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Atwood ME. Emotion dysregulation and obesity: A conceptual review of the literature. Clin Obes 2024:e12699. [PMID: 39119935 DOI: 10.1111/cob.12699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 06/18/2024] [Accepted: 07/20/2024] [Indexed: 08/10/2024]
Abstract
Problematic eating behaviours are prevalent in individuals living with obesity and have been linked to weight gain over time. Furthermore, there is evidence that heightened negative emotionality is common in a subset of individuals living with obesity and that negative emotions often precede problematic eating behaviours. Consequently, several theories have highlighted emotion dysregulation as a potential explanatory mechanism of this relationship. However, to date, no comprehensive review has compiled the specific ways in which individuals living with obesity exhibit emotion dysregulation. The present review utilizes Gratz and Roemer's (2004) multidimensional conceptualization of emotion regulation and dysregulation as a framework to summarize the extant literature on emotion dysregulation in obesity. Specifically, this review examines research related to: (1) awareness and clarity of emotions; (2) acceptance of, and willingness to experience, emotion; (3) the ability to remain goal directed and inhibit impulsive behaviour when distressed; and (4) access to emotion regulation strategies. Overall, findings from the present review demonstrate that individuals living with obesity exhibit deficits in emotion clarity, and experience difficulty inhibiting impulsive behaviour and remaining goal directed when experiencing emotion. Strengths and limitations of the literature are reviewed, and future research directions and clinical implications are discussed in light of these findings.
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Affiliation(s)
- Molly E Atwood
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Jacobs A, Monpellier VM, Torensma B, Antoniou EE, Janssen IMC, Tollenaar RAEM, Jansen ATM. Influence of mental and behavioral factors on weight loss after bariatric surgery: A systematic review and meta-analysis. Obes Rev 2024; 25:e13729. [PMID: 38450930 DOI: 10.1111/obr.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/16/2023] [Accepted: 01/12/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Multiple factors are related to lower weight loss after bariatric surgery. This review and meta-analysis evaluates the influence of several mental and behavioral factors on weight loss. METHOD Six electronic databases were searched. Percentage excess weight loss (%EWL) was calculated for all moderator and non-moderator groups of the variables: symptoms of depression, anxiety and binge eating, compliance, physical activity, quality of life, and body image. All moderators, surgery types, and follow-up moments were analyzed separately. RESULTS In total, 75 articles were included in the review; 12 meta-analyses were conducted. Higher postoperative compliance to follow-up was associated with 6.86%-13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24- and 36-month follow-up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms. CONCLUSION Despite the high heterogeneity between studies, a trend emerges suggesting that the presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric-metabolic surgery. Additionally, preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss.
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Affiliation(s)
- Anne Jacobs
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | | | - Ignace M C Janssen
- Nederlandse Obesitas Kliniek (Dutch Obesity Clinic), Utrecht, The Netherlands
| | - Rob A E M Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Anita T M Jansen
- Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands
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3
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Iljin A, Wlaźlak M, Sitek A, Antoszewski B, Zieliński T, Gmitrowicz A, Kropiwnicki P, Strzelczyk J. Mental Health, and Eating Disorders in Patients After Roux-en-Y Gastric Bypass Surgery (RYGB). POLISH JOURNAL OF SURGERY 2024; 96:1-11. [PMID: 38979584 DOI: 10.5604/01.3001.0054.5209] [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] [Indexed: 07/10/2024]
Abstract
<b>Introduction:</b> Obesity, as one of the main health problems worldwide, is associated with an increased risk of developing mental and eating disorders and negative eating habits. Bariatric surgery allows for rapid weight loss and alleviates the symptoms of concomitant diseases in obese patients.<b>Aim:</b> Pre- and postoperative estimation of mental disorders and eating behaviors in patients after Roux-en-Y Gastric Bypass (RYGB).<b>Material and methods:</b> Analysis of data from up to 5 years of follow-up including clinical examination and questionnaires.<b>Results:</b> Following parameters decreased after RYGB: anxiety and hyperactivity from 32.81% to 21.88%, mood disorders - 31.25% to 20.31%, substance abuse - 40.63% to 28.13%, emotional eating - 76.56% to 29.69%, binge eating - 50% to 6.25%, night eating - 87.5% to 20.31%. Postoperative rates of: negative eating habits, daily intake of calories and sweetened beverages, flatulence, constipation, and abdominal pain decreased, while the rate of food intolerance and emesis increased.<b>Conclusions:</b> In our patients, the occurrence of: mental and eating disorders, negative eating habits, daily calories, sweetened beverages, coffee intake decreased after weight loss (as a result of RYGB), but water, vegetables and fruit consumption increased. Lower rate of flatulence, constipation, and abdominal pain, but higher of food intolerance and emesis were also confirmed after RYGB.
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Affiliation(s)
- Aleksandra Iljin
- Department of Plastic, Reconstructive and Aesthetic SurgeryMedical University of Lodz, Poland
| | - Michał Wlaźlak
- Department of General and Transplant Surgery, Medical University of Lodz, Poland
| | - Aneta Sitek
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, Poland
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Poland
| | - Tomasz Zieliński
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Lodz, Poland
| | | | - Paweł Kropiwnicki
- Department of Adolescent Psychiatry, Medical University of Lodz, Poland
| | - Janusz Strzelczyk
- Department of General and Transplant Surgery, Medical University of Lodz, Poland
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Mowoh DPM, Cole R, Sarvepalli S, Grover K, Abbas M, Khaitan L. Bariatric surgery efficacy in patients with mood disorders. Surgery 2024; 175:943-946. [PMID: 38171967 DOI: 10.1016/j.surg.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 10/02/2023] [Accepted: 11/26/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Mood disorders are comorbid in patients with obesity and found in approximately 22.0% to 54.8% of patients who are eligible for bariatric surgery. Given the unclear effect of mood disorders on bariatric surgery outcomes, we aimed this study to assess the impact of mood disorders index bariatric surgery weight loss outcomes. METHODS A retrospective study institutional database of index bariatric surgery patients at University Hospitals Cleveland Medical Center between 2016 and 2018. The primary outcome of body mass index was followed over a 4-year period. The secondary outcomes measured were mortality and suicide rates. Mood disorders defined by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, included depressive and bipolar disorders obtained from electronic medical records International Classification of Diseases, Tenth Revision, coding. RESULTS A total of 790 patients underwent bariatric surgery between 2016 and 2018. Of these, 15 patients were excluded due to death in the postoperative period or insufficient weight loss data, and a total of 775 patients (620 women and 155 men) were included. Two hundred and ninety-five (38.1%) had an electronic medical record mood disorder diagnosis before surgery, while 480 (61.9%) did not. Both groups had a significant decrease in postoperative body mass index; however, there was no significant difference in the body mass index change between the mood disorder group (mean = 37.63, standard deviation = 9.88) and the control group (mean = 38.72, standard deviation = 9.54; t[294] = 1.40; P = .1634). CONCLUSION Patients with mood disorders are as successful with weight loss after index bariatric surgery as those without mood disorders. There was no significant difference in mortality rates between the mood disorder group and the control group. Hence, mood disorders should not be prohibitive for weight loss surgery.
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Affiliation(s)
| | - Rachel Cole
- Case Western Reserve University School of Medicine, Cleveland, OH
| | - Shravan Sarvepalli
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/ShravanSar63428
| | - Karan Grover
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/DrGroverSays
| | - Mujjahid Abbas
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/M_AbbasMD
| | - Leena Khaitan
- University Hospitals Cleveland Medical Center, Cleveland, OH. https://twitter.com/DrLeenaK
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Ivezaj V, Dilip A, Grilo CM. Psychiatric comorbidity as a prospective predictor of long-term weight and psychosocial outcomes after bariatric surgery. Gen Hosp Psychiatry 2023; 83:51-58. [PMID: 37099869 DOI: 10.1016/j.genhosppsych.2023.03.005] [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: 11/15/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVES Psychiatric comorbidity is common among the bariatric population although the prognostic significance of psychiatric comorbidity on outcomes is uncertain. This prospective study examined differences in weight and psychosocial functioning outcomes based on lifetime and current (post-surgical) psychiatric comorbidity. METHODS Participants were 140 adults in a RCT for loss-of-control (LOC)-eating approximately six months post-bariatric surgery. Two structured interviews were administered: the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV) to assess LOC-eating and eating-disorder psychopathology, and the Mini International Neuropsychiatric Interview (MINI) to assess lifetime and current (post-surgical) psychiatric disorders. The EDE-BSV and Beck Depression Inventory (BDI-II) were repeated at post-treatment and 24-month follow-ups. RESULTS Lifetime (75.7%) and current/post-surgical (25%) psychiatric diagnoses were common. Groups with and without psychiatric comorbidity did not differ significantly in weight loss outcomes at any timepoint but psychiatric comorbidity was associated significantly with greater LOC-eating, eating-disorder psychopathology, and depression. CONCLUSIONS Among participants with LOC-eating post-bariatric surgery, lifetime and post-surgical psychiatric comorbidity was not associated with acute or longer-term weight outcomes but predicted poorer psychosocial functioning. Findings challenge prevailing views that psychiatric comorbidity is related to poorer longer-term weight outcomes following bariatric surgery but highlight its clinical significance as it is associated with broad psychosocial difficulties.
