate or severe depression and 6% had suicidal ideation. Severe binge eating was positively associated with depressive symptoms (p < 0.001) and suicidal ideation (p < 0.05). Cases of severe binge eating were more frequent in young adults, but not necessarily associated with symptoms of depression or suicidal ideation in this portion of the sample. CONCLUSIONS The present findings underscore the need for psychological and psychiatric follow-up of obese candidates for bariatric surgery using appropriate assessment scales to guide therapeutic approaches. LEVEL III Evidence obtained from cross-sectional study.
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Affiliation(s)
- Priscilla Vasconcelos Aguiar
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | - Weslley Álex da Silva Dionisio
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil.
| | | | - Davi Vantini
- Clinical Analysis Laboratory, Faculdade de Medicina Do ABC, Centro Universitário FMABC, Santo André, SP, Brazil
| | - Raphael Campanholi
- Clinical Analysis Laboratory, Faculdade de Medicina Do ABC, Centro Universitário FMABC, Santo André, SP, Brazil
| | - Tiago Coimbra Costa Pinto
- Postgraduate Program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco, Recife, PE, Brazil
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Felske AN, Williamson TM, Rash JA, Telfer JA, Toivonen KI, Campbell T. Proof of Concept for a Mindfulness-Informed Intervention for Eating Disorder Symptoms, Self-Efficacy, and Emotion Regulation among Bariatric Surgery Candidates. Behav Med 2022; 48:216-229. [PMID: 33052762 DOI: 10.1080/08964289.2020.1828255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Up to 64% of patients seeking bariatric (weight-loss) surgery report eating disorder (ED) symptoms (addictive-like eating, binge eating, emotional eating, grazing) that can interfere with post-surgical weight loss. This prospective proof-of-concept study aimed to evaluate the impact of a pre-surgical mindfulness-informed intervention (MII) on ED symptoms and potential mechanisms-of-action to inform optimization of the intervention. Surgery-seeking adults attended four, 2-hour, MII sessions held weekly. Participants completed validated questionnaires assessing ED symptoms, eating self-efficacy, emotion regulation, and mindful eating pre-MII, post-MII, and at a 12-week follow-up. The MII consisted of mindfulness training, with cognitive, behavioral, and psychoeducational components. Fifty-six patients (M = 47.41 years old, 89.3% female) participated. Improvements in addictive-like eating, binge eating, emotional eating, and grazing were observed from pre- to post-MII. ED symptom treatment gains were either maintained or improved further at 12-week follow-up. Eating self-efficacy and emotion regulation improved from pre-MII to follow-up. Scores on the mindful eating questionnaire deteriorated from pre-MII to follow-up. In mediation analyses, there was a combined indirect effect of emotion regulation, eating self-efficacy, and mindful eating on grazing and binge eating, and an indirect effect of emotion regulation on emotional eating and addictive-like eating. Participation in the MII was associated with improvements in ED symptoms and some mechanisms-of-action, establishing proof-of-concept for the intervention. Future work to establish the MII's efficacy in a randomized controlled trial is warranted.
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Affiliation(s)
- Ashley N Felske
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | | | - Joshua A Rash
- Department of Psychology, Memorial University of Newfoundland, St. John's, NL, Canada
| | - Jo Ann Telfer
- Calgary Adult Bariatric Surgery Clinic, Alberta Health Services, Richmond Road Diagnostic and Treatment Services, Calgary, AB, Canada
| | - Kirsti I Toivonen
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Tavis Campbell
- Department of Psychology, University of Calgary, Calgary, AB, Canada
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Muraca E, Oltolini A, Binda A, Pizzi M, Ciardullo S, Manzoni G, Zerbini F, Bianconi E, Cannistraci R, Perra S, Pizzi P, Lattuada G, Perseghin G, Villa M. Metabolic and Psychological Features are Associated with Weight Loss 12 Months After Sleeve Gastrectomy. J Clin Endocrinol Metab 2021; 106:e3087-e3097. [PMID: 33705552 DOI: 10.1210/clinem/dgab161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Laparoscopic sleeve gastrectomy (LSG) is a recognized effective procedure of bariatric surgery, but a poor response in weight loss may still represent a clinical problem. To date there are no validated predictors useful to better perform patient selection. OBJECTIVE To establish the association of baseline anthropometric, metabolic, and psychologic features with the percent total weight loss (%TWL) and percent excess weight loss (%EWL) 12 months after surgery. DESIGN Retrospective longitudinal analysis of a set of data about obese patients attending the outpatient service of a single obesity center from June 2016 to June 2019. PATIENTS A total of 106 obese patients underwent LSG with presurgery evaluation and follow-up at 12 months after surgery. MAIN OUTCOME Weight loss 12 months after LSG. RESULTS Patients who achieved a %TWL higher than the observed median (≥34%) were younger, with a lower fasting plasma glucose and glycated hemoglobin, with a lower prevalence of hypertension and with a lower score in the impulsiveness scale, compared with patients with a %TWL < 34%. Similar findings were found when %EWL was considered. Multivariable stepwise regression analysis showed that younger age, lower impulsiveness, higher-than-normal urinary free cortisol, and lower HbA1c were associated with higher %TWL, explaining about 31.5% of the weight loss. CONCLUSION Metabolic and psychologic features at baseline were independently associated with weight loss and explained a non-negligible effect on the response to LSG. These data suggest that careful metabolic and psychologic profiling could help in sharper indications and personalized pre- and postsurgical follow-up protocols in candidates for LSG.
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Affiliation(s)
- Emanuele Muraca
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Alice Oltolini
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Alberto Binda
- Clinical Psychology; Policlinico di Monza, 20900 Monza, Italy
| | - Mattia Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, 20900 Monza, Italy
| | - Stefano Ciardullo
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
| | - Giuseppina Manzoni
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Francesca Zerbini
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Eleonora Bianconi
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Rosa Cannistraci
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
| | - Silvia Perra
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Pietro Pizzi
- Centro per lo Studio, la Ricerca e la terapia dell'Obesità, Policlinico di Monza, 20900 Monza, Italy
| | - Guido Lattuada
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
| | - Gianluca Perseghin
- Department of Medicine and Rehabilitation; Policlinico di Monza, 20900 Monza, Italy
- Department of Medicine and Surgery, Università degli Studi di Milano Bicocca; 20900 Monza, Italy
| | - Matteo Villa
- Clinical Psychology; Policlinico di Monza, 20900 Monza, Italy
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Psychological predictors of poor weight loss following LSG: relevance of general psychopathology and impulsivity. Eat Weight Disord 2020; 25:1621-1629. [PMID: 31728923 DOI: 10.1007/s40519-019-00800-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/17/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE After bariatric surgery (BS) a significant minority of patients do not reach successful weight loss or tend to regain weight. In recent years, interest for the psychological factors that predict post-surgical weight loss has increased with the objective of developing interventions aimed to ameliorate post-surgical outcomes. In the present study, predictive models of successful or poor weight loss 12 months after BS were investigated considering pre-surgery level of psychopathological symptoms, dysfunctional eating behaviors and trait impulsivity at baseline (pre-surgery). METHODS Sixty-nine patients with morbid obesity canditates for laparoscopic sleeve gastrectomy were assessed regarding metabolic and psychological dimensions. Successful post-surgery weight loss was defined as losing at least 50% of excess body weight (%EWL). RESULTS Logistic models adjusted for patient sex, age and presence of metabolic diseases showed that the baseline presence of intense psychopathological symptoms and low attentional impulsivity predict poor %EWL (< 50%), as assessed 12-month post-surgery. CONCLUSIONS The present findings suggest that intensity of general psychopathology and impulsivity, among other psychological factors, might affect post-surgery %EWL. Conducting adequate psychological assessment at baseline of patients candidates for BS seems to be crucial to orient specific therapeutic interventions. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Kops NL, Vivan MA, Fülber ER, Fleuri M, Fagundes J, Friedman R. Preoperative Binge Eating and Weight Loss After Bariatric Surgery: A Systematic Review and Meta-analysis. Obes Surg 2020; 31:1239-1248. [PMID: 33219919 DOI: 10.1007/s11695-020-05124-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND Several studies have investigated if bariatric surgery candidates with binge eating disorder (BED) are at risk for suboptimal postoperative weight loss. The aim of this systematic review with meta-analysis was to evaluate the association between binge eating diagnosed preoperatively and weight loss after bariatric surgery. METHODS MEDLINE, EMBASE, CENTRAL, LILACS, and other specialized databases were searched on August 2020. Clinical trials and observational studies including individuals who had undergone any type of bariatric surgical treatment with preoperative evaluation of BED and at least one postoperative measure of weight were initially selected. Four reviewers independently screened for eligibility. The mean difference was calculated using the random-effects model. RESULTS Nineteen studies, comprising 3223 participants (80.25% women; median age 41 years), met the inclusion criteria for meta-analysis. At 6 months postoperative, the percentage of total weight loss (%TWL) was not significantly different between BED and non-BED groups [6 studies, 914 participants: - 0.75% (95% CI, - 2.79 to 1.29; I2 = 0%)], even when analyzing only those three studies that included gold standard assessment tools. No significant differences were found at 12, 24, 36, or 60 months. CONCLUSIONS Pre-bariatric BED seems to have little or no influence on weight loss after surgery. However, many questions remain unanswered because of the use of different measures across studies. The heterogeneity among studies emphasizes the importance of investigators using the same assessment measures.
