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Sarwer DB, Schroeder K, Fischbach SR, Atwood SM, Heinberg LJ. Applying the Principles of Trauma-Informed Care to the Evaluation and Management of Patients Who Undergo Metabolic and Bariatric Surgery. Obes Surg 2025; 35:305-311. [PMID: 39592546 PMCID: PMC11717798 DOI: 10.1007/s11695-024-07597-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 11/14/2024] [Accepted: 11/17/2024] [Indexed: 11/28/2024]
Abstract
Evaluation of relevant psychosocial variables is an important aspect of comprehensive, high-quality metabolic and bariatric surgery (MBS) care. Given the high rates of adverse childhood experience (ACEs) and other forms of trauma experienced later in life reported by individuals with class III obesity, it is time to apply the principles of trauma-informed care to the multidisciplinary care of MBS patients. This narrative review begins with a summary of the literature on the psychosocial functioning of individuals who present for MBS. Emphasis is placed upon the relationship between ACEs, class III obesity, and MBS. Trauma-informed care is defined, and its principles are applied to the MBS care continuum. The paper ends with a recommendation on how the field of MBS can integrate trauma-informed care into clinical practice and future research.
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Affiliation(s)
- David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Suite 175, 3223 N. Broad St, Philadelphia, PA, 19104, USA.
| | - Krista Schroeder
- Department of Nursing, Temple University College of Public Health, Philadelphia, PA, USA
| | - Sarah R Fischbach
- Center for Obesity Research and Education, College of Public Health, Temple University, Suite 175, 3223 N. Broad St, Philadelphia, PA, 19104, USA
| | - Sophia M Atwood
- Center for Obesity Research and Education, College of Public Health, Temple University, Suite 175, 3223 N. Broad St, Philadelphia, PA, 19104, USA
| | - Leslie J Heinberg
- Department of Surgery, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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Tabone JK, Cox S, Aylward L, Abunnaja S, Szoka N, Tabone LE. Addressing Adverse Childhood Experiences and Psychological Symptoms Among Bariatric Patients. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:321-327. [PMID: 37234836 PMCID: PMC10205957 DOI: 10.1007/s40653-022-00491-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/20/2022] [Indexed: 05/28/2023]
Abstract
Adverse Childhood Experiences (ACEs) have been shown to be prevalent in bariatric surgery candidates with comorbid psychological symptoms. While bariatric patients who have mental illness or a history of ACEs are less likely to lose weight, presence of a support system has been reported to mitigate ACEs' effects and to maintain long-term weight loss. The current study aims to examine the association between ACEs and psychological symptoms and the effect of potential protective factors on the association among bariatric patients. The study included a total of 199 subjects seeking bariatric surgery who completed a psychological evaluation including ACEs, psychological symptoms, and presence of support system as part of the presurgical multidisciplinary weight management consultations at a large university hospital. Multivariate regression models were used to examine the association between ACEs and psychological symptoms and potential effect of support system on the association. The study found that there is a significant association between ACEs and psychological symptoms. The study also revealed that patients who reported having a childhood supportive person were significantly associated with a lower BMI, while those who reported having adulthood supportive person showed significantly less symptoms of depression, anxiety, and binge eating. The findings have significant implications that addressing ACEs in preoperative surgical process in relation to psychological conditions and therapeutic interventions within their close environmental system will be beneficial for patients to achieve optimal surgical outcomes.
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Affiliation(s)
- Jiyoung K. Tabone
- School of Social Work, West Virginia University, PO Box 6830, Morgantown, WV 26506 USA
| | - Stephanie Cox
- Department of Behavioral Medicine and Psychiatry, West Virginia University, PO Box 9100, Morgantown, WV 26506 USA
| | - Laura Aylward
- Department of Behavioral Medicine and Psychiatry, West Virginia University, PO Box 9100, Morgantown, WV 26506 USA
| | - Salim Abunnaja
- Department of Surgery, West Virginia University, PO Box 9100, Morgantown, WV 26506 USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, PO Box 9100, Morgantown, WV 26506 USA
| | - Lawrence E. Tabone
- Department of Surgery, West Virginia University, PO Box 9100, Morgantown, WV 26506 USA
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Burns CJ, Borah L, Terrell SM, James LN, Erkkinen E, Owens L. Trauma-Informed Care Curricula for the Health Professions: A Scoping Review of Best Practices for Design, Implementation, and Evaluation. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:401-409. [PMID: 36538661 DOI: 10.1097/acm.0000000000005046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
PURPOSE Trauma-exposed persons often experience difficulties accessing medical care, remaining engaged in treatment plans, and feeling psychologically safe when receiving care. Trauma-informed care (TIC) is an established framework for health care professionals, but best practices for TIC education remain unclear. To remedy this, the authors conducted a multidisciplinary scoping literature review to discern best practices for the design, implementation, and evaluation of TIC curricula for health care professionals. METHOD The research team searched Ovid MEDLINE, Cochrane Library, Elsevier's Scopus, Elsevier's Embase, Web of Science, and the PTSDpubs database from the database inception date until May 14, 2021. Worldwide English language studies on previously implemented TIC curricula for trainees or professionals in health care were included in this review. RESULTS Fifty-five studies met the inclusion criteria, with medicine being the most common discipline represented. The most prevalent learning objectives were cultivating skills in screening for trauma and responding to subsequent disclosures (41 studies [74.5%]), defining trauma (34 studies [61.8%]), and understanding trauma's impact on health (33 studies [60.0%]). Fifty-one of the studies included curricular evaluations, with the most common survey items being confidence in TIC skills (38 studies [74.5%]), training content knowledge assessment (25 studies [49.0%]), participant demographic characteristics (21 studies [41.2%]), and attitudes regarding the importance of TIC (19 studies [37.3%]). CONCLUSIONS Future curricula should be rooted in cultural humility and an understanding of the impacts of marginalization and oppression on individual and collective experiences of trauma. Moreover, curricula are needed for clinicians in more diverse specialties and across different cadres of care teams. Additional considerations include mandated reporting, medical record documentation, and vicarious trauma experienced by health care professionals.