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Affiliation(s)
- Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA.
| | - Abhaya Dilip
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Carlos M Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA; Yale University, Department of Psychology, New Haven, CT, USA
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Beltrán-Garrayo L, Solar M, Blanco M, Graell M, Sepúlveda AR. Examining associations between obesity and mental health disorders from childhood to adolescence: A case-control prospective study. Psychiatry Res 2023; 326:115296. [PMID: 37331070 DOI: 10.1016/j.psychres.2023.115296] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 06/20/2023]
Abstract
Childhood obesity and mental disorders often co-exist. To date, most of the studies are cross-sectional, involve the assessment of a specific disorder, and rely on self-report questionnaires. This study aimed to provide a comprehensive psychological assessment to examine the concurrent and prospective association between childhood obesity and mental health problems. We compared 34 children with obesity with 37 children with normal weight at baseline, and at a five-year follow-up, to examine the development of mental health disorders from childhood (8-12 years) to adolescence (13-18 years). Both assessments included a clinical interview and self-reported measures of psychosocial and family markers. Findings showed that the obesity group had a higher prevalence of mental disorders, and psychological comorbidity increased in five years. Prospectively, childhood obesity was associated with a psychological diagnosis in adolescence. Moreover, the obesity group displayed higher severity of symptoms at both times. Finally, body esteem contributed to predicting mental health disorders in adolescence regardless of weight status, while eating symptomatology was a specific marker for the obesity group. Therefore, in the management of childhood obesity is suggested to address also psychosocial variables such as weight-related teasing and body esteem, to prevent the onset or development of mental health problems.
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Affiliation(s)
- Lucia Beltrán-Garrayo
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain.
| | - María Solar
- Research & Development Department, Hogrefe TEA Ediciones, Madrid, Spain
| | - Miriam Blanco
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Montserrat Graell
- Department of Child and Adolescent Psychiatry and Psychology, University Hospital Niño Jesús, Madrid, Spain
| | - Ana Rosa Sepúlveda
- Department of Biological and Health Psychology, Faculty of Psychology, Autonomous University of Madrid, Madrid, Spain
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Romagna EC, Mattos DMF, Lopes KG, Kraemer-Aguiar LG. Screening Risks of Alcohol Abuse, Depressive Symptoms, and Decreased Health-Related Quality of Life in Post-Bariatric Patients and Their Relations to Weight Regain. Obes Surg 2023:10.1007/s11695-023-06605-3. [PMID: 37097429 DOI: 10.1007/s11695-023-06605-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE Not all patients who underwent bariatric surgery keep their regular medical follow-up. We screened alcohol use, depressive symptoms, and health-related quality of life (HRQoL) in post-bariatric patients who have lost medical follow-up at their first appointment in our healthcare unit. These screened disorders were compared between low vs. high ratios of weight regain (RWR) and correlated with surgical outcomes. MATERIAL AND METHODS Ninety-four post-bariatric patients without medical follow-up (87.2% female, aged 42 ± 9 years, BMI = 32.9 ± 6.5kg/m2) were included. They underwent Roux-en-Y gastric bypass (n = 80) or sleeve gastrectomy (n = 14). They were divided into high RWR (≥ 20%) and low RWR (< 20%) groups. We used Alcohol Use Disorders Inventory Test, Beck Depression Inventory, and 36-Item Short-Form Health Survey. RESULTS Neck and waist circumferences, diastolic blood pressure, and time since surgery were higher in the high than low RWR group (P≤ 0.05). No differences between groups for alcohol use and depressive symptoms were detected (P≥ 0.07), but those who regained more weight exhibited poorer health scores in physical functioning, physical role limitations, bodily pain, and vitality (P≤ 0.05). In the low RWR group, the RWR was inversely correlated to physical/social functioning and vitality. Positive associations were present between RWR vs. depressive symptoms, while negative ones were noted to physical functioning and general health perception in the high RWR group. CONCLUSIONS HRQoL has deteriorated in those post-bariatric patients without medical follow-up who regained more weight, possibly indicating the need for regular long-term health care.
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Affiliation(s)
- Eline Coan Romagna
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Diogo Menezes Ferrazani Mattos
- MídiaCom / Postgraduate Program on Electrical and Telecommunications Engineering (PPGEET), Fluminense Federal University, Niteroi, RJ, Brazil
| | - Karynne Grutter Lopes
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Luiz Guilherme Kraemer-Aguiar
- Postgraduate Program in Clinical and Experimental Physiopathology, Faculty of Medical Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Obesity Unit, Centro de Pesquisas Clínicas Multiusuário (CePeM), Hospital Universitário Pedro Ernesto (HUPE), State University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil.
- Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Rio de Janeiro, Boulevard 28 de setembro, 77, Vila Isabel, Rio de Janeiro, RJ, Brazil.
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Wen X, Britton M, Cohen S. Sampling and data missingness in Almandoz et al. Obesity (Silver Spring) 2023; 31:889. [PMID: 36863770 DOI: 10.1002/oby.23694] [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: 10/28/2022] [Accepted: 11/08/2022] [Indexed: 03/04/2023]
Affiliation(s)
- Xiaoxiao Wen
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Mark Britton
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Scott Cohen
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
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Brunault P, Bourbao-Tournois C, Ballon N, de Luca A. Psychiatric, psychological and addiction management in obesity surgery: Early identification for better support. J Visc Surg 2023; 160:S22-S29. [PMID: 36725454 DOI: 10.1016/j.jviscsurg.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Although bariatric surgery results in a significant weight reduction and an improvement in the quality of life in most people who undergo surgery, there are inter-individual differences in terms of postoperative results. Psychological, psychiatric and addictive disorders contribute substantially to these difficulties. Between 20% and 50% of bariatric surgery candidates have a current psychiatric/addictive disorder and approximately 30-75% have a history of a psychiatric/addictive disorder within their lifetime. Surgery is accompanied in the short-term by an improvement in depressive symptoms and binge eating, but these symptoms tend to increase again beyond the 3rd postoperative year. Over the long-term, only the improvement in depression remains durable, whilepostoperative anxiety and disordered eating symptoms do not differ significantly from the preoperative levels. There is a two to four fold increased risk of post-surgical suicide and suicide attempts (from the 1st postoperative year onward), as well as an increased risk of alcohol-abuse (beyond two years after surgery). Psychological support must therefore continue long-term. Several psychotherapeutic and pharmacological treatments have demonstrated their effectiveness in improving the postoperative prognosis of patients with psychological/psychiatric disorders. The early integration of psychological/psychiatric/addiction evaluation and support into multidisciplinary management makes it easier to identify these difficulties and to optimize the postoperative prognosis, both in terms of weight and quality of life. Prior to surgery, patients should be systematically evaluated by a psychologist or psychiatrist in order to identify and to manage disorders that could negatively impact the postoperative prognosis. After surgery, this assessment and support can be carried out in a programmed and systematic way for those patients who were identified preoperatively as the most vulnerable, but support can also be offered during follow-up in the event of specific symptoms (i.e., loss of control over food intake, failure in terms of weight or quality of life, suicidal ideation, loss of control over alcohol use, significant depression or anxiety symptoms).
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Affiliation(s)
- P Brunault
- CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Université de Tours, QualiPsy, EE 1901, Tours, France; Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France.
| | - C Bourbao-Tournois
- Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France; CHRU de Tours, Service de Chirurgie Digestive et Endocrinienne, Tours, France
| | - N Ballon
- CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France; UMR 1253, iBrain, Université de Tours, Inserm, Tours, France; Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France
| | - A de Luca
- Centre Spécialisé pour la prise en charge de l'Obésité sévère, CHRU de Tours, Tours, France; Inserm U1069, Université de Tours, Tours, France; CHRU de Tours, Unité Mobile de Nutrition, Tours, France
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Cigrovski Berkovic M, Bilic-Curcic I, Mrzljak A, Canecki Varzic S, Cigrovski V. Prehabilitation of overweight and obese patients with dysglycemia awaiting bariatric surgery: Predicting the success of obesity treatment. World J Diabetes 2022; 13:1096-1105. [PMID: 36578866 PMCID: PMC9791574 DOI: 10.4239/wjd.v13.i12.1096] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 09/09/2022] [Accepted: 11/03/2022] [Indexed: 12/15/2022] Open
Abstract
Bariatric surgery offers the best health results in overweight and obese patients but is not a risk and/or complication-free treatment. In cases with additional hyperglycemia, the burden of surgery can be even higher and alter both short-term and long-term outcomes. Although bariatric surgery offers glycemic improvements and in the case of early onset diabetes disease remission, weight loss results are lower than for obese patients without diabetes. Different multimodal programs, usually including interventions related to patients’ performance, nutritional and psychological status as well as currently available pharmacotherapy before the surgery itself might considerably improve the immediate and late postoperative course. However, there are still no clear guidelines addressing the prehabilitation of obese patients with dysglycemia undergoing bariatric surgery and therefore no unique protocols to improve patients’ health. In this minireview, we summarize the current knowledge on prehabilitation before bariatric surgery procedures in patients with obesity and dysglycemia.