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Affiliation(s)
- Natália Luiza Kops
- Graduate Program in Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, 90560-030, Brazil.
| | - Manoela Astolfi Vivan
- Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Elisa Ruiz Fülber
- Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Marco Fleuri
- Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Julia Fagundes
- Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Rogério Friedman
- Graduate Program in Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, 90560-030, Brazil.,Endocrinology Division, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Rio Grande do Sul, Brazil
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10
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Kourounis G, Kong CY, Logue J, Gibson S. Weight loss in adults following bariatric surgery, a systematic review of preoperative behavioural predictors. Clin Obes 2020; 10:e12392. [PMID: 32691530 DOI: 10.1111/cob.12392] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/02/2020] [Accepted: 07/04/2020] [Indexed: 12/23/2022]
Abstract
Bariatric surgery is effective in treating obesity in many cases, yet as many as 50% of patients may not achieve the desired weight reduction. Preoperative modifiable behavioural factors could help patient selection and intervention design to improve outcomes. Medline, EMBASE, Cochrane Library and PsychINFO were searched to identify studies published between 1 January 2008 and 14 February 2019 reporting on preoperative modifiable behavioural factors associated with postoperative weight loss, with minimum 2 years follow-up. A total of 6888 articles were screened, 34 met the inclusion criteria. Maladaptive eating behaviours (MEB), preoperative weight loss (PWL), and tobacco use were reported 21, 18, and 3 times respectively. Physical activity and substance abuse were each reported once. Most articles on PWL (72.2%) and MEB (52.4%) reported no association. Positive associations were reported in 22.2% and 14.3% of articles for PWL and MEB respectively. Negative associations were reported in 5.6% and 33.3% of articles for PWL and MEB, respectively. Marked heterogeneity in outcome reporting hindered quantitative synthesis. The current paucity of evidence amenable to synthesis leads to ongoing uncertainty regarding the size and direction of association between PWL and MEB with outcomes following bariatric surgery. Long-term studies with common reporting of outcomes are needed.
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Affiliation(s)
- Georgios Kourounis
- College of Medicine & Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
- Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Chia Yew Kong
- College of Medicine & Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
- Department of General Surgery, Monklands Hospital, Airdrie, UK
| | - Jennifer Logue
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Simon Gibson
- Department of General Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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Kops NL, Vivan MA, de Castro MLD, Horvath JDC, Costa FS, Friedman R. Binge eating scores pre-bariatric surgery and subsequent weight loss: A prospective, 5 years follow-up study. Clin Nutr ESPEN 2020; 38:146-152. [PMID: 32690149 DOI: 10.1016/j.clnesp.2020.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/30/2020] [Accepted: 05/13/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS To compare groups of bariatric patients with preoperative scores of Binge Eating Scale (BES) above and below the clinical cut off value on weight outcomes up to 60 months following surgery. METHODS This is a prospective observational study involving 108 Brazilian patients (follow-up rate: 48.1%) operated by Roux-en-Y gastric bypass. In the preoperative period, they were clinically evaluated, and BES was applied. Based on the scores, patients were categorized as high or low according to established cut off 17 for binge eaters. Follow-up weight loss was obtained (3, 6, 12, 24, 36, 48, and 60 months) using data from medical records. The percentage of total weight loss (%TWL) was examined by generalized linear model. RESULTS 41.7% of patients had BES scores higher than 17 at baseline. Weight loss was significant up to 12 months. The greatest weight loss was at 24 months of follow-up, ranging from 2.7 to 110.4 kg (mean 42.9 ± 17.8 kg). In the short postoperative period (3, 24, and 36 months), %TWL was significantly different between groups. At 24 months, patients with higher scores lost more %TWL than those with lower scores (35.1 ± 0.8% vs 31.6 ± 0.7%, p = 0.029). However, this difference was not fount at 60 months postoperatively (mean 28.9 ± 9.6%). In a multivariate analysis, the presence of depression, age, and BES score were not associated with %TWL at 24 and 60 months. CONCLUSIONS The results suggest that preoperative BES scores point to a similar weight loss after bariatric surgery. Further studies with long-term follow-up are necessary to evaluate this finding.
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Affiliation(s)
- Natalia Luiza Kops
- Post-Graduate Program in Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.
| | | | - Mariana L Dias de Castro
- Post-Graduate Program in Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Jaqueline D Correia Horvath
- Post-Graduate Program in Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Hospital Moinhos de Vento, Porto Alegre, RS, Brazil.
| | - Fabiana Silva Costa
- Post-Graduate Program in Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Rogério Friedman
- Post-Graduate Program in Endocrinology, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil; Endocrinology Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
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12
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Cella S, Cipriano A, Giardiello C, Cotrufo P. Relationships Between Self-Esteem, Interoceptive Awareness, Impulse Regulation, and Binge Eating. Path Analysis in Bariatric Surgery Candidates. CLINICAL NEUROPSYCHIATRY 2019; 16:213-220. [PMID: 34908958 PMCID: PMC8650187 DOI: 10.36131/clinicalnpsych2019050604] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE The current study investigates the hypothesis that the effect of low self-esteem on binge eating in bariatric candidates was mediated by both difficulties in the perception of bodily signals and impulse regulation after accounting for gender, age, and body mass index. METHOD 59 preoperative patients (both male and female) were screened by means of self-report measures of self-esteem, interoceptive deficits, impulse dysregulation, and severity of binge eating. Results: Results indicated that all direct effects were significant, except for the self-esteem on impulse dysregulation and the interoceptive deficits on binge eating. Self-esteem had a significant indirect effect on impulse dysregulation mediated by interoceptive deficits. Impulse dysregulation, in turn, mediates the effect of interoceptive deficits on binge eating. Moreover, the path starting from self-esteem, going first to interoceptive deficits, then going via impulse regulation difficulties to binge eating was significant. RESULTS AND CONCLUSIONS A potential underlying mechanism through which self-esteem is linked to binge eating has been suggested. Obese individuals who perceived themselves as inadequate may carry a stronger burden by the confusion and mistrust related to bodily functioning and, consequently, may act more impulsively, through binge eating.
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Affiliation(s)
- Stefania Cella
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31-81100, Caserta, Italy
| | - Annarosa Cipriano
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31-81100, Caserta, Italy
| | | | - Paolo Cotrufo
- Observatory on Eating Disorders, Department of Psychology, University of Campania “Luigi Vanvitelli”, Viale Ellittico, 31-81100, Caserta, Italy
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13
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Novaes Ravelli M, Schoeller DA, Crisp AH, Shriver T, Ferriolli E, Ducatti C, Marques de Oliveira MR. Influence of Energy Balance on the Rate of Weight Loss Throughout One Year of Roux-en-Y Gastric Bypass: a Doubly Labeled Water Study. Obes Surg 2019; 29:3299-3308. [PMID: 31230202 DOI: 10.1007/s11695-019-03989-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the influence of changes in energy balance and body composition on the rate of weight loss throughout 1 year of Roux-en-Y gastric bypass. METHODS Variables were collected pre-, 6, and 12 months (M) post-surgery from 18 women (BMI ≥ 40 and ≤ 50 kg m-2, 20 to 45 years). Total energy expenditure (TEEm), fat-free mass (FFM), and fat mass (FM) were measured by doubly labeled water. Self-reported energy intake (EIsr) was obtained from three non-consecutive food diaries. Metabolic adaptation was assessed via deviations from TEE predictive equation, and the calculated energy intake (EIc) via the sum of TEE and change in body stores. RESULTS BMI significantly decreased (mean ± SD) from 45 ± 2 kg m-2 to 32 ± 3 kg m-2 at 6 M, and to 30 ± 3 kg m-2 at 12 M after surgery. The TEEm reduced significantly at both time points when compared with pre-surgery (6 M: - 612 ± 317 kcal day-1; 12 M: - 447 ± 516 kcal day-1). At 6 M, a metabolic adaptation was observed and the energy balance was - 1151 ± 195 kcal day-1, while at 12 M it was - 332 ± 158 kcal day-1. Changes in the values of TEEm were associated with changes in body weight at 12 M post-surgery. A significant underreporting was observed for EIsr (1057 ± 385 kcal day-1) vs. EIc (2083 ± 309 kcal day-1) at 12 M post-operative. CONCLUSION The higher rate of weight loss at 6 M post-surgery was a response to energy imbalance, which was caused by high restriction in energy intake even with the presence of metabolic adaptation at this time. The EIsr was not sufficiently accurate to assess the energy consumption of this population. REGISTRATION OF CLINICAL TRIALS (OBSERVATIONAL STUDY) Brazilian Clinical Trials Registry: RBR-8k5jsj. Universal Trial Number: U1111-1206-0858.