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Affiliation(s)
- Courtney Julia Burns
- C.J. Burns is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3216-5921
| | - Luca Borah
- L. Borah is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-8975-1051
| | - Stephanie M Terrell
- S.M. Terrell is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0001-7776-4621
| | - LaTeesa N James
- L.N. James is a health sciences informationist, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-5955-2876
| | - Elizabeth Erkkinen
- E. Erkkinen is a medical student, University of Michigan Medical School, Ann Arbor, Michigan; ORCID: https://orcid.org/0000-0002-3522-7286
| | - Lauren Owens
- L. Owens is assistant professor, Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington; ORCID https://orcid.org/0000-0002-8277-2826
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Tabone JK, Cox S, Aylward L, Abunnaja S, Szoka N, Tabone LE. The Roles of Depression and Binge Eating in the Relationship Between Adverse Childhood Experiences (ACEs) and Obesity. Obes Surg 2022; 32:3034-3040. [PMID: 35790671 DOI: 10.1007/s11695-022-06192-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Research has demonstrated that adverse childhood experiences (ACEs) were related to elevated lifetime risk of developing obesity, but the underlying mechanisms between ACEs and development of obesity are yet to be fully elucidated. The current study aims to extend exiting evidence on underlying mechanisms between ACEs and development of obesity by examining whether depressive symptom and binge eating symptom have independently significant mediating effects on the association. METHODS The study used data from a total of 473 patients seeking bariatric surgery who completed psychological evaluation including ACEs, depressive symptom, and binge eating scale as a part of presurgical multidisciplinary weight management consultations. Mediation analyses were conducted using the PROCESS macro for SPSS to examine the research objective. RESULTS The study found that depressive symptom uniquely mediated the relationship between ACEs and obesity, but binge eating symptom did not significantly mediate the relationship independently of depression. CONCLUSIONS The unique role of depression in relation to childhood trauma in this study argues for more focus on a mental health intervention with bariatric patients during the preoperative period. Addressing ACEs for bariatric patients who present psychiatric symptoms during preoperative process could have potential benefits to patient care.
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Affiliation(s)
- Jiyoung K Tabone
- School of Social Work, West Virginia University, PO Box 6830, Morgantown, WV, 26506, USA.
| | - Stephanie Cox
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Laura Aylward
- Department of Behavioral Medicine and Psychiatry, West Virginia University, Morgantown, WV, USA
| | - Salim Abunnaja
- Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Nova Szoka
- Department of Surgery, West Virginia University, Morgantown, WV, USA
| | - Lawrence E Tabone
- Department of Surgery, West Virginia University, Morgantown, WV, USA
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Osadchiy V, Mayer EA, Bhatt R, Labus JS, Gao L, Kilpatrick LA, Liu C, Tillisch K, Naliboff B, Chang L, Gupta A. History of early life adversity is associated with increased food addiction and sex-specific alterations in reward network connectivity in obesity. Obes Sci Pract 2019; 5:416-436. [PMID: 31687167 PMCID: PMC6819979 DOI: 10.1002/osp4.362] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neuroimaging studies have identified obesity-related differences in the brain's resting state activity. An imbalance between homeostatic and reward aspects of ingestive behaviour may contribute to obesity and food addiction. The interactions between early life adversity (ELA), the reward network and food addiction were investigated to identify obesity and sex-related differences, which may drive obesity and food addiction. METHODS Functional resting state magnetic resonance imaging was acquired in 186 participants (high body mass index [BMI]: ≥25: 53 women and 54 men; normal BMI: 18.50-24.99: 49 women and 30 men). Participants completed questionnaires to assess ELA (Early Traumatic Inventory) and food addiction (Yale Food Addiction Scale). A tripartite network analysis based on graph theory was used to investigate the interaction between ELA, brain connectivity and food addiction. Interactions were determined by computing Spearman rank correlations, thresholded at q < 0.05 corrected for multiple comparisons. RESULTS Participants with high BMI demonstrate an association between ELA and food addiction, with reward regions playing a role in this interaction. Among women with high BMI, increased ELA was associated with increased centrality of reward and emotion regulation regions. Men with high BMI showed associations between ELA and food addiction with somatosensory regions playing a role in this interaction. CONCLUSIONS The findings suggest that ELA may alter brain networks, leading to increased vulnerability for food addiction and obesity later in life. These alterations are sex specific and involve brain regions influenced by dopaminergic or serotonergic signalling.
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Affiliation(s)
- V. Osadchiy
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - E. A. Mayer
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Ahmanson‐Lovelace Brain Mapping CenterUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - R. Bhatt
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Pediatric Pain and Palliative Care ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - J. S. Labus
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - L. Gao
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - L. A. Kilpatrick
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - C. Liu
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - K. Tillisch
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Pediatric Pain and Palliative Care ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - B. Naliboff
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - L. Chang
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
| | - A. Gupta
- G. Oppenheimer Family Center for Neurobiology of Stress and Resilience, Ingestive Behavior and Obesity ProgramUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- David Geffen School of MedicineUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
- Vatche and Tamar Manoukin Division of Digestive DiseasesUniversity of California, Los Angeles (UCLA)Los AngelesCAUSA
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Association of Adverse Childhood Experiences and Food Addiction to Bariatric Surgery Completion and Weight Loss Outcome. Obes Surg 2018; 28:3386-3392. [DOI: 10.1007/s11695-018-3370-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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