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Affiliation(s)
- Maja Cigrovski Berkovic
- Department of Endocrinology, Diabetes and Clinical Pharmacology, Clinical Hospital Dubrava, Zagreb 10000, Croatia
- Faculty of Kinesiology, University of Zagreb, Zagreb 10000, Croatia
| | - Ines Bilic-Curcic
- Faculty of Medicine University of Osijek, Osijek 31000, Croatia
- Department of Endocrinology and Diabetes, Clinical Hospital Centre Osijek, Osijek 31000, Croatia
| | - Anna Mrzljak
- Department of Gastroenterology and Hepatology, University Hospital Center Zagreb, Zagreb 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb 10000, Croatia
| | - Silvija Canecki Varzic
- Faculty of Medicine University of Osijek, Osijek 31000, Croatia
- Department of Endocrinology and Diabetes, Clinical Hospital Centre Osijek, Osijek 31000, Croatia
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Paul L, van der Heiden C, van Hoeken D, Deen M, Vlijm A, Klaassen R, Biter LU, Hoek HW. Three- and five-year follow-up results of a randomized controlled trial on the effects of cognitive behavioral therapy before bariatric surgery. Int J Eat Disord 2022; 55:1824-1837. [PMID: 36268671 PMCID: PMC10092022 DOI: 10.1002/eat.23825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 09/29/2022] [Accepted: 09/29/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Up to 37% of bariatric surgery patients suffer from insufficient weight loss or weight regain and mental health symptoms in the longer term. Cognitive behavioral therapy (CBT) may be an effective adjunct intervention to optimize patients' psychological functioning and weight loss results. To examine the value of adding preoperative CBT to bariatric surgery, three- and five-year follow-up data are presented. METHOD In this multi-center randomized controlled trial (RCT; N = 130), a CBT group was compared to a treatment-as-usual (TAU) control group. Measurements were conducted at five time points: pretreatment (T0) and posttreatment/presurgery (T1) and at one- (T2; N = 120), three- (T3; N = 117), and five-year postsurgery (T4; N = 115). The intervention group received a 10-weeks, individual, preoperative CBT focused on self-monitoring, identifying triggers for disordered eating and goal setting for eating behavior and physical exercise, as well as postoperative lifestyle. Outcome measures included weight change, eating behavior, eating disorders, depression, quality of life (QoL), and overall psychological health. RESULTS Preoperative CBT was not associated with better three- and five-year results than TAU regarding weight, dysfunctional eating behaviors, eating disorders, depression, overall psychological health, and QoL. DISCUSSION Contrary to our hypothesis, three- and five-year postsurgery differences between groups regarding weight change and mental health were not significant.. Further exploration suggested that in both groups weight problems and depressive symptoms worsened at three and five-year follow-up. Future research should focus on long-term postoperative monitoring of weight and mood and on associated postoperative interventions and their specific timing. PUBLIC SIGNIFICANCE After bariatric surgery, in the longer term weight problems re-occur in 30% of patients, which is probably partly related to psychopathology. We investigated whether cognitive behavior therapy (CBT) prior to bariatric surgery improved weight maintenance and mental health after surgery. Our study provided definite proof that preoperative CBT is not effective. Long-term postoperative monitoring and prompt psychological intervention after first signs of deterioration, are important to prevent further problems.
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Affiliation(s)
- Linda Paul
- Parnassia Psychiatric Institute, PsyQ, Department of Eating Disorders, Rotterdam, South Holland, The Netherlands.,Parnassia Psychiatric Institute, The Hague, South Holland, The Netherlands
| | - Colin van der Heiden
- Parnassia Psychiatric Institute, The Hague, South Holland, The Netherlands.,Institute of Psychology, Erasmus University, Rotterdam, South Holland, The Netherlands
| | - Daphne van Hoeken
- Parnassia Psychiatric Institute, The Hague, South Holland, The Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, The Hague, South Holland, The Netherlands.,Institute of Psychology, Leiden University, Leiden, South Holland, The Netherlands
| | - Ashley Vlijm
- Parnassia Psychiatric Institute, The Hague, South Holland, The Netherlands
| | - René Klaassen
- Department of Bariatric Surgery, Maasstad Hospital, Rotterdam, South Holland, The Netherlands
| | - L Ulas Biter
- Department of Bariatric Surgery, Franciscus Hospital, Rotterdam, South Holland, The Netherlands
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, South Holland, The Netherlands.,University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, The Netherlands.,Mailman School of Public Health, Department of Epidemiology, Columbia University, New York, New York, USA
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12
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Erden Aki ŞÖ, Yıldız Mİ, Kamış GZ, Aytulun A, Karakaya J, Işıklı S. Relationship of depression, impulsivity, distress intolerance and coping styles with maladaptive eating patterns in bariatric candidates. Eat Weight Disord 2022; 27:3351-3366. [PMID: 35999437 DOI: 10.1007/s40519-022-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/27/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The study aimed to investigate the problematic eating patterns and understand their relationship to psychological constructs, including stress intolerance, coping mechanisms and impulsivity, and psychiatric symptoms among bariatric surgery candidates. METHODS The bariatric candidates were evaluated by psychiatric interview and standard scales assessing maladaptive eating behaviors (Eating Attitudes Test (EAT), Bulimia Investigatory Test-Edinburgh (BITE), Dutch Eating Behavior Questionnaire (DEBQ)), depression (Beck Depression Inventory (BDI)), psychiatric symptoms (Brief Symptom Inventory (BSI)), and psychological constructs (Distress Intolerance Index (DSI), Coping Styles Scale (CSS), UPPS Impulsive Behavior Scale(UPPS)). RESULTS More than half (57.8%) had maladaptive eating behaviors, and 23.6% had binge-eating behavior. Depression and anxiety predicted EAT, BITE, and DEBQ emotional and external eating sub-scale scores; distress intolerance, helpless coping style, and impulsivity predicted maladaptive eating behaviors in bariatric candidates. CONCLUSION Maladaptive eating patterns play an essential role in the failure to lose weight and regain weight and are predicted by depression, anxiety, and psychological constructs in this study. Evaluation of pathological trait characteristics besides discrete psychiatric syndromes should be recommended in the pre-operation process to plan relevant interventions in the long-term management of weight. LEVEL OF EVIDENCE Level III, evidence obtained from well-designed cohort analytic studies.
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Affiliation(s)
| | - M İrem Yıldız
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - G Zuhal Kamış
- Health Ministry of Turkish Republic Ankara City Hospital, Ankara, Turkey
| | - Aslı Aytulun
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sedat Işıklı
- Department of Psychology, Hacettepe University Faculty of Letters, Ankara, Turkey
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Aylward L, Konsor M, Cox S. Binge Eating Before and After Bariatric Surgery. Curr Obes Rep 2022; 11:386-394. [PMID: 36287376 DOI: 10.1007/s13679-022-00486-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The purpose is to review the state of the literature of binge eating in the context of bariatric surgery including prevalence, conceptualization, assessment, course, and related sequela throughout the perioperative continuum, particularly highlighting new advancements and future directions. RECENT FINDINGS Accurate assessment of binge eating in bariatric samples is essential for optimization of patient outcomes. Binge eating is less prevalent after bariatric surgery; however, prevalence rates increase over time. Most studies do not find a relationship between pre-operative binge eating and suboptimal weight outcomes after surgery. Refinement in understanding and conceptualization of post-operative binge eating is needed; new conceptualizations have proposed such a definition. Emerging constructs relevant to binge eating for bariatric patients include food addiction and food insecurity. Despite the introduction of formal diagnostic criteria for binge eating disorder, many uncertainties regarding the prevalence, course, and effects of binge eating currently exist; varied assessment methods continue to be a barrier to research on binge eating in bariatric surgery samples. Consensus on operational definitions for post-operative binge eating and best practices for assessment are areas for future consideration.
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Affiliation(s)
- Laura Aylward
- West Virginia University School of Medicine, Department of Behavioral Medicine and Psychiatry, Morgantown, USA
| | - Madeline Konsor
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Stephanie Cox
- West Virginia University School of Medicine, Department of Behavioral Medicine and Psychiatry, Morgantown, USA.
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Gangopadhyay A, Ibrahim R, Theberge K, May M, Houseknecht KL. Non-alcoholic fatty liver disease (NAFLD) and mental illness: Mechanisms linking mood, metabolism and medicines. Front Neurosci 2022; 16:1042442. [PMID: 36458039 PMCID: PMC9707801 DOI: 10.3389/fnins.2022.1042442] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/21/2022] [Indexed: 09/26/2023] Open
Abstract
Non-alcoholic fatty liver disease (NAFLD) is the most common cause of chronic liver disease in the world and one of the leading indications for liver transplantation. It is one of the many manifestations of insulin resistance and metabolic syndrome as well as an independent risk factor for cardiovascular disease. There is growing evidence linking the incidence of NAFLD with psychiatric illnesses such as schizophrenia, bipolar disorder and depression mechanistically via genetic, metabolic, inflammatory and environmental factors including smoking and psychiatric medications. Indeed, patients prescribed antipsychotic medications, regardless of diagnosis, have higher incidence of NAFLD than population norms. The mechanistic pharmacology of antipsychotic-associated NAFLD is beginning to emerge. In this review, we aim to discuss the pathophysiology of NAFLD including its risk factors, insulin resistance and systemic inflammation as well as its intersection with psychiatric illnesses.