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Affiliation(s)
- Michele Novaes Ravelli
- School of Pharmaceutical Sciences, Sao Paulo State University - UNESP, Rodovia Araraquara Jaú, Km 01, s/n. Bairro: Campos Ville, Araraquara, SP, 14800-903, Brazil. .,Department of Neurology, University of Wisconsin - Madison, 1685 Highland Avenue, Medical Foundation Centennial Building, 7th Floor, Madison, WI, 53705, USA.
| | - Dale A Schoeller
- Biotechnology Center, University of Wisconsin - Madison, 425 Henry Mall Street, Madison, WI, 53706, USA
| | - Alex Harley Crisp
- School of Pharmaceutical Sciences, Sao Paulo State University - UNESP, Rodovia Araraquara Jaú, Km 01, s/n. Bairro: Campos Ville, Araraquara, SP, 14800-903, Brazil
| | - Timothy Shriver
- Biotechnology Center, University of Wisconsin - Madison, 425 Henry Mall Street, Madison, WI, 53706, USA
| | - Eduardo Ferriolli
- Ribeirao Preto Medical School, University of Sao Paulo - USP, Avenida Bandeirantes, 3900 - Bairro: Monte Alegre, Ribeirão Preto, SP, 14049-900, Brazil
| | - Carlos Ducatti
- Stable Isotope Center, Bioscience Institute, Sao Paulo State University - UNESP, Rua Prof. Dr. Antônio Celso Wagner Zanin, 250 - Bairro: Distrito de Rubião Junior, Botucatu, SP, 18618-689, Brazil
| | - Maria Rita Marques de Oliveira
- Education Department, Institute of Biosciences, Sao Paulo State University - UNESP, Rua Prof. Dr. Antônio Celso Wagner Zanin, 250 - Bairro: Distrito de Rubião Junior, Botucatu, SP, 18618-689, Brazil
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14
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Sans A, Bailly L, Anty R, Sielezenef I, Gugenheim J, Tran A, Gual P, Iannelli A. Baseline Anthropometric and Metabolic Parameters Correlate with Weight Loss in Women 1-Year After Laparoscopic Roux-En-Y Gastric Bypass. Obes Surg 2018; 27:2940-2949. [PMID: 28550439 DOI: 10.1007/s11695-017-2720-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND In this study, we explored in a prospective cohort of morbidly obese women undergoing laparoscopic Roux-en-Y gastric bypass (LRYGP) correlations between baseline anthropometrics, metabolic parameters, resting energy expenditure (REE), body composition, and 1-year % excess body mass index loss (%EBMIL). We also investigated risk factors for insufficient %EBMIL. METHODS One hundred three consecutive women were prospectively evaluated at baseline (age 40.6 ± 11.2, weight 113.9 kg ± 15.3, BMI 43.3 ± 4.9 kg/m2) and 1 year after LRYGP. Weight, excess weight, brachial circumference, waist circumference, fat mass (FM) and fat-free mass (FFM) (measured with bioelectrical impedance analysis), REE, inflammation, insulin resistance, and lipid disturbances were determined before and 1 year after LRYGP. RESULTS At 1 year, mean weight loss was 39.8 kg ± 11.7 and mean EBMIL was 15.2 kg/m2 ± 4.2. Mean %EBMIL was 86% ± 21% (range 30-146%). Baseline brachial circumference, waist circumference and triceps skinfold thickness decreased significantly at 1 year (P < 0.001). Blood glucose and insulin levels, HDL cholesterol, LDL cholesterol, triglycerides, and CRP also decreased significantly (P < 0.001). The mean loss of initial FFM and FM was 9.1 kg ± 8.2 (15%) and 30.7 kg ± 11.8 (53%), respectively. REE on body weight ratio (REE/BW) increased from 15.3 kcal/kg ± 2.8 to 18.4 kcal/kg ± 2.5 (p < 0.0001) and REE on FFM ratio decreased from 31.2 to 28.7 kcal/day/kg (p < 0.001). Preoperative waist circumference (r = -0.3; P < 0.001), blood glucose level (r = -0.37; P < 0.001), and CRP (r = -0.28; P = 0.004) were negatively correlated with EBMIL% 1 year after surgery. Among baseline body composition parameters, only preoperative FM was negatively correlated with %EBMIL (r = -0.23; p = 0.02). One year after surgery FM change was negatively correlated with EBMIL% (r = -0.49; P < 0.001) while FFM/BW ratio was positively correlated with %EBMIL (r = 0.71; P < 0.001). Increase in REE/BW at 1 year was positively correlated with %EBMIL (r = 0.47; p < 0.001). On multivariate analysis, baseline blood glucose level (OR = 1.77; CI 95%: [1.3-2.4]) was the only predictive factor of EBMIL <60% at 1 year. CONCLUSION LRYGB has beneficial effects on clinical, biological parameters, and body composition. Increasing the proportion of FFM on total BW and REE/BW is associated with better results in terms of weight loss. Baseline glucose level may be helpful in identifying poor responders to LRYGBP. TRIAL REGISTRATION NCT02820285y ( https://clinicaltrials.gov/ct2/show/NCT02820285?term=Characterization+of+Immune+Semaphorin+in+Non-Alcoholic+Fatty+Liver+Disease+and+NASH&rank=1 ).
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Affiliation(s)
- Arnaud Sans
- Department of Digestive Surgery, CHU Timone, Marseille, France.,INSERM UMR-S1076, VRCM, Aix Marseille University, Marseille, France
| | - Laurent Bailly
- Université Côte d'Azur, LAMHESS, Nice, France.,Département de santé publique, CHU de Nice, Nice, France
| | - Rodolphe Anty
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France.,University of Nice Sophia-Antipolis, 06107, Nice, France
| | - Igor Sielezenef
- Department of Digestive Surgery, CHU Timone, Marseille, France.,INSERM UMR-S1076, VRCM, Aix Marseille University, Marseille, France
| | - Jean Gugenheim
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France.,University of Nice Sophia-Antipolis, 06107, Nice, France
| | - Albert Tran
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France.,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France.,University of Nice Sophia-Antipolis, 06107, Nice, France
| | - Philippe Gual
- Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France
| | - Antonio Iannelli
- Digestive Unit, Archet 2 Hospital, University Hospital of Nice, 06202, Nice, France. .,Inserm, U1065, Team 8 "Hepatic complications of obesity", 06204, Nice, France. .,University of Nice Sophia-Antipolis, 06107, Nice, France. .,Service de Chirurgie Digestive et Centre de Transplantation Hépatique, Hôpital Archet 2, 151 Route Saint Antoine de Ginestière, BP 3079, Nice, Cedex 3, France.
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15
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Goldschmidt AB, Khoury J, Jenkins TM, Bond DS, Thomas JG, Utzinger LM, Zeller MH, Inge TH, Mitchell JE. Adolescent Loss-of-Control Eating and Weight Loss Maintenance After Bariatric Surgery. Pediatrics 2018; 141:peds.2017-1659. [PMID: 29237801 PMCID: PMC5744387 DOI: 10.1542/peds.2017-1659] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Loss-of-control (LOC) eating is common in adults undergoing bariatric surgery and is associated with poorer weight outcomes. Its long-term course in adolescent bariatric surgery patients and associations with weight outcomes are unclear. METHODS Adolescents (n = 234; age range = 13-19 years) undergoing bariatric surgery across 5 US sites were assessed for postsurgery follow-up at 6 months and 1, 2, 3, and 4 years. Descriptive statistics and generalized linear mixed models were used to describe the prevalence of LOC eating episodes involving objectively large amounts of food and continuous eating, respectively. Generalized linear mixed models investigated the association of any LOC eating with short- and long-term BMI changes. RESULTS At baseline, objectively large LOC eating was reported by 15.4% of adolescents, and continuous LOC eating by 27.8% of adolescents. Both forms of LOC eating were significantly lower at all postsurgical time points relative to presurgery (range = 0.5%-14.5%; Ps < .05). However, both behaviors gradually increased from 6-month to 4-year follow-up (Ps < .05). Presurgical LOC eating was not related to percent BMI change over follow-up (P = .79). However, LOC eating at 1-, 2-, and 3-year follow-up was associated with lower percent BMI change from baseline at the next consecutive assessment (Ps < .05). CONCLUSIONS Although presurgical LOC eating was not related to relative weight loss after surgery, postoperative LOC eating may adversely affect long-term weight outcomes. Rates of LOC eating decreased from presurgery to 6-months postsurgery but increased thereafter. Therefore, this behavior may warrant additional empirical and clinical attention.