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Affiliation(s)
| | | | | | | | - Karen L. Houseknecht
- Department of Biomedical Sciences, College of Osteopathic Medicine, University of New England, Biddeford, ME, United States
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15
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Abouzed M, Elsherbiny AM, Kamel A, Salama B, Elag KA, Abou Elzahab NF, Abdelkader HR, Altuhayni AS. Relation of Depression and Anxiety Disorders in Choosing Obesity Management in Obese Patients. Int J Prev Med 2022; 13:136. [PMID: 36452465 PMCID: PMC9704478 DOI: 10.4103/ijpvm.ijpvm_102_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 01/25/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Obesity is a chronic medical illness with a higher risk of physical and mental cascade. People who seek obesity treatment were reported to have some psychiatric disorders affecting their disease and selection of management. AIMS OF THE STUDY This study aims to estimate the prevalence of depressive and anxiety disorders in obese patients seeking obesity management and explore the relationship between common psychiatric disorders (depression and anxiety disorders) and selection of the type of obesity management (surgical or non-surgical). METHODS Patients were recruited from Alazhar Universityhospitals, Egypt, and the total number completing the study was 1115 patients. All subjects underwent psychiatric interview through Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (SCID-5 for DSM-5) for diagnosis of psychiatric disorders and completed two questionnaires, Hamilton Rating Scale for Depression (HRSD) and Hamilton Rating Scale for Anxiety (HRSA). RESULTS The prevalences of depressive and anxiety disorders were 29.23% and 25.56%, respectively, in all subjects. The most prevalent diagnoses were dysthymic disorder (20.7%), general anxiety disorder (16.95%), major depressive disorder (13.04%), and social phobia (12.4%). Our sample was divided into two groups (surgical and non-surgical). Dysthymia was more common in the surgical group (21.4% versus 19.8% P = 0.560), whereas major depressive disorder was more common in the non-surgical group (7.4% versus 5.4 P = 0.593); also, the non-surgical group was more likely to have "anxiety disorders" (29.23% versus 22.4%, P = 0.840), but severity of anxiety was higher in the surgical group according to HRSA score with a highly significant difference. CONCLUSIONS A high prevalence of depression and anxiety disorders was found among patients who sought obesity treatment. Severity of anxiety was higher in the surgical group according to HRSA score with a highly significant difference, which may affect selection of treatment, so psychiatric evaluation and management are needed before and after obesity management to improve the outcome.
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Affiliation(s)
- Mohamed Abouzed
- Department of Psychiatry, Cairo Faculty of Medicine, Al-Azhar University, Saudi Arabia,Address for correspondence: Dr. Mohamed Abouzed, Department of Psychiatry, Cairo Faculty of Medicine, Al Azhar University, Egypt. E-mail:
| | - Ashraf M. Elsherbiny
- Department of Psychiatry, Cairo Faculty of Medicine, Al-Azhar University, Saudi Arabia
| | - Ahmed Kamel
- Department of Psychiatry, Cairo Faculty of Medicine, Al-Azhar University, Saudi Arabia
| | - Basem Salama
- Department of Community Medicine, Faculty of Medicine, Al-Azhar University, Egypt and Northern Border University, Saudi Arabia
| | - Khaled A. Elag
- Department of Psychiatry, Faculty of Medicine, Ain Shams University, Saudi Arabia
| | - Nasr F. Abou Elzahab
- Department of Psychiatry, Damietta Faculty of Medicine, Al-Azhar University, Saudi Arabia
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SCL-90 empirical factors predict post-surgery weight loss in bariatric patients over longer time periods. Eat Weight Disord 2022; 27:2845-2855. [PMID: 35829901 PMCID: PMC9556354 DOI: 10.1007/s40519-022-01424-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/16/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE This longitudinal study examined how pre-intervention psychological health helps predict bariatric surgery (BS) success as percentage of expected body mass index loss (%EBMIL) over shorter to longer periods. METHODS Adult candidates for BS (N = 334, 67.4% females) completed the Symptoms Checklist 90 (SCL-90) questionnaire; on average, 11 months occurred between the pre-surgery psychological evaluations and the bariatric intervention. We explored the factor structure of the SCL-90 items and inspected how SCL-90 empirical factors compared with SCL-90 scales and general indices predicted %EBMIL at 3-6-month, 1-year, and 2-year follow-up occasions, adjusting for gender, pre-intervention use of antidepressants and actual and ideal BMIs. RESULTS Factor analysis combined the 90 items into 8 factors, which partially replicated the expected item structure. The SCL-90 empirical factors (but not the SCL-90 scales and indices) contributed to predict BS success. In fact, the Relational Distress factor directly protected from weight regain at 1-year follow-up, indirectly via 1-year %EBMIL at the 2-year follow-up, when it further strengthened the impact of the empirical factor of Generalized Anxiety on the 2-year BS outcome. The results also evidenced a cascade effect of the pre-surgery actual BMI across time as well as unique and direct effects of pre-surgery use of antidepressants and perceived ideal BMI on the 2-year outcome. CONCLUSIONS SCL-90 empirical factor scores for obese patients are more efficient in anticipating BS success compared with original scale scores. They reveal that relational distress and anxiety are risk factors for postoperative weight loss, in addition to pre-intervention actual BMI, antidepressant therapy, and perceived ideal BMI. LEVEL OF EVIDENCE III, well-designed cohort.
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Rego de Figueiredo I, Carvalho Vasques M, Cunha N, Martins D, Silva-Nunes J. Quality of Life in Obese Patients from a Multidisciplinary Bariatric Consultation: A Cross-Sectional Study Comparing to a Non-Bariatric Population and to the General Population. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12029. [PMID: 36231331 PMCID: PMC9564586 DOI: 10.3390/ijerph191912029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/13/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Obesity is a chronic disease defined by a body mass index of ≥30 kg/m2, which can result in a decrease in quality of life (QoL). Our study aim was to assess the QoL of an obese population of bariatric surgery (BS) candidates, and to compare it to both that of a non-bariatric obese population (C) and that of the general population. This was a cross-sectional study using: (1) the EQ-5D-3L instrument: comparing BS with the C population and with the Portuguese general population; and (2) the Bariatric Quality of Life (BQL) Index: comparing the two groups of obese patients. We included 228 BS and 68 C obese patients. BS patients had higher BMI (44 ± 6 kg/m2 vs. 41 ± 6.5 kg/m2; p < 0.001), higher waist circumference (130 ± 13 cm vs. 123 ± 17 cm; p = 0.03), and higher total body fat mass (49.9 ± 6.7% vs. 45 ± 6.7%; p < 0.001). QoL as evaluated by EQ-5D-3L was similar, but the BQL index showed lower QoL in BS patients (40.9 ± 8.9 vs. 44.2 ± 11.2; p = 0.01). Compared to the Portuguese general population, BS patients had lower QoL (VAS: 55 ± 19 vs. 74.9; p < 0.001; index: 0.33 ± 0.2 vs. 0.76; p < 0.001). Despite higher adiposity in the BS group, QoL was similar between the groups by EQ-5D-3L. Nevertheless, there was a decrease in the QoL for the BS patients as determined using the BQL, a tool with higher sensitivity to bariatric patients.
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Affiliation(s)
- Inês Rego de Figueiredo
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- Transplantation Unit, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, New University of Lisbon/Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
| | - Miguel Carvalho Vasques
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, New University of Lisbon/Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
| | - Nelson Cunha
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
| | - Diana Martins
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, New University of Lisbon/Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
| | - José Silva-Nunes
- Multidisciplinary Unit for Bariatric and Metabolic Surgery, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- NOVA Medical School/Faculdade de Ciencias Medicas, New University of Lisbon/Universidade Nova de Lisboa, 1169-056 Lisbon, Portugal
- Department of Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário Lisboa Central, 1069-166 Lisbon, Portugal
- Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, 1990-096 Lisbon, Portugal
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Hilbert A, Staerk C, Strömer A, Mansfeld T, Sander J, Seyfried F, Kaiser S, Dietrich A, Mayr A. Nonnormative Eating Behaviors and Eating Disorders and Their Associations With Weight Loss and Quality of Life During 6 Years Following Obesity Surgery. JAMA Netw Open 2022; 5:e2226244. [PMID: 35951326 PMCID: PMC9372790 DOI: 10.1001/jamanetworkopen.2022.26244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Individuals with severe obesity presenting for obesity surgery (OS) frequently show nonnormative eating behaviors (NEBs) and eating disorders (EDs), but the long-term course and prospective associations with weight loss and health-related quality of life (HRQOL) remain unclear. OBJECTIVE To examine the prevalence and prospective relevance of presurgical and postsurgical NEBs and EDs according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, diagnosed through clinical interview, for weight loss and HRQOL up to 6 years following OS. DESIGN, SETTING, AND PARTICIPANTS In the prospective, multicenter Psychosocial Registry for Obesity Surgery cohort study, patients seeking OS were recruited at 6 OS centers in Germany and assessed at baseline before surgery and at 6 months and 1 to 6 years after surgery. From a consecutive sample of 1040 volunteers with planned OS from March 1, 2012, to December 31, 2020, a total of 748 (71.92%) were included in this study. Across follow-up, 93 of the 748 patients (12.43%) dropped out. Data were analyzed from April to November 2021. INTERVENTIONS Laparoscopic Roux-en-Y gastric bypass or sleeve gastrectomy. MAIN OUTCOMES AND MEASURES Both NEBs and EDs were identified using the Eating Disorder Examination interview. Main outcomes were the percentage of total body weight loss (%TBWL) and HRQOL (Impact of Weight on Quality of Life-Lite; range, 0-100, with 0 indicating worst and 100 indicating best). RESULTS In 748 patients undergoing OS (mean [SD] age, 46.26 [11.44] years; mean [SD] body mass index [calculated as weight in kilograms divided by height in meters squared], 48.38 [8.09]; 513 [68.58%] female), the mean (SD) %TBWL was 26.70% (9.61%), and the mean (SD) HRQOL improvement was 35.41 (20.63) percentage points across follow-up. Both NEBs and EDs were common before surgery, with postsurgical improvements of varying degrees. Whereas NEBs and EDs did not reveal significant prospective associations with %TBWL, loss-of-control eating at follow-up was concurrently associated with lower %TBWL (estimate, -0.09; 95% CI, -0.14 to -0.04). Loss-of-control eating (estimate, -0.10; 95% CI, -0.17 to -0.03 percentage points) and binge-eating disorder of low frequency and/or limited duration (estimate, -6.51; 95% CI, -12.69 to -0.34 percentage points) at follow-up showed significant prospective associations with lower HRQOL. CONCLUSIONS AND RELEVANCE This cohort study found prospective relevance of loss-of-control eating and binge-eating disorder of low frequency and/or limited duration for reduced long-term HRQOL following OS. These findings underline the importance of monitoring both NEBs, especially loss-of-control eating, and EDs in the long term postsurgically to identify patients in need of targeted prevention or psychotherapy.