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Affiliation(s)
- Andrea B. Goldschmidt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University and Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
| | | | - Todd M. Jenkins
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Dale S. Bond
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University and Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
| | - J. Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University and Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, Rhode Island
| | - Linsey M. Utzinger
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California
| | - Meg H. Zeller
- Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Thomas H. Inge
- Department of Surgery, University of Colorado, Denver and Children’s Hospital Colorado, Aurora, Colorado; and
| | - James E. Mitchell
- Department of Clinical Neuroscience, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota
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16
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Pekkarinen T, Mustonen H, Sane T, Jaser N, Juuti A, Leivonen M. Long-Term Effect of Gastric Bypass and Sleeve Gastrectomy on Severe Obesity: Do Preoperative Weight Loss and Binge Eating Behavior Predict the Outcome of Bariatric Surgery? Obes Surg 2017; 26:2161-2167. [PMID: 26843084 DOI: 10.1007/s11695-016-2090-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Few studies have examined weight loss sustainability after sleeve gastrectomy (SG). The purpose of this study was to determine long-term outcome after SG and gastric bypass (GBP) and learn whether preoperative weight loss and binge eating behavior can be used to predict outcome. MATERIALS AND METHODS Together, 257 patients (64 % women) were operated, 163 by GBP and 94 by SG. Binge eating was assessed by binge eating scale (BES) and preoperative weight loss was advised to all, including very low-calorie diet for 5 weeks. Postoperative visits took place at 1 and 2 years, and long-term outcome was at median 5 years (range 2.29-6.85). Multivariate linear regression analysis was used to predict outcome at 2-year and long-term control. RESULTS Median age was 48 years, weight 141.1 kg, and BMI 48.2 kg/m(2). Preoperative weight loss was median 4.9 % before GBP and 3.8 % before SG, P = 0.04. Total weight loss at year one was 24.1 % in GBP and 23.7 % in SG (P = 0.40), at year two 24.4 and 23.4 % (P = 0.26), and at long-term control 23.0 and 20.2 % (P = 0.006), respectively. Weight was analyzed in 93, 88, and 89 % of those alive, respectively. BES did not predict weight outcome, but larger preoperative weight loss predicted less postoperative weight loss at 2 years. CONCLUSION On long term, weight loss was better maintained after GBP compared with SG. Binge eating behavior was not a significant predictor, but larger preoperative weight loss predicted less postoperative weight loss for the next 2 years.
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Affiliation(s)
- Tuula Pekkarinen
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland.
| | - Harri Mustonen
- University of Helsinki and Helsinki University Hospital, P.O. Box 440, FIN-00029 HUS, Helsinki, Finland
| | - Timo Sane
- Abdominal Center, Meilahti Hospital, Helsinki University Hospital, P.O. Box 340, FIN-00029 HUS, Helsinki, Finland
| | - Nabil Jaser
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland
| | - Anne Juuti
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland
| | - Marja Leivonen
- Abdominal Center, Peijas Hospital, Helsinki University Hospital, P.O. Box 900, FIN-00029 HUS, Vantaa, Finland
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17
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Taylor VH, Hensel J. Multimorbidity: A Review of the Complexity of Mental Health Issues in Bariatric Surgery Candidates Informed by Canadian Data. Can J Diabetes 2017. [DOI: 10.1016/j.jcjd.2017.04.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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18
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Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients. Surg Obes Relat Dis 2017; 13:514-521. [DOI: 10.1016/j.soard.2016.11.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 02/05/2023]
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19
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Evers SS, Sandoval DA, Seeley RJ. The Physiology and Molecular Underpinnings of the Effects of Bariatric Surgery on Obesity and Diabetes. Annu Rev Physiol 2017; 79:313-334. [DOI: 10.1146/annurev-physiol-022516-034423] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Simon S. Evers
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109;
| | - Darleen A. Sandoval
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109;
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109
| | - Randy J. Seeley
- Department of Surgery, University of Michigan, Ann Arbor, Michigan 48109;
- Department of Nutritional Sciences, University of Michigan, Ann Arbor, Michigan 48109
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20
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Queiroz CD, Sallet JA, DE Barros E Silva PGM, Queiroz LDGPDS, Pimentel JA, Sallet PC. Application of BAROS' questionnaire in obese patients undergoing bariatric surgery with 2 years of evolution. ARQUIVOS DE GASTROENTEROLOGIA 2017; 54:60-64. [PMID: 28079242 DOI: 10.1590/s0004-2803.2017v54n1-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 08/10/2016] [Indexed: 01/24/2023]
Abstract
BACKGROUND: -In recent decades, the high prevalence of obesity in the general population has brought serious concerns in terms of public health. Contrarily to conventional treatment involving dieting and physical exercising, often ineffective in generating long term results, bariatric opera-tions have been an effective method for sustained weight loss in morbidly obese individuals. The Bariatric Analysis and Reporting Outcome System (BAROS) is an objective and recognized system in the overall evaluation of results after bariatric surgery. OBJECTIVE - To investigate results concerning a casuistic of morbidly obese patients undergoing bariatric surgery over a 2-year follow-up in terms of weight loss, related medical conditions, safety and changes in quality of life. METHODS - A total of 120 obese (17 male and 103 female) patients, who underwent bariatric surgery, were assessed and investigated using the BAROS system after a 2- year follow-up. RESULTS - Patients obtained a mean excess weight loss of 74.6 (±15.9) % and mean body mass index reduction of 15.6 (±4.4) Kg/m2. Pre-surgical comorbidities were present in 71 (59%) subjects and they were totally (86%) or partially (14%) resolved. Complications resulting specifically from the surgical procedure were observed in 4.2% of cases (two bowel obstructions requiring re-operation, and three stomal stenosis treated with endoscopic dilation). Sixteen subjects (13% of total number of patients) presented minor clinical complications managed through outpatient care. The final scores for the BAROS questionnaire showcased excellent to good results in 99% of cases (excellent 44%, very good 38%, good 23%, acceptable 1%). CONCLUSION - According to the BAROS questionnaire, bariatric surgery is a safe and effective method for managing obesity and associated clinical comorbidities, allowing for satisfactory results after a 2-year follow-up. Future studies should address other clinical and psychosocial variables that impact outcome as well as allow for longer follow-ups.
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21
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Maladaptive Eating Behaviors and Metabolic Profile in Patients Submitted to Bariatric Surgery: a Longitudinal Study. Obes Surg 2017; 27:1554-1562. [PMID: 28054295 DOI: 10.1007/s11695-016-2523-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aims to investigate relations between maladaptive eating behaviors (MEB) and metabolic profile in patients submitted to bariatric surgery. METHODS Longitudinal study including 70 patients before (T0), in the first year after surgery assessment (T1), and the second year after surgery assessment (T2). A face-to-face clinical interview assessed MEB at T0 and T2. Blood samples were collected at T0, T1, and T2 to assess fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), insulin, insulin resistance (IR), and triglycerides (TG). Mixed model analyses with growth curves tested the differences between patients with MEB (M group) and non-MEB patients (NM group) on the course of metabolic parameters, while controlling for total weight loss and type of surgery. RESULTS No differences between both groups were reached for levels of FPG (F(1, 140) = 2.936, p = 0.089), HbA1c (F(1, 96) = 0.099, p = 0.754), insulin (F(1, 121) = 0.146, p = 0.703), IR (F(1, 60) = 0.976, p = 0.327), and TG (F(1, 128) = 0.725, p = 0.396). All parameters improved from T0 to T1 for both groups. A distinct trend on the course of metabolic markers in the M group but not the NM group is observed, presenting an increase in HbA1c levels, insulin, and TG levels. CONCLUSIONS Both groups progressed favorably in the first 12 months of surgery. MEB may be associated with a trend for deterioration of metabolic profile after 12 months of surgery. The study should be replicated with longer-term assessments and a larger sample size.
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22
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Deluchi M, Costa FS, Friedman R, Gonçalves R, Bizarro L. Attentional bias to unhealthy food in individuals with severe obesity and binge eating. Appetite 2017; 108:471-476. [DOI: 10.1016/j.appet.2016.11.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 11/02/2016] [Accepted: 11/03/2016] [Indexed: 11/16/2022]
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23
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Luiz LB, Brito CLDS, Debon LM, Brandalise LN, de Azevedo JT, Monbach KD, Heberle LS, Mottin CC. Variation of Binge Eating One Year after Roux-en-Y Gastric Bypass and Its Relationship with Excess Weight Loss. PLoS One 2016; 11:e0167577. [PMID: 27992541 PMCID: PMC5167256 DOI: 10.1371/journal.pone.0167577] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 11/16/2016] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Bariatric surgery is the most effective treatment for obesity classes II and III. However, some patients do not get the desired results or initially lose and then regain the lost weight. Identifying these individuals early on and treating them adequately remains a challenge. As binge eating directly affects food intake, the study of this symptom and its relation to bariatric surgery and its results is increasing, because it appears to have an influence on the results of surgery. OBJECTIVES This study aimed to see how binge eating changes, measured with the Binge Eating Scale, interferes in the % excess weight loss one year after Roux-en-Y gastric bypass. METHODS We conducted a cross-sectional study with 149 patients older than 18 years who were evaluated one year after undergoing Roux-en-Y gastric bypass. The variation in the intensity of binge eating was measured with the pre- and postoperative Binge Eating Scale scores. RESULTS The variation of one unit in the Binge Eating Scale implied an inverse variation of 0.41% of % excess weight loss (p<0.05). The correlation coefficient between the variation of binge eating and the % excess weight loss was -0.186 (p = 0.033). The correlation coefficient between the binge eating symptoms one year after surgery and the % excess weight loss was -0.353 (p<0.001). CONCLUSIONS There was a correlation between the variation of binge eating one year after gastric bypass and the % excess weight loss. The correlation between binge eating and the % excess weight loss was greater after the surgery than it was at the preoperative stage. This study provides new, valuable information on the intensity and variation of binge eating symptoms one year after gastric bypass, which, to the best of our knowledge, have not been studied in depth earlier.
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Affiliation(s)
- Luciano Billodre Luiz
- Center of Obesity and Metabolic Syndrome, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- * E-mail: ,
| | - César Luis de Souza Brito
- Center of Obesity and Metabolic Syndrome, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Faculty of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Letícia Manoel Debon
- Center of Obesity and Metabolic Syndrome, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Lívia Nora Brandalise
- Center of Obesity and Metabolic Syndrome, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Juliana Tainski de Azevedo
- Center of Obesity and Metabolic Syndrome, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Karin Daniele Monbach
- Center of Obesity and Metabolic Syndrome, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Luísa Schmidt Heberle
- Center of Obesity and Metabolic Syndrome, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Cláudio Corá Mottin
- Center of Obesity and Metabolic Syndrome, São Lucas Hospital of Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Faculty of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
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Chao AM, Wadden TA, Faulconbridge LF, Sarwer DB, Webb VL, Shaw JA, Thomas JG, Hopkins CM, Bakizada ZM, Alamuddin N, Williams NN. Binge-eating disorder and the outcome of bariatric surgery in a prospective, observational study: Two-year results. Obesity (Silver Spring) 2016; 24:2327-2333. [PMID: 27616677 PMCID: PMC5093053 DOI: 10.1002/oby.21648] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 07/04/2016] [Accepted: 07/13/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE A previous study reported that preoperative binge-eating disorder (BED) did not attenuate weight loss at 12 months after bariatric surgery. This report extends the authors' prior study by examining weight loss at 24 months. METHODS A modified intention-to-treat population was used to compare 24-month changes in weight among 59 participants treated with bariatric surgery, determined preoperatively to be free of a current eating disorder, with changes in 33 surgically treated participants with BED. Changes were also compared with 49 individuals with obesity and BED who sought lifestyle modification for weight loss. Analyses included all available data points and were adjusted for covariates. RESULTS At month 24, surgically treated patients with BED preoperatively lost 18.6% of initial weight, compared with 23.9% for those without BED (P = 0.049). (Mean losses at month 12 had been 21.5% and 24.2%, respectively; P = 0.23.) Participants with BED who received lifestyle modification lost 5.6% at 24 months, significantly less than both groups of surgically treated patients (P < 0.001). CONCLUSIONS These results suggest that preoperative BED attenuates long-term weight loss after bariatric surgery. We recommend that patients with this condition, as well as other eating disturbances, receive adjunctive behavioral support, the timing of which remains to be determined.
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Affiliation(s)
- Ariana M Chao
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
| | - Lucy F Faulconbridge
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - David B Sarwer
- Temple College of Public Health, Philadelphia, Pennsylvania, USA
| | - Victoria L Webb
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Jena A Shaw
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - J Graham Thomas
- Department of Psychiatry and Human Behavior, Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA
| | - Christina M Hopkins
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zayna M Bakizada
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Naji Alamuddin
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Noel N Williams
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Parker K, Mitchell S, O'Brien P, Brennan L. Psychometric Evaluation of Disordered Eating Measures in Bariatric Surgery Candidates. Obes Surg 2016; 26:563-75. [PMID: 26163361 DOI: 10.1007/s11695-015-1780-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Assessment of disordered eating is common in bariatric surgery candidates, yet psychometric properties of disordered eating measures in this population are largely unknown. METHODS Measures were completed by 405 adult bariatric surgery candidates at pre-surgical consultation. Fit of the original scale structures was tested using confirmatory factor analysis (CFA) and alternative factor solutions were generated using exploratory factor analysis (EFA). Reliability (internal consistency), construct validity (convergent and divergent) and criterion validity (with the EDE as criterion) were assessed. MATERIALS The measures prioritised for evaluation are the following: Eating Disorder Examination Questionnaire (EDE-Q; n = 405), Three-Factor Eating Questionnaire (TFEQ; n = 405), Questionnaire of Eating and Weight Patterns Revised (QEWP-R; n = 204), Clinical Impairment Assessment (CIA; n = 204) and the Eating Disorder Examination clinical interview (EDE; n = 131). RESULTS CFA revealed adequate fit for only the CIA in its current form (CFI = 0.925, RMSEA = 0.096). EFA produced revised scales with improved reliability for the EDE, EDE-Q and TFEQ. Reliability of revised subscales was improved (original scales α = 0.43-0.82; revised scales α = 0.67-0.93). Correlational analyses of the CIA and revised versions of remaining scales with measures of psychological wellbeing and impairment revealed adequate convergent validity. All measures differentiated an EDE-classified disordered eating group from a non-disordered eating group (criterion validity). Diagnostic concordance between the EDE, EDE-Q and QEWP-R was low, and identification of disordered eating behaviours was inconsistent across measures. CONCLUSIONS Findings highlight the limitations of existing disordered eating questionnaires in bariatric surgery candidates. Results suggest revised assessments are required to overcome these limitations and ensure that measures informing clinical recommendations regarding patient care are reliable and valid.
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Affiliation(s)
- Katrina Parker
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, VIC, Australia. .,School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
| | - Sarah Mitchell
- School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.
| | - Paul O'Brien
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, VIC, Australia.
| | - Leah Brennan
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, VIC, Australia. .,School of Psychology, Australian Catholic University, 115 Victoria Parade, Locked Bag 4115, Melbourne, VIC, 3450, Australia.
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Novelle JM, Alvarenga MS. Cirurgia bariátrica e transtornos alimentares: uma revisão integrativa. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
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.
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Çelik Erden S, Seyit H, Yazısız V, Türkyılmaz Uyar E, Akçakaya RÖ, Beşirli A, Alış H, Karamustafalıoğlu O, Yücel B. Binge Eating Disorder Prevalence in Bariatric Surgery Patients: Evaluation of Presurgery and Postsurgery Quality of Life, Anxiety and Depression Levels. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Hakan Seyit
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | - Veli Yazısız
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | | | | | - Aslı Beşirli
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | - Halil Alış
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
| | | | - Başak Yücel
- Şişli Etfal Research and Training Hospital, İstanbul, Turkey
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Sogg S, Lauretti J, West-Smith L. Recommendations for the presurgical psychosocial evaluation of bariatric surgery patients. Surg Obes Relat Dis 2016; 12:731-749. [DOI: 10.1016/j.soard.2016.02.008] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 02/05/2016] [Indexed: 12/20/2022]
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Ho AL, Sussman ES, Pendharkar AV, Azagury DE, Bohon C, Halpern CH. Deep brain stimulation for obesity: rationale and approach to trial design. Neurosurg Focus 2016; 38:E8. [PMID: 26030708 DOI: 10.3171/2015.3.focus1538] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Obesity is one of the most serious public health concerns in the US. While bariatric surgery has been shown to be successful for treatment of morbid obesity for those who have undergone unsuccessful behavioral modification, its associated risks and rates of relapse are not insignificant. There exists a neurological basis for the binge-like feeding behavior observed in morbid obesity that is believed to be due to dysregulation of the reward circuitry. The authors present a review of the evidence of the neuroanatomical basis for obesity, the potential neural targets for deep brain stimulation (DBS), as well as a rationale for DBS and future trial design. Identification of an appropriate patient population that would most likely benefit from this type of therapy is essential. There are also significant cost and ethical considerations for such a neuromodulatory intervention designed to alter maladaptive behavior. Finally, the authors present a consolidated set of inclusion criteria and study end points that should serve as the basis for any trial of DBS for obesity.
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Affiliation(s)
| | | | | | | | - Cara Bohon
- 3Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Casey H Halpern
- 1Departments of Neurosurgery.,3Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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30
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Parker K, Mitchell S, O'Brien P, Brennan L. Psychometric evaluation of disordered eating measures in bariatric surgery patients. Eat Behav 2015; 19:39-48. [PMID: 26164672 DOI: 10.1016/j.eatbeh.2015.05.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 03/17/2015] [Accepted: 05/13/2015] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Bariatric surgery is considered the most effective weight loss intervention for obese persons. However, accurate assessment is essential to identify disordered eating that may impair achievement of optimal post-surgical outcomes. Measures of disordered eating are yet to be thoroughly psychometrically evaluated in bariatric surgery patients, therefore their utility is unknown. METHODS Participants were 108 adults who completed psychological measures approximately 12 months after bariatric surgery. The fit of the original scale structures was tested using Confirmatory Factor Analysis (CFA) and alternative factor solutions were generated using Exploratory Factor Analysis (EFA). Reliability (internal consistency) and construct validity (convergent and divergent) were also assessed. MATERIALS Eating Disorder Examination Questionnaire (EDE-Q), Questionnaire of Eating and Weight Patterns Revised (QEWP-R), Three Factor Eating Questionnaire (TFEQ) and Clinical Impairment Assessment (CIA). RESULTS CFA revealed none of the original disordered eating measures met adequate fit statistics. EFA produced revised scales with improved reliability (original scales α=0.47-0.94; revised scales α=0.76-0.98) and correlational analyses with measures of psychological wellbeing and impairment demonstrated adequate convergent validity. Reported prevalence of disordered eating behaviours differed between the EDE-Q and QEWP-R. CONCLUSIONS Psychometric evaluation did not support the use of the commonly used disordered eating measures in bariatric patients in their original form. The revised version of the EDE-Q replicates findings from recent research in bariatric surgery candidates. The alternate structures of the CIA and TFEQ suggest differences in the manifestation of disordered eating following surgery. Results suggest that revised measures are required to overcome the limitations of existing measures.