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Affiliation(s)
- Anja Hilbert
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
| | - Christian Staerk
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
- Department of Medical Biometrics, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Annika Strömer
- Integrated Research and Treatment Center AdiposityDiseases, Behavioral Medicine Research Unit, Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig Medical Center, Leipzig, Germany
- Department of Medical Biometrics, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
| | - Thomas Mansfeld
- Department of General Surgery, Asklepios Clinic, Hamburg, Germany
| | - Johannes Sander
- Schön Klinik Hamburg Eilbek, Obesity Clinic, Hamburg, Germany
| | - Florian Seyfried
- Department of General, Visceral, Transplant, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefan Kaiser
- Department of Visceral, Pediatric and Vascular Surgery, Hospital Konstanz, Konstanz, Germany
| | - Arne Dietrich
- Department of Surgery, Clinic for Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Andreas Mayr
- Department of Medical Biometrics, Informatics and Epidemiology, University Hospital Bonn, Bonn, Germany
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Di Natale C, Lucidi L, Montemitro C, Pettorruso M, Collevecchio R, Di Caprio L, Giampietro L, Aceto L, Martinotti G, Giannantonio MD. Gender Differences in the Psychopathology of Obesity: How Relevant Is the Role of Binge Eating Behaviors? Brain Sci 2022; 12:brainsci12070955. [PMID: 35884761 PMCID: PMC9321462 DOI: 10.3390/brainsci12070955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/15/2022] [Accepted: 07/19/2022] [Indexed: 12/10/2022] Open
Abstract
Background: Obesity is a condition that affects humans both physically and mentally. Moreover, many psychopathological conditions can be observed in obese patients that may threaten the positive outcomes of bariatric surgery. Purpose: The aim of this study was to identify the main psychopathological correlates of obese candidates for bariatric surgery, with particular attention on the relationship between psychopathology and gender. Methods: In total, 273 candidates for bariatric surgery for obesity underwent a psychiatric evaluation using a compilation of psychometric scales: the Revised Symptom Checklist 90-R (SCL-90-R), the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale (BES), the Body Uneasiness Test (BUT) and the Obesity-Related Well-Being (ORWELL 97). The sample was divided on the basis of gender and binge eating disorder (BED) severity. Comparisons between the groups were performed using an analysis of variance model (ANOVA) or a Pearson’s chi-squared test. Further, we also divided our sample into a severe binge eating group (score > 27), a mild to moderate group (18 < score < 26) and a low/no symptoms group (score < 17). Results: Male and female subjects showed different results for the BES, with higher scores reported among women (17.50 ± 9.59) compared to men (14.08 ± 8.64). Women also showed higher scores across most of the SCL-90-R domains and worse outcomes in terms of quality of life. Both women and men in the severe binge eating group reported higher scores for the SCL-90-R. Conclusion: The symptoms of BED, along with body image dissatisfaction (BID), are among the most important to investigate for candidates for bariatric surgery in order to improve the surgery outcomes. Level of evidence: Level III as the evidence came from a cohort analytic study.
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Affiliation(s)
- Chiara Di Natale
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.D.N.); (C.M.); (M.P.); (R.C.); (G.M.); (M.d.G.)
| | - Lorenza Lucidi
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.D.N.); (C.M.); (M.P.); (R.C.); (G.M.); (M.d.G.)
- Correspondence:
| | - Chiara Montemitro
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.D.N.); (C.M.); (M.P.); (R.C.); (G.M.); (M.d.G.)
| | - Mauro Pettorruso
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.D.N.); (C.M.); (M.P.); (R.C.); (G.M.); (M.d.G.)
| | - Rebecca Collevecchio
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.D.N.); (C.M.); (M.P.); (R.C.); (G.M.); (M.d.G.)
| | - Lucia Di Caprio
- Psychiatry Department, Madonna del Soccorso Hospital, 63074 San Benedetto del Tronto, Italy;
| | - Luana Giampietro
- Psychiatry Department, SS. Annunziata Hospital, 66100 Chieti, Italy;
| | - Liberato Aceto
- Obesity Surgery Center, SS. Annunziata Hospital, 66100 Chieti, Italy;
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.D.N.); (C.M.); (M.P.); (R.C.); (G.M.); (M.d.G.)
- Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire, Hatfield AL10, UK
| | - Massimo di Giannantonio
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University, 66100 Chieti, Italy; (C.D.N.); (C.M.); (M.P.); (R.C.); (G.M.); (M.d.G.)
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Obesity and Psychological Factors Associated with Weight Loss after Bariatric Surgery: A Longitudinal Study. Nutrients 2022; 14:nu14132690. [PMID: 35807869 PMCID: PMC9268521 DOI: 10.3390/nu14132690] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023] Open
Abstract
Bariatric surgery is indicated for treatment of severely obese people and can lead to significant weight loss as well as reduction of comorbidities associated with obesity. The present study aims to investigate the relationship between different psychological factors (e.g., tendency to binge eating, impulsivity, alexithymia), adherence to the nutritional plan, and weight loss after bariatric surgery. Forty-five candidates for bariatric surgery accessing a center for the care of obesity were assessed at T0 (pre-surgery) and T1 (6 months post-surgery) through anthropometric and psychometric measures. Simple linear correlations and linear regressions were conducted to evaluate the relationship between the psychological variables, adherence to nutritional plan, and weight loss 6 months after bariatric surgery. Non-planning impulsivity was the principal factor that succeeded in explaining adherence to the diet plan among all the variables considered. Adherence to the nutritional plan and non-planning impulsivity were considered reliable short-term predictors of weight loss after bariatric surgery. This evidence explains the usefulness of promoting research on psychological predictors of outcome in bariatric surgery. Mid- and long-term weight maintenance and quality of life need to be investigated through further follow-up.
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Athinarayanan SJ, Adams RN, VanTieghem M, McKenzie AL, Volk BM, Ratner RE, Phinney SD. Impact of the COVID-19 Pandemic on the Effectiveness of a Metabolic Health Telemedicine Intervention for Weight Loss: A Propensity Score Matching Analysis. Front Public Health 2022; 10:897099. [PMID: 35784202 PMCID: PMC9246258 DOI: 10.3389/fpubh.2022.897099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/09/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundCoronavirus disease 2019 (COVID-19) pandemic public health measures such as stay-at-home and mandatory work-from-home orders have been associated with obesogenic lifestyle changes, increased risk of weight gain, and their metabolic sequelae. We sought to assess the impact of this pandemic on weight loss from a telemedicine-delivered very-low-carbohydrate intervention targeting nutritional ketosis (NKI).MethodsA total of 746 patients with a BMI ≥25kg/m2, enrolled between January and March 2020 and treated for at least 1 year with the NKI, were classified as pandemic cohort (PC). A separate cohort of 699 patients who received 1 year of the NKI in the preceding years, enrolled between January and March 2018, were identified as pre-pandemic cohort (Pre-PC). Demographic and clinical data were obtained from medical records to compare the cohorts and assess the outcomes. Using propensity score matching (PSM), balanced and matched groups of 407 patients in the Pre-PC and 407 patients in the PC were generated. Longitudinal change in absolute weight and percentage weight change from baseline to 1 year were assessed.ResultsWeight significantly decreased in both PC and Pre-PC at 3, 6, 9, and 12 months. The weight loss trajectory was similar in both PC and Pre-PC with no significant weight differences between the two cohorts at 3, 6, 9, and 12 months. On an average, the PC lost 7.5% body weight while the Pre-PC lost 7.9% over 1 year, and the percent weight loss did not differ between the two cohorts (p = 0.50).ConclusionA very-low-carbohydrate telemedicine intervention delivered comparable and medically significant weight loss independent of pandemic stress and lifestyle limitations.
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Barbuti M, Brancati GE, Calderone A, Fierabracci P, Salvetti G, Weiss F, Carignani G, Santini F, Perugi G. Prevalence of mood, panic and eating disorders in obese patients referred to bariatric surgery: patterns of comorbidity and relationship with body mass index. Eat Weight Disord 2022; 27:1021-1027. [PMID: 34137006 PMCID: PMC8964582 DOI: 10.1007/s40519-021-01236-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 05/31/2021] [Indexed: 12/14/2022] Open
Abstract
PURPOSE We aimed at investigating the lifetime prevalence of mood, eating and panic disorders in a large sample of obese patients referred to bariatric surgery. We also explored the patterns of psychiatric comorbidity and their relationship with Body Mass Index (BMI). METHODS The sample was composed of patients consecutively referred for pre-surgical evaluation to the Obesity Center of Pisa University Hospital between January 2004 and November 2016. Clinical charts were retrieved and examined to obtain sociodemographic information, anthropometric variables and lifetime psychiatric diagnoses according to DSM-IV criteria. RESULTS A total of 871 patients were included in the study; 72% were females, and most patients had BMI ≥ 40 kg/m2 (81%). Overall, 55% of the patients were diagnosed with at least one lifetime psychiatric disorder. Binge eating disorder (27.6%), major depressive disorder (16%), bipolar disorder type 2 (15.5%), and panic disorder (16%) were the most common psychiatric diagnoses. Mood disorders showed associations with panic disorder (OR = 2.75, 95% CI = 1.90-3.99, χ2 = 41.85, p = 0.000) and eating disorders (OR = 2.17, 95% CI 1.64-2.88, χ2 = 55.54, p = 0.000). BMI was lower in patients with major depressive disorder (44.9 ± 7.89) than in subjects without mood disorders (46.75 ± 7.99, padj = 0.017). CONCLUSION Bariatric patients show high rates of psychiatric disorders, especially binge eating and mood disorders. Longitudinal studies are needed to explore the possible influence of such comorbidities on the long-term outcome after bariatric surgery. LEVEL OF EVIDENCE V, cross sectional descriptive study.