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Affiliation(s)
- Katrina Parker
- Centre for Obesity Research and Education (CORE), Level 6, The Alfred Centre, Monash University, 99 Commercial Rd, Melbourne, Victoria 3004, Australia; School of Psychological Sciences, Level 4, Building 17, Monash University Clayton Campus, Clayton, Victoria 3168, Australia.
| | - Sarah Mitchell
- School of Psychological Sciences, Level 4, Building 17, Monash University Clayton Campus, Clayton, Victoria 3168, Australia.
| | - Paul O'Brien
- Centre for Obesity Research and Education (CORE), Level 6, The Alfred Centre, Monash University, 99 Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Leah Brennan
- Centre for Obesity Research and Education (CORE), Level 6, The Alfred Centre, Monash University, 99 Commercial Rd, Melbourne, Victoria 3004, Australia; School of Psychology, Australian Catholic University, Locked Bag 4115, Melbourne, Victoria 3065, Australia.
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León F, Maiz C, Daroch D, Quezada N, Gabrielli M, Muñoz C, Boza C. Laparoscopic hand-sewn revisional gastrojejunal plication for weight loss failure after Roux-en-Y gastric bypass. Obes Surg 2015; 25:744-9. [PMID: 25618780 DOI: 10.1007/s11695-014-1463-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Revisional surgery has become a widely accepted alternative for weight loss failure/regain after bariatric surgery. However, it is associated to higher morbi-mortality and lesser weight loss than primary bariatric procedure. Our aims are to present a novel technique for weight loss treatment after failed laparoscopic Roux-en-Y gastric bypass (LRYGB) and to report its short-term results. METHODS This is a retrospective analysis of patients submitted to a revisional hand-sewn double-layer gastrojejunal plication (GJP) for treatment of weight loss failure/regain after LRYGB. Analysis of demographics, body mass index (BMI), and percentage of excess weight loss (%EWL) at the 6th month complications, and financial costs involved was included. RESULTS Four patients were submitted to revisional GJP. Three patients were female and the mean age at revision was 30 ± 9 years (21-44). The median time interval between LRYGB and GJP was 51 months (24-120). The median BMI at the moment of GJP and the 3rd and 6th month was 35.6 kg/m2 (32.0-37.8), 32.2 kg/m2 (29.7-34.1), and 30.7 kg/m2 (28.1-32.1), respectively. The median %EWL at the 3rd and 6th month was 35.4% (13.6-38.9) and 46.2 % (45.1-55.5), respectively, reaching a cumulative (combined surgeries) %EWL of 62.9% (16.5-67.9) and 71.7% (65.1-77.6), respectively. There were no complications or mortality. Financial costs were significantly lower compared to revisional gastrojejunal stapled reduction (US $1400 cheaper). CONCLUSION Revisional GJP is a feasible, safe, and cost-effective novel procedure for treatment of weight loss failure/regain after LRYGB. Mid- and long-term results are necessary in order to establish its real effectiveness.
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Affiliation(s)
- Felipe León
- Bariatric Surgery Unit, Digestive Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Marcoleta 350, patio interior, División de Cirugía, Región Metropolitana, Santiago, Chile,
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Fereidouni F, Atef-Vahid MK, Fathali Lavasani F, Jamshidi Orak R, Klonsky ED, Pazooki A. Are Iranian obese women candidate for bariatric surgery different cognitively, emotionally and behaviorally from their normal weight counterparts? Eat Weight Disord 2015; 20:397-403. [PMID: 25500838 DOI: 10.1007/s40519-014-0168-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 11/13/2014] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Fatemeh Fereidouni
- Tehran Institute of Psychiatry and Mental Health Research Center, Iran University of Medical Science, Satarkhan Street, Tehran, Iran
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Parker K, O'Brien P, Brennan L. Measurement of disordered eating following bariatric surgery: a systematic review of the literature. Obes Surg 2015; 24:945-53. [PMID: 24744189 DOI: 10.1007/s11695-014-1248-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Disordered eating is elevated in bariatric surgery patients and is a risk factor for poor surgical outcomes. A systematic review evaluated the definitions and measurement methods used to identify and assess disordered eating in patients following bariatric surgery. One hundred articles were identified featuring 35 questionnaires and 23 interviews. There were numerous variations to diagnostic criteria and amendments to measures to account for the post-surgical eating context. Only 20% of questionnaires and 4% of interviews had reported psychometric evaluation in post-surgery samples. Results highlight the need for a consistent definition of disordered eating and for current assessment measures to be (a) adapted to account for the altered gastrointestinal system in patients following surgery and (b) psychometrically evaluated in bariatric surgery patients.
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Affiliation(s)
- Katrina Parker
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, VIC, Australia,
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Opolski M, Chur-Hansen A, Wittert G. The eating-related behaviours, disorders and expectations of candidates for bariatric surgery. Clin Obes 2015; 5:165-97. [PMID: 26173752 DOI: 10.1111/cob.12104] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 05/13/2015] [Accepted: 05/21/2015] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- M Opolski
- School of Psychology, University of Adelaide, Adelaide, Australia
- Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| | - A Chur-Hansen
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - G Wittert
- Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
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Weineland S, Lillis J, Dahl J. Measuring experiential avoidance in a bariatric surgery population--psychometric properties of AAQ-W. Obes Res Clin Pract 2015; 7:e464-75. [PMID: 24308889 DOI: 10.1016/j.orcp.2012.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2012] [Revised: 05/11/2012] [Accepted: 06/04/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Valid measures capturing underlying psychological processes post surgery for obesity are needed to help identify important clinical targets and develop psychosocial interventions in conjunction with surgery. The Acceptance and Action Questionnaire for Weight (AAQ-W) measures experiential avoidance and has never been evaluated in a bariatric surgery population. METHOD Participants were recruited at a bariatric surgery clinic during follow-up care. The evaluation of psychometric properties of AAQ-W was done by repeated measurements of reliability (n = 62), convergent validity (n = 75 and n = 178), predictive validity (n = 61), factor analysis and calculation of internal consistency (n = 178). RESULTS The AAQ-W was found to have satisfactory psychometric properties. Internal consistency was high (α = .86). Results showed good stability over time (r = .77) and validity coefficients ranging from r = .36 to .71. AAQ-W scores measured six months post surgery predicted satisfaction with life, negative emotional states, emotional eating and general eating pathology measured one year post surgery. However AAQ-W measured at six months did not predict percent excess BMI Loss at one year. Factor analysis showed that a five factor solution (Food as Control, Body Acceptance, Self-Stigma, Self-Efficacy and Emotional Avoidance) might be a good fit (n = 178). CONCLUSION This study shows that the AAQ-W appears to be a psychometrically sound measure that can be used by researchers and clinicians in the context of bariatric surgery.
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Affiliation(s)
- Sandra Weineland
- Department of Psychology, University of Uppsala, Uppsala, Sweden.
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Nikolić M, Kruljac I, Kirigin L, Mirošević G, Ljubičić N, Nikolić BP, Bekavac-Bešlin M, Budimir I, Vrkljan M. Initial Weight Loss after Restrictive Bariatric Procedures May Predict Mid-Term Weight Maintenance: Results From a 12-Month Pilot Trial. Bariatr Surg Pract Patient Care 2015; 10:68-73. [PMID: 26594600 DOI: 10.1089/bari.2014.0049] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: Bariatric procedures are effective options for weight loss (WL) in the morbidly obese. However, some patients fail to lose any weight after bariatric surgery, and mid-term weight maintenance is variable. The aim of this study was to investigate whether initial WL could predict mid-term weight maintenance. Methods: Eighty patients were enrolled, of whom 44 were treated with the BioEnterics Intragastric Balloon (BIB), 21 with laparoscopic adjustable gastric lap-banding (LAGB), and 15 with laparoscopic sleeve gastrectomy (LSG). Percentage of body WL and percentage of excess weight loss (EWL) were calculated at baseline and after 1, 3, 6, and 12 months. Successful WL was defined as EWL >20% for patients treated with BIB and >50% for patients treated with LAGB and SG. Results: Success in the 6th and 12th month was achieved in 80% and 58% of patients in the BIB group, 33% and 40% in the LAGB group, and 60% and 73% in the LSG group. In the BIB group, WL in the 1st month correlated positively with WL at the 6th and 12th month, and an initial WL >6.5% best predicted success (sensitivity 50%, specificity 80%). A similar association was observed in the LAGB group at the 6th and 12th month and an initial WL >9.4% best predicted success (sensitivity 90.0%, specificity 81.2%). In patients treated with LSG, WL in the 3rd month correlated positively with EWL at the 6th and 12th month, with a cutoff value of 17% (sensitivity 66.7%, specificity 100%). Conclusions: WL in the 1st month in patients treated with BIB and LAGB and WL in the 3rd month in patients treated with LSG could be used as a prognostic factor to predict mid-term weight maintenance.
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Affiliation(s)
- Marko Nikolić
- Department of Gastroenterology and Hepatology, University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine , Zagreb, Croatia
| | - Ivan Kruljac
- Department of Endocrinology, Diabetology, and Metabolic Diseases "Mladen Sekso," University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine , Zagreb, Croatia
| | - Lora Kirigin
- Department of Gastroenterology, Jewish General Hospital , Montréal, Canada
| | - Gorana Mirošević
- Department of Endocrinology, Diabetology, and Metabolic Diseases "Mladen Sekso," University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine , Zagreb, Croatia
| | - Neven Ljubičić
- Department of Gastroenterology and Hepatology, University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine , Zagreb, Croatia
| | - Borka Pezo Nikolić
- Department of Cardiovascular Diseases, University Hospital Center "Zagreb ," Zagreb, Croatia
| | - Miroslav Bekavac-Bešlin
- Department of Abdominal Surgery, University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine , Zagreb, Croatia
| | - Ivan Budimir
- Department of Gastroenterology and Hepatology, University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine , Zagreb, Croatia
| | - Milan Vrkljan
- Department of Endocrinology, Diabetology, and Metabolic Diseases "Mladen Sekso," University Hospital Center "Sestre Milosrdnice," University of Zagreb School of Medicine , Zagreb, Croatia
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Natvik E, Gjengedal E, Moltu C, Råheim M. Re-embodying eating: patients' experiences 5 years after bariatric surgery. QUALITATIVE HEALTH RESEARCH 2014; 24:1700-1710. [PMID: 25156217 PMCID: PMC4232339 DOI: 10.1177/1049732314548687] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Health experts advise and expect patients to eat healthily after bariatric surgery. For patients, difficulties with eating might have been a long-standing, problematic part of life-a part that is not necessarily healed by surgery. Empirical research on patients' experiences of eating practices after bariatric surgery is lacking. Aiming to contribute to the development of clinical practice, we explored meanings attached to eating in the long term and sought descriptions of change and bodily sensations. We interviewed 14 patients at least 5 years after bariatric surgery. The surgical restriction forced changes in the way patients sensed their own body in eating, but the uncertainty related to maintaining weight loss in the long term remained. Meanings attached to eating transcended food as choices situated in a nourishment and health perspective, and were not necessarily changed. Eating was an existential and embodied practice, which remained an ambiguous and sensitive matter after surgery.
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The Impact of Temperament and Character Inventory Personality Traits on Long-Term Outcome of Roux-en-Y Gastric Bypass. Obes Surg 2014; 24:1647-55. [DOI: 10.1007/s11695-014-1229-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Loss of control eating and weight outcomes after bariatric surgery: a study with a Portuguese sample. Eat Weight Disord 2014; 19:103-9. [PMID: 24065351 DOI: 10.1007/s40519-013-0069-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 09/03/2013] [Indexed: 01/09/2023] Open
Abstract
The present study aim is to investigate the frequency of loss of control eating (LOC) episodes in three groups with different assessment times: one before, one at short and one at long-term after bariatric surgery; as well as to explore the association of postoperative problematic eating behaviors and weight outcomes and psychological characteristics. This cross-sectional study compared a group of preoperative bariatric surgery patients (n = 176) and two postoperative groups, one at short-term with <2 years follow-up (n = 110), and one at long-term >2 years follow-up (n = 53). Assessments included the EDE diagnostic interview and a set of self-report measures assessing eating disordered symptomatology, depression, and body image. We found the presence of LOC in 26.7 and 16.9 % of the pre-operative and long-term patients, respectively, and in about 11.8% of the short-term patients. One patient (0.9%) reported objective binge eating episodes at short-time, but subjective binge eating episodes were present in about 10% of the patients in all groups. LOC eating was related with the highest BMIs, the least weight loss, most weight regain, and most psychological impairment in the long-term assessments, but not at short-term. Despite the lower frequencies of disordered eating behavior in the short-term group, patients reporting LOC seem to represent a subgroup of individuals with poorest outcomes after surgery and most psychological distress.
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Abstract
Three mental health problems commonly associated with obesity are major depression, binge eating disorder (BED), and Night Eating Syndrome (NES). Evidence from both cross-sectional and longitudinal studies support independent relationships between obesity and depression, and between obesity and binge eating. These problems are most prevalent in severely obese individuals (Class III obesity; a body mass index (BMI) of >40kgm(2)), many of whom seek bariatric surgery, and we briefly review whether the presence of pre-operative depression, BED or NES affects post-operative outcomes. Historically depressed individuals have been screened out of weight loss trials due to concerns of worsening mood with weight loss. Such practices have precluded the development of effective treatments for depressed, obese individuals, leaving large numbers of people without appropriate care. We present recent advances in this area, and attempt to answer whether depressed individuals can lose clinically significant amounts of weight, show improvements in mood, and adhere to the demands of a weight loss intervention.
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Affiliation(s)
- Lucy F Faulconbridge
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA
| | - Colleen F Bechtel
- Center for Weight and Eating Disorders, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, 3535 Market Street, Philadelphia, PA 19104, USA
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Meany G, Conceição E, Mitchell JE. Binge eating, binge eating disorder and loss of control eating: effects on weight outcomes after bariatric surgery. EUROPEAN EATING DISORDERS REVIEW 2014; 22:87-91. [PMID: 24347539 PMCID: PMC4420157 DOI: 10.1002/erv.2273] [Citation(s) in RCA: 196] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 11/19/2013] [Accepted: 11/20/2013] [Indexed: 11/09/2022]
Abstract
There is increasing evidence that patients who have problems with binge eating (BE) or BE disorder (BED) are quite common among the severely obese, including bariatric surgery candidates. The literature suggests that in many cases such eating behaviours improve after bariatric surgery, although this is not uniformly true. The current paper reviews the data on the development of BE, BED and loss of control (LOC) eating after bariatric surgery and the impact of these problems on long-term weight outcome. A search was made of various databases regarding evidence of BE, BED and LOC eating post-operatively in bariatric surgery patients. The data extracted from the literature suggests that 15 research studies have now examined this question. Fourteen of the available 15 studies suggest that the development of problems with BE, BED or LOC eating post-bariatric surgery is associated with less weight loss and/or more weight regain post-bariatric surgery. These data suggests that it is important to identify individuals at high risk for these problems, to follow them post-operatively, and, if appropriate interventions can be developed if such behaviours occur in order to maximize weight loss outcomes.
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Affiliation(s)
- Gavin Meany
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | | | - James E. Mitchell
- Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
- Neuropsychiatric Research Institute, Fargo, North Dakota, USA
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Parker K, Brennan L. Measurement of disordered eating in bariatric surgery candidates: a systematic review of the literature. Obes Res Clin Pract 2014; 9:12-25. [PMID: 25660171 DOI: 10.1016/j.orcp.2014.01.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/09/2014] [Accepted: 01/25/2014] [Indexed: 12/16/2022]
Abstract
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.
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Affiliation(s)
- Katrina Parker
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Victoria, Australia; School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Leah Brennan
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Victoria, Australia; School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia.
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Malik S, Mitchell JE, Engel S, Crosby R, Wonderlich S. Psychopathology in bariatric surgery candidates: a review of studies using structured diagnostic interviews. Compr Psychiatry 2014; 55:248-59. [PMID: 24290079 PMCID: PMC3985130 DOI: 10.1016/j.comppsych.2013.08.021] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/08/2013] [Accepted: 08/04/2013] [Indexed: 12/15/2022] Open
Abstract
Psychiatric disorders are not uncommon among severely obese patients who present for bariatric surgery. This paper (1) reviews the results of the published studies using the structured interviews to assess psychopathology in bariatric surgery candidates; (2) compares the prevalence rates of psychiatric disorders across these studies with the data from other population samples; and (3) assesses whether sociodemographic variables appear to affect these prevalence rates. We searched online resources, PubMed, PsychINFO and reference lists of all the relevant articles to provide an overview of evidence so far and highlight some details in the assessment and comparisons of different samples in different countries. The prevalence estimates in the non-treatment obese group did not appear to differ substantially from the general population group in the US or the Italian population samples, although they were relatively higher for the German population. However, the rates of psychopathology in the bariatric surgery candidates were considerably higher than the other two population groups in all the samples. Overall, the most common category of lifetime Axis I disorders in all the studies was affective disorders, with anxiety disorders being the most common category of current Axis I disorders. Certain demographic characteristics are also associated with higher rates of psychopathology, such as, female gender, low socioeconomic status, higher BMI. Overall, methodological and sociodemographic differences make these studies difficult to compare and these differences should be taken into account when interpreting the results.
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Affiliation(s)
- Sarah Malik
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Internal Medicine, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA
| | - James E. Mitchell
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA,Corresponding Author: (J.E. Mitchell)
| | - Scott Engel
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA
| | - Ross Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA
| | - Steve Wonderlich
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, North Dakota 58103 USA,Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, 58102, USA
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Wimmelmann CL, Dela F, Mortensen EL. Psychological predictors of weight loss after bariatric surgery: a review of the recent research. Obes Res Clin Pract 2013; 8:e299-313. [PMID: 25091351 DOI: 10.1016/j.orcp.2013.09.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/09/2013] [Accepted: 09/16/2013] [Indexed: 01/06/2023]
Abstract
BACKGROUND Morbid obesity is the fastest growing BMI group in the U.S. and the prevalence of morbid obesity worldwide has never been higher. Bariatric surgery is the most effective treatment for severe forms of obesity especially with regard to a sustained long-term weight loss. Psychological factors are thought to play an important role for maintaining the surgical weight loss. However, results from prior research examining preoperative psychological predictors of weight loss outcome are inconsistent. The aim of this article was to review more recent literature on psychological predictors of surgical weight loss. METHODS We searched PubMed, PsycInfo and Web of Science, for original prospective studies with a sample size >30 and at least one year follow-up, using a combination of search terms such as 'bariatric surgery', 'morbid obesity', 'psychological predictors', and 'weight loss'. Only studies published after 2003 were included. RESULTS 19 eligible studies were identified. Psychological predictors of surgical weight loss investigated in the reviewed studies include cognitive function, personality, psychiatric disorder, and eating behaviour. CONCLUSION In general, recent research remains inconsistent, but the findings suggest that pre-surgical cognitive function, personality, mental health, composite psychological variables and binge eating may predict post-surgical weight loss to the extent that these factors influence post-operative eating behaviour.