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Affiliation(s)
- Margherita Barbuti
- Psychiatry 2 Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italia
| | - Giulio E Brancati
- Psychiatry 2 Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italia
| | - Alba Calderone
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Pisa, Italy
| | - Paola Fierabracci
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Pisa, Italy
| | - Guido Salvetti
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Pisa, Italy
| | - Francesco Weiss
- Psychiatry 2 Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italia
| | - Giulia Carignani
- Psychiatry 2 Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italia
| | - Ferruccio Santini
- Endocrinology Unit, Department of Clinical and Experimental Medicine, Obesity and Lipodystrophy Research Center, University Hospital of Pisa, Pisa, Italy
| | - Giulio Perugi
- Psychiatry 2 Unit, Department of Clinical and Experimental Medicine, University Hospital of Pisa, Via Savi 10, 56126, Pisa, Italia.
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Mejaddam A, Krantz E, Höskuldsdóttir G, Fändriks L, Mossberg K, Eliasson B, Trimpou P, Landin-Wilhelmsen K. Comorbidity and quality of life in obesity-a comparative study with the general population in Gothenburg, Sweden. PLoS One 2022; 17:e0273553. [PMID: 36194568 PMCID: PMC9531784 DOI: 10.1371/journal.pone.0273553] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 08/11/2022] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Obesity is considered to have a detrimental impact on health-related quality of life (HRQoL). OBJECTIVE To compare HRQoL in a well-defined group of people with obesity with a population-based control group from the general public. DESIGN Observational cross-sectional cohort study with a reference population. SETTING The Regional Obesity Center at the Department of Medicine at Sahlgrenska University Hospital, Gothenburg, Sweden. PARTICIPANTS People with obesity (n = 1122) eligible for surgical and non-surgical obesity treatment in routine care were included consecutively between 2015 and 2017 into the BASUN study. Men and women from the WHO-MONICA-GOT project were used as a reference population (n = 414). MAIN OUTCOME MEASURES HRQoL was measured with the RAND-36/Short Form-36 questionnaire (SF-36) and a Visual Analogue Scale (VAS) for self-related health (SRH). Prescription drugs for hypertension, diabetes mellitus, depression, and anxiety were taken as a proxy for these conditions. RESULTS People with obesity rated their overall HRQoL lower than the reference population according to the SRH-VAS. Lower scores were reported on physical and social functioning, vitality, general and mental health after adjustment for age and use of prescription drugs (considered a proxy for burden of disease, or comorbidities) using the RAND-36/SF-36 questionnaire. Use of some psychopharmacological agents was more common in patients with obesity. CONCLUSION People with obesity seeking help with weight reduction are more likely to have lower physical and mental self-reported HRQoL than the general population.
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Affiliation(s)
- Ala Mejaddam
- Department of Internal Medicine, Sahlgrenska University Hospital/Östra, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- * E-mail:
| | - Emily Krantz
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Gothenburg, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gudrún Höskuldsdóttir
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lars Fändriks
- Department of Surgery, Institution for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Mossberg
- Department of Public Health and Community Medicine Primary Health Care, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Eliasson
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Penelope Trimpou
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Landin-Wilhelmsen
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Gothenburg, Sweden
- Section for Endocrinology and Diabetology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Akkuş ÖÖ, Atalay BG, Parlak E. COVID 19 Pandemic: Changes in the emotions, body weights and nutrition habits of individuals during social intervention measures. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2021. [DOI: 10.3233/mnm-210006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: During the Covid 19 pandemic, the increase in the anxiety levels of individuals is associated with the increase in body weight. OBJECTIVE: To evaluate the effects of changes in individuals’ experiences and mood on eating habits and body weights in during social restrictions due to COVID-19. METHODS: The study included 623 adults in Turkey. Demographic characteristics, anthropometric measurements, information about nutritional habits during the pandemic period were questioned via an online survey. The Beck Depression Inventory (BDI) was used to evaluate individuals’ negative perspectives. RESULTS: The rate of patients who experienced body weight changes during the pandemic period was 61.4% (40.2% experienced increase), the mean BDI value was found to be higher in individuals whose body weight increased/decreased compared to those who experienced no change in body weight (p = 0.008, p = 0.02, respectively). Variables that positively affected the BDI scores, which was performed in individuals with increased body weight, main meal numbers (p < 0.03), and change in dried fruit consumption (p = 0.05). The variables that negatively affected the BDI scores were body weight increase (p = 0.05) and changes in cheese consumption. CONCLUSIONS: We found that the changes in the emotional state during COVID-19 had an effect on dietary habits and body weight. There is a need for more comprehensive randomized studies on the interaction between lifestyle changes during the social intervention period due to the Covid 19 epidemic, quality of life, emotional state and eating habits.
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Affiliation(s)
| | | | - Eda Parlak
- Toros University, Nutrition and Dietetic Department, Mersin, Turkey
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25
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The Assessment of Food Addiction and the Yale Food Addiction Scale in Bariatric Surgery Populations. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Food addiction (FA) appears among bariatric weight loss surgery candidates who struggle to control the intake of hyperpalatable/refined foods have high rates of psychopathology and related health problems. Despite this, prevalence rates of FA in the bariatric sector are reported as low or variable. We investigated the prevalence of FA and the applicability of conventionally used metrics for 166 pre-surgery candidates from a weight management centre (USA) and a major metropolitan hospital (Australia). Self-report measures assessed FA (Yale Food Addiction Scale (YFAS)), body mass index (BMI), disordered eating, addictive personality, psychopathology, and diet. Consistent with prior research, standard YFAS scoring, requiring the endorsement of a distress/impairment (D/I) criterion (FA + D/I), yielded a FA prevalence rate of 12.7%, compared to 37.3% when D/I was omitted (FA − D/I). We compared profiles for those with FA using each scoring method against those ‘without’, who did not meet a minimum of three YFAS symptoms (non-FA ≤ 2). Both methods differentiated those with and without FA on addictive traits, disordered eating and hyperpalatable food consumption. Only FA + D/I differentiated markers of psychological distress or impairment, including depression, anxiety and quality of life. Results indicate a need for further FA research in bariatric settings.
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26
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The psychological impact of COVID-19 pandemic on patients included in a bariatric surgery program. Eat Weight Disord 2021; 26:1737-1747. [PMID: 32857287 PMCID: PMC7453189 DOI: 10.1007/s40519-020-00988-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/10/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The COVID-19 pandemic has radically impacted the world lifestyle. Epidemics are well-known to cause mental distress, and patients with a current or past history of obesity are at increased risk for the common presence of psychological comorbidities. This study investigates the psychological impact of the current pandemic in patients participating in a bariatric surgery program. METHODS Patients were consecutively enrolled during the Italian lockdown among those waiting for bariatric surgery or attending a post-bariatric follow-up, and were asked to complete through an online platform the Depression Anxiety Stress Scales-21 and a self-assessment questionnaire of 22 items evaluating the resilience, change in eating behavior and emotional responses referring to the ongoing pandemic. RESULTS 59% of the 434 enrolled subjects reported of being worried about the pandemic, and 63% specifically reported of being worried about their or their relatives' health. 37% and 56% felt lonelier and more bored, respectively. 66% was hungrier with increased frequency of snacking (55%) and 39% reported more impulse to eat. Noteworthy, 49% felt unable to follow a recommended diet. No difference in terms of psychological profile was recorded among pre and post-bariatric subjects. Logistic regression analysis on post-bariatric patients showed a relationship between snacking, hunger, eating impulsivity, and anxiety, stress, and/or depression symptoms. CONCLUSION The pandemic led to increased psychological distress in patients with a current or past history of obesity, reducing quality of life and affecting dietary compliance. Targeted psychological support is warranted in times of increased stress for fragile subjects such as pre- and post-bariatric patients. LEVEL OF EVIDENCE Level V: cross-sectional descriptive study.
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27
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Herb Neff KM, Schuh LM, Saules KK, Creel DB, Stote JJ, Schuh KM, Inman M. Psychological Functioning and Health Behaviors Associated with Weight Loss Patterns up to 13.7 Years After Weight Loss Surgery. J Clin Psychol Med Settings 2021; 28:833-843. [PMID: 34324141 DOI: 10.1007/s10880-021-09807-y] [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] [Accepted: 07/13/2021] [Indexed: 01/22/2023]
Abstract
Weight loss surgery produces dramatic health improvements immediately after surgery, including rapid declines in diabetes. However, less is known about its long-term effects. 124 St. Vincent Bariatric Center patients completed questionnaires on weight and psychological functioning a mean of 7.7 and 13.7 years post-surgery (T1 and T2, respectively). Because mean weight data may mask differing weight trajectories, participants were categorized based on weight over time. Most participants underwent Roux-En-Y gastric bypass (90.3%) and were Caucasian (96%), female (81.5%), and married (69.1%). Mean age at T2 was 64; mean %EWL was 64.9%. Most patients fit into one of three weight change patterns, reaching weight nadir, and regaining by T1 and then, by T2, experiencing (1) Weight Loss (n = 36), (2) Weight Maintenance (n = 37), or (3) Continued Weight Gain (n = 39). Groups differed significantly on body satisfaction, weighing frequency, and conscientiousness, with Weight Gainers significantly lower than other groups on conscientiousness and body satisfaction, and Weight Losers reporting higher frequency of weighing than Maintainers. Bariatric patients can maintain substantial weight loss and positive psychological functioning for many years post-surgery, although weight regain is associated with less body satisfaction. Conscientiousness may signify medical adherence, whereas frequent weighing may be a behavior that promotes ongoing weight loss.
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Affiliation(s)
| | - Leslie M Schuh
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA
| | - Karen K Saules
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA. .,Community Behavioral Health Clinic, Eastern Michigan University, 1075 North Huron River Drive, Ypsilanti, MI, 48197, USA.
| | - David B Creel
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA.,Cleveland Clinic, Cleveland, OH, USA
| | - Joseph J Stote
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA
| | - Kristen M Schuh
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA.,Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Margaret Inman
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA
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28
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Depression, anxiety, and suicidal ideation in young adults 5 years after undergoing bariatric surgery as adolescents. Eat Weight Disord 2021; 26:1211-1221. [PMID: 33079376 PMCID: PMC8062317 DOI: 10.1007/s40519-020-01024-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/16/2020] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Metabolic and bariatric surgery (MBS) is increasingly used in adolescents. The aim was to explore symptoms of depression and anxiety in young adults over 5 years' follow-up after undergoing MBS. METHODS Beck Depression Inventory-2 and the Beck Anxiety Inventory were used to assess symptoms of depression and anxiety in 62 patients 1, 2, and 5 years after having Roux-en-Y gastric bypass at 13-18 years of age. Mental health, eating-related problems, and weight outcomes were tested for association with suicidal ideation at the 5-year follow-up. RESULTS At the 5-year follow-up, the mean score for depression was 11.4 (± 12.4), indicating minimal symptoms of depression. The mean score for anxiety was 12.82 (± 11.50), indicating mild anxiety symptoms. Still, several participants reported moderate or severe symptoms of depression (26%) and anxiety (32%). Women reported more symptoms than men (P = 0.03 and 0.04). No significant changes were found in self-reported symptoms of depression and anxiety between the 1-year and the 5-year follow-up (P = 0.367 and 0.934). Suicidal ideation was reported by 16% at the 5-year follow-up. Participants reporting suicidal ideation had lost significantly less excess weight than participants without suicidal ideation (P = 0.009). CONCLUSION Five years after adolescent MBS, a substantial minority still struggles with mental health issues, and women are more burdened than men. Our results indicate an association between less optimal weight loss and suicidal ideation 5 years after MBS. The findings emphasize the importance of offering long-term follow-up and mental health treatment several years after MBS. LEVEL OF EVIDENCE Level III, cohort study. CLINICAL TRIAL REGISTRATION The study is registered with ClinicalTrials.gov (NCT00289705). First posted February 10, 2006.
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29
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Mellinger JL, Shedden K, Winder GS, Fernandez AC, Lee BP, Waljee J, Fontana R, Volk ML, Blow FC, Lok ASF. Bariatric surgery and the risk of alcohol-related cirrhosis and alcohol misuse. Liver Int 2021; 41:1012-1019. [PMID: 33529460 PMCID: PMC8204517 DOI: 10.1111/liv.14805] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/29/2020] [Accepted: 01/26/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Bariatric surgery is common, but alcohol misuse has been reported following these procedures. We aimed to determine if bariatric surgery is associated with increased risk of alcohol-related cirrhosis (AC) and alcohol misuse. METHODS Retrospective observational analysis of obese adults with employer-sponsored insurance administrative claims from 2008 to 2016. Subjects with diagnosis codes for bariatric surgery were included. Primary outcome was risk of AC. Secondary outcome was risk of alcohol misuse. Bariatric surgery was divided into before 2008 and after 2008 to account for patients who had a procedure during the study period. Cox proportional hazard regression models using age as the time variable were used with interaction analyses for bariatric surgery and gender. RESULTS A total of 194 130 had surgery from 2008 to 2016 while 209 090 patients had bariatric surgery prior to 2008. Age was 44.1 years, 61% women and enrolment was 3.7 years. A total of 4774 (0.07%) had AC. Overall risk of AC was lower for those who received sleeve gastrectomy and laparoscopic banding during the study period (HR 0.4, P <.001; HR 0.43, P =.02) and alcohol misuse increased for Roux-en-Y and sleeve gastrectomy recipients (HR 1.86 and 1.35, P <.001, respectively). In those who had surgery before 2008, women had increased risk of AC and alcohol misuse compared to women without bariatric surgery (HR 2.1 [95% CI: 1.79-2.41] for AC; HR 1.98 [95% CI 1.93-2.04]). CONCLUSIONS Bariatric surgery is associated with a short-term decreased risk of AC but potential long-term increased risk of AC in women. Post-operative alcohol surveillance is necessary to reduce this risk.
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Affiliation(s)
- Jessica L. Mellinger
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Kerby Shedden
- Department of Statistics, University of Michigan, Ann Arbor, MI
| | | | | | | | - Jennifer Waljee
- Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Robert Fontana
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
| | - Michael L. Volk
- Transplantation Institute, Loma Linda University Health, Loma Linda CA
| | - Frederic C. Blow
- Department of Psychiatry, Ann Arbor, MI,VA Center for Clinical Management Research (CCMR), Ann Arbor, MI
| | - Anna SF Lok
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI
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30
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Geerts MM, van den Berg EM, van Riel L, Peen J, Goudriaan AE, Dekker JJM. Behavioral and psychological factors associated with suboptimal weight loss in post-bariatric surgery patients. Eat Weight Disord 2021; 26:963-972. [PMID: 32472495 DOI: 10.1007/s40519-020-00930-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 05/14/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE Bariatric surgery is the most effective long-term treatment for sustained weight loss in obesity. Studies have shown that not all patients lose the expected amount of weight. The aim of this study was to develop a better understanding of which behavioral and psychological factors are associated with suboptimal weight loss. METHODS The present paper describes a cross-sectional study that included 140 participants. The mean follow-up period after bariatric surgery was 3.16 years. Eating disorder pathology (Eating Disorder Examination-Questionnaire), impulsivity (Barratt Impulsiveness scale-II) and depressive symptoms (Beck Depression Inventory) were compared with successful and suboptimal participants. A weight loss of more than or equal to 50% of excess weight, was considered to be successful. RESULTS More than 81% of the participants met the criterion for successful weight loss. The suboptimal weight loss group reported more symptoms of eating disorder pathology (p = .001), more loss of control over eating (p = .001), and more avoidant behavior due to poor body image (p < .001). The suboptimal weight loss group scored higher on impulsivity (p = .007) and on depression (p < .001). More early weight loss was associated with better weight outcome later on (r = .491). Reporting more eating disorder pathology, a longer follow-up period and pre-operative super-obesity (body mass index ≥ 50 kg/m2) at the time of surgery were associated with poorer weight loss (p < .001). CONCLUSION Eating disorder pathology, loss of control over eating and avoidant behavior due to poor body image, as well as depressive symptoms and impulsivity, (as reported postoperatively) are associated with suboptimal weight loss. Level III: Case-control analytic study.
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Affiliation(s)
- Marjolein M Geerts
- Novarum, Center for Eating Disorders and Obesity, Jacob Obrechtstraat 92, 1071 KR, Amsterdam, The Netherlands.
| | - Elske M van den Berg
- Novarum, Center for Eating Disorders and Obesity, Jacob Obrechtstraat 92, 1071 KR, Amsterdam, The Netherlands
| | - Laura van Riel
- Novarum, Center for Eating Disorders and Obesity, Jacob Obrechtstraat 92, 1071 KR, Amsterdam, The Netherlands
| | - Jaap Peen
- Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
| | - Anna E Goudriaan
- Novarum, Center for Eating Disorders and Obesity, Jacob Obrechtstraat 92, 1071 KR, Amsterdam, The Netherlands.,Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Jack J M Dekker
- Arkin, Klaprozenweg 111, 1033 NN, Amsterdam, The Netherlands
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Sarwer DB, Heinberg LJ. A review of the psychosocial aspects of clinically severe obesity and bariatric surgery. ACTA ACUST UNITED AC 2021; 75:252-264. [PMID: 32052998 DOI: 10.1037/amp0000550] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
For the past 2 decades, clinically severe obesity (operationalized as a body mass index ≥40 kg/m2) has increased at a more pronounced rate that less severe obesity. As a result, the surgical treatment of obesity (bariatric surgery) has become a more widely accepted, yet still underutilized, treatment for persons with severe obesity and significant weight-related health problems. Psychologists play a central role on the multidisciplinary team involved in the preoperative assessment and postoperative management of patients. They also have played a central role in clinical research which has enhanced understanding of the psychosocial and behavioral factors that contribute to the development of severe obesity as well as how those factors and others contribute to postoperative outcomes. This article, written specifically for psychologists and other mental health professionals who currently work with these patients or are considering the opportunity to do so in the future, reviews these contributions over the past 20 years. The article highlights how this work has become a fundamental part of international clinical care guidelines, which primarily focus on preoperative psychosocial screening. The article also outlines avenues for future research in the field, with a specific focus on the need for additional behavioral and psychosocial interventions to promote lifelong success after bariatric surgery. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
- David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University
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32
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Anxiety and Depression Affect Early Postoperative Pain Dimensions after Bariatric Surgery. J Clin Med 2020; 10:jcm10010053. [PMID: 33375765 PMCID: PMC7801948 DOI: 10.3390/jcm10010053] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022] Open
Abstract
Uncontrolled postoperative pain and prolonged immobilization after bariatric surgery have been associated with increased postoperative complications and prolonged hospitalization. The aim of our study was to evaluate the postoperative pain that follows bariatric surgery and identify any psychological factors that may affect the early postoperative perception of pain. The study included 100 patients with obesity (women, n = 61; age 37.4 ± 9.9 years, mean ± standard deviation; Body Mass Index (BMI) 47.6 ± 6.5 kg/m2) who underwent bariatric surgery. Preoperative anxiety and depression were evaluated by the Hospital Anxiety and Depression Scale (HADS), and the quantitative and qualitative dimension of early postoperative pain were evaluated by the McGill Pain Questionnaire Short Form (MPQ-SF). Furthermore, the postoperative analgesia protocol was recorded for each patient. Pain declined gradually during the first 24 h postoperative. Although preoperative anxiety had no correlation with the overall pain of postoperative Day 0, patients with a higher level of preoperative anxiety had significantly more intense and more unpleasant pain at 1 h post operation. In addition, depression influences both the intensity and unpleasantness of pain at different time points (1 h, 4 h and 24 h postoperative). Preoperative pain correlated with educational level, but not with age, BMI, gender, marital status, smoking and surgery type. In conclusion, preoperative anxiety and depression influence the early postoperative pain after bariatric surgery, and their preoperative identification is of major importance to enhance the implementation of fast-track postoperative protocols to prevent complications and prolonged hospitalization.
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Marchitelli S, Mazza C, Lenzi A, Ricci E, Gnessi L, Roma P. Weight Gain in a Sample of Patients Affected by Overweight/Obesity with and without a Psychiatric Diagnosis during the Covid-19 Lockdown. Nutrients 2020; 12:E3525. [PMID: 33207742 PMCID: PMC7697678 DOI: 10.3390/nu12113525] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/01/2023] Open
Abstract
The present study aimed at identifying psychological and psychosocial variables that might predict weight gain during the COVID-19 lockdown in patients affected by overweight/obesity with and without a psychiatric diagnosis. An online survey was administered between 25 April and 10 May 2020, to investigate participants' changes in dietary habits during the lockdown period. 110 participants were recruited and allocated to two groups, 63 patients had no psychiatric diagnosis; there were 47 patients with psychiatric diagnosis. ANOVA analyses compared the groups with respect to psychological distress levels, risk perception, social support, emotion regulation, and eating behaviors. For each group, a binary logistic regression analysis was conducted, including the factors that were found to significantly differ between groups. Weight gain during lockdown was reported by 31 of the participants affected by overweight/obesity without a psychiatric diagnosis and by 31 patients with a psychiatric diagnosis. Weight gain predictors were stress and low depression for patients without a psychiatric diagnosis and binge eating behaviors for patients with a psychiatric diagnosis. Of patients without a psychiatric diagnosis, 60% reported much more frequent night eating episodes. The risk of night eating syndrome in persons affected by overweight/obesity with no psychiatric diagnosis should be further investigated to inform the development of tailored medical, psychological, and psychosocial interventions.
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Affiliation(s)
- Serena Marchitelli
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (A.L.); (L.G.)
| | - Cristina Mazza
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (A.L.); (L.G.)
| | - Eleonora Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d’Annunzio” University of Chieti-Pescara, 66100 Chieti, Italy;
| | - Lucio Gnessi
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy; (S.M.); (A.L.); (L.G.)
| | - Paolo Roma
- Department of Human Neuroscience, Sapienza University of Rome, 00185 Rome, Italy;
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Marek RJ, Martin-Fernandez K, Heinberg LJ, Ben-Porath YS. An Investigation of the Eating Concerns Scale of the Minnesota Multiphasic Personality Inventory-3 (MMPI-3) in a Postoperative Bariatric Surgery Sample. Obes Surg 2020; 31:2335-2338. [PMID: 33196980 DOI: 10.1007/s11695-020-05113-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/03/2020] [Accepted: 11/10/2020] [Indexed: 01/24/2023]
Abstract
Eating pathology is common pre-operatively and continues to be prevalent following bariatric surgery. A new version of the Minnesota Multiphasic Personality Inventory (MMPI), the MMPI-3, contains a new scale called Eating Concerns (EAT) that aims to assess problematic eating behaviors. The current investigation seeks to establish preliminary convergent validity of the MMPI-3 EAT scale in a postoperative bariatric surgery sample. Thirty-eight consecutive participants took the MMPI-3 and the Eating Disorder Examination-Questionnaire (EDE-Q). Higher MMPI-3 EAT scale scores were meaningfully associated with %Weight Regain (r = .37) and scale scores on the EDE-Q [Eating Concerns (r = .67), Weight Concerns (r = .39), Shape Concerns (r = .54), and the EDE total score (r = .59)]. Initial examination of the EAT Specific Problem Scale of the MMPI-3 yields good clinical utility in assessing eating pathology in a postoperative bariatric surgery sample.
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Affiliation(s)
- Ryan J Marek
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, 2700 Bay Area Blvd, Houston, TX, 77058, USA.
| | | | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue/M61, Cleveland, OH, 44195, USA
| | - Yossef S Ben-Porath
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
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Paul L, van der Heiden C, van Hoeken D, Deen M, Vlijm A, Klaassen RA, Biter LU, Hoek HW. Cognitive Behavioral Therapy Versus Usual Care Before Bariatric Surgery: One-Year Follow-Up Results of a Randomized Controlled Trial. Obes Surg 2020; 31:970-979. [PMID: 33170444 PMCID: PMC7921027 DOI: 10.1007/s11695-020-05081-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/15/2020] [Accepted: 10/21/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Although early results of bariatric surgery are beneficial for most patients, some patients regain weight later. Cognitive behavioral therapy (CBT) has been suggested as a way to improve patients' psychological health and maintaining weight loss in the longer term. The added value of preoperative CBT to bariatric surgery was examined. Pre- and posttreatment and 1-year follow-up data are presented. METHODS In a multi-center randomized controlled trial, CBT was compared to a treatment-as-usual (TAU) control group. Measurements were conducted pre- and posttreatment/pre-surgery (T0 and T1) and at 1-year post-surgery (T2). Patients in the intervention group received 10 individual, weekly sessions of preoperative CBT focused on modifying thoughts and behaviors regarding eating behavior, physical exercise, and postoperative life style. Outcome measures included weight change, eating behavior, eating disorders, depression, quality of life, and overall psychological health. RESULTS Though no significant differences between conditions were found per time point, in the CBT, condition scores on external eating, emotional eating, depressive symptoms, and psychological distress decreased significantly more over time between pre- (T0) and posttreatment (T1) pre-surgery compared to TAU. No significant time x condition differences were found at 1-year post-surgery (T2). CONCLUSIONS Compared to TAU, preoperative CBT showed beneficial effects on eating behavior and psychological symptoms only from pretreatment to posttreatment/pre-surgery, but not from pre-surgery to 1-year post-surgery. Preoperative CBT does not seem to contribute to better long-term outcomes post-surgery. Recent studies suggest that the optimal time to initiate psychological treatment may be early in the postoperative period, before significant weight regain has occurred. TRIAL REGISTRATION https://www.trialregister.nl Identifier: Trial NL3960.
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Affiliation(s)
- Linda Paul
- PsyQ Department of Eating Disorders, Rotterdam, Netherlands.,Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH, The Hague, Netherlands
| | - Colin van der Heiden
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH, The Hague, Netherlands.,Institute of Psychology, Erasmus University, Rotterdam, Netherlands
| | - Daphne van Hoeken
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH, The Hague, Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH, The Hague, Netherlands.,Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Ashley Vlijm
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH, The Hague, Netherlands
| | - René A Klaassen
- Department of Surgery, Maasstad Hospital, Rotterdam, Netherlands
| | - L Ulas Biter
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Hans W Hoek
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH, The Hague, Netherlands. .,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Netherlands. .,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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Martens K, Hamann A, Miller-Matero LR, Miller C, Bonham AJ, Ghaferi AA, Carlin AM. Relationship between depression, weight, and patient satisfaction 2 years after bariatric surgery. Surg Obes Relat Dis 2020; 17:366-371. [PMID: 33127323 DOI: 10.1016/j.soard.2020.09.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/16/2020] [Accepted: 09/14/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Findings regarding longer term symptoms of depression and the impact of depression on outcomes such as weight loss and patient satisfaction, are mixed or lacking. OBJECTIVES This study sought to understand the relationship between depression, weight loss, and patient satisfaction in the two years after bariatric surgery. SETTING This study used data from a multi-institutional, statewide quality improvement collaborative of 45 different bariatric surgery sites. METHODS Participants included patients (N = 1991) who underwent Roux-en-Y gastric bypass (RYGB) or sleeve gastrectomy (SG) between 2015-2018. Participants self-reported symptoms of depression (Patient Health Questionnaire-8 [PHQ-8]), satisfaction with surgery, and weight presurgery and 1 year and 2 years postsurgery. RESULTS Compared to presurgery, fewer patients' PHQ-8 scores indicated clinically significant depression (PHQ-8≥10) at 1 year (P < .001; 14.3% versus 5.1%) and 2 years postsurgery (P < .0001; 8.7%). There was a significant increase in the prevalence of clinical depression from the first to second year postsurgery (P < .0001; 5.1% versus 8.7%). Higher PHQ-8 at baseline was related to less weight loss (%Total Weight Loss [%TWL] and %Excess Weight Loss [%EWL]) at 1 year postsurgery (P < .001), with a trend toward statistical significance at 2 years (P = .06). Postoperative depression was related to lower %TWL and %EWL, and less reduction in body mass index