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Affiliation(s)
- Cathrine L Wimmelmann
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Flemming Dela
- Systems Biology Research Section, Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Erik L Mortensen
- Section of Environmental Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Center for Healthy Aging, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Abstract
Diet-induced weight loss is often limited in its magnitude and often of short duration, followed by weight regain. On the contrary, bariatric surgery now commonly used in the treatment of severe obesity favors large and sustained weight loss, with resolution or improvement of most obesity-associated comorbidities. The mechanisms of sustained weight loss are not well understood. Whether changes in the various components of energy expenditure favor weight maintenance after bariatric surgery is unclear. While the impact of diet-induced weight loss on energy expenditure has been widely studied and reviewed, the impact of bariatric surgery on total energy expenditure, resting energy expenditure, and diet-induced thermogenesis remains unclear. Here, we review data on energy expenditure after bariatric surgery from animal and human studies. Bariatric surgery results in decreased total energy expenditure, mainly due to reduced resting energy expenditure and explained by a decreased in both fat-free mass and fat mass. Limited data suggest increased diet-induced thermogenesis after gastric bypass, a surgery that results in gut anatomical changes and modified the digestion processes. Physical activity and sustained intakes of dietary protein may be the best strategies available to increase non-resting and then total energy expenditure, as well as to prevent the decline in lean mass and resting energy expenditure.
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Sysko R, Zandberg LJ, Devlin MJ, Annunziato RA, Zitsman JL, Walsh BT. Mental Health Evaluations for Adolescents Prior to Bariatric Surgery: A Review of Existing Practices and a Specific Example of Assessment Procedures. Clin Obes 2013; 3:62-72. [PMID: 24073019 PMCID: PMC3781169 DOI: 10.1111/cob.12019] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Best practice guidelines for adolescents considering bariatric surgery recommend a pre-operative mental health evaluation. However, only general information about these assessments appears in the literature, which makes consistency of administration challenging. This review proposes a specific empirically-derived format for pre-surgical mental health evaluations and summarizes currently available data on the psychiatric functioning of adolescents seeking bariatric surgery. DESIGN Studies of mental health evaluations for adults preparing for bariatric surgery are reviewed, as is the limited literature relevant to adolescent evaluations. A specific and detailed example of an evaluation (clinical interview, self-report questionnaires, cognitive assessment) used for younger patients at a major metropolitan hospital center is presented, followed by data from an initial group of adolescents completing this evaluation. SUBJECTS 200 adolescents (n=139 female; age: 14-18 y, BMI: 35.4-83.3 kg/m2) presenting for bariatric surgery. RESULTS A notable subset of adolescents reported current Axis I conditions (31.5%) and current mental health treatment (29.5%), but reports of current illicit drug use (1.5%) and regular alcohol use (0.5%) were relatively rare. Procedures for using the completed evaluation and post-surgery monitoring of psychosocial issues are discussed. CONCLUSIONS Adolescents considering weight loss surgery should receive comprehensive pre-surgical mental health evaluations, but additional data are needed to develop specific recommendations the use of these evaluations in post-operative care.
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Affiliation(s)
- Robyn Sysko
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, NY
| | | | - Michael J. Devlin
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, NY
| | | | - Jeffrey L. Zitsman
- Center for Adolescent Bariatric Surgery, Department of Surgery, Division of Pediatric Surgery, Columbia University Medical Center, New York, NY
| | - B. Timothy Walsh
- Columbia Center for Eating Disorders, Division of Clinical Therapeutics, New York State Psychiatric Institute and the Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, New York, NY
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Benson-Davies S, Davies ML, Kattelmann K. Understanding Eating and Exercise Behaviors in Post Roux-en-Y Gastric Bypass Patients: A Quantitative and Qualitative Study. Bariatr Surg Pract Patient Care 2013; 8:61-68. [PMID: 24761367 PMCID: PMC3827846 DOI: 10.1089/bari.2013.9989] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Weight regain following gastric bypass (GB) surgery continues to plague many individuals across the United States. However, understanding long-term eating and exercise behaviors to promote and sustain a lower weight following GB surgery is limited. METHOD The purpose of this study was to explore the perceptions and attitudes of eating and exercise behaviors associated with weight maintenance in post-GB patients (n=24) 2 or more years postsurgery. Demographic, anthropometric, and food record data were collected. Focus groups and personal interviews were used to understand behaviors and support systems associated with weight stabilization. Focus groups were audio-taped, transcribed, and organized into common themes. RESULTS All participants were female, with a mean of 6 years postsurgery, and had a mean age of 51.8±10.5 years. The majority were married (71%) and had a college degree (58%). Although the average weight regain postsurgery was estimated at 16.2±12.7 kg, most of the women (75%) had maintained a significant weight loss of at least 50% of their excess body weight. Themes associated with weight regain emerging from the focus groups included variable family support and a return to "old eating habits." CONCLUSION Focus group participants identified lack of long-term emotional support from family members and limited community support for weight loss surgery patients.
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Affiliation(s)
- Sue Benson-Davies
- Bariatric Nutrition Consultant, Private Practice, Whitewood, South Dakota
| | | | - Kendra Kattelmann
- Department of Health and Nutritional Sciences, South Dakota State University, Brooking, SD
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Uncontrolled, Repetitive Eating of Small Amounts of Food or ‘Grazing’: Development and Evaluation of a New Measure of Atypical Eating. BEHAVIOUR CHANGE 2013. [DOI: 10.1017/bec.2013.6] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Grazing, or the uncontrolled, repetitive eating of small amounts of food is being increasingly recognised as an important eating behaviour associated with obesity. In spite of the need for a better understanding of this eating behaviour for improved obesity treatment, currently there is no empirically validated self-report measure to assess grazing. Therefore, to contribute to a better understanding of this relatively understudied eating pattern, a new self-report questionnaire of grazing was developed in this study. Questionnaire items were designed to reflect previous empirical descriptions of grazing. A group of 248 university students completed the Grazing Questionnaire, other measures of eating-related behaviours and cognitions, and negative emotion. Sixty-two participants completed the Grazing Questionnaire a second time to calculate its temporal stability. Exploratory factor analysis revealed a clear two-factor solution for the questionnaire, reflecting repetitive eating behaviour and a perception of loss of control. Scores on the Grazing Questionnaire were positively associated with other measures of disordered eating, especially with binge eating. Initial psychometric properties of the new questionnaire are promising. Future research is now needed to examine the prevalence of this eating behaviour in more diverse populations, including those with binge eating disorder and obesity.
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Adams ST, Salhab M, Hussain ZI, Miller GV, Leveson SH. Roux-en-Y gastric bypass for morbid obesity: what are the preoperative predictors of weight loss? Postgrad Med J 2013; 89:411-6; quiz 415, 416. [PMID: 23472004 DOI: 10.1136/postgradmedj-2012-131310] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Obesity has become an increasingly important health problem over the past 30 years. Presently around a quarter of the UK adult population are obese and this figure is set to increase further in the coming decades. The health consequences of obesity on multiple body systems have been well established as has the financial cost of the condition to both the individuals affected as well as to society as a whole. Bariatric surgery has been shown to be the only long term effective solution in terms of sustained weight loss and comorbidity resolution. The commonest bariatric procedure in the UK is the Roux-en-y gastric bypass which consistently results in the loss of 70%-80% of excess bodyweight. Results however are variable and in order to optimise resource allocation and avoid exposing patients unlikely to benefit from surgery to its inherent risks, much research has been done to try to identify those patients most likely to obtain a good result. The only factor which has been subjected to meta-analysis is that of preoperative weight loss which shows a positive association with postoperative weight loss following bypass surgery. Although the remaining data are not based on level 1 evidence those other preoperatively identifiable factors which are associated with an improved outcome include Caucasian or Hispanic ethnicity, higher educational status, non-shift-work working patterns, female gender and divorced or single marital status. Similarly increased levels of preoperative physical activity and an absence of binge eating behaviour are consistent with a favourable result whereas increased age, smoking and other socioeconomic factors have not been shown to have a significant impact. Conversely diabetes mellitus seems to have a slight negative correlation with postoperative weight loss; however, a history of sexual abuse or psychiatric illness has not been shown to have a lasting influence.
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Affiliation(s)
- Simon T Adams
- Department of General Surgery, York Hospital, York, UK.
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50
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Benson-Davies S, Davies ML, Kattelmann K. Energy Balance Following Gastric Bypass Surgery: A Pilot Study of Daily Caloric Intake and Step Count. Bariatr Surg Pract Patient Care 2013. [DOI: 10.1089/bari.2013.9997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Affiliation(s)
| | | | - Kendra Kattelmann
- Department of Health and Nutritional Sciences, South Dakota State University, Brooking, South Dakota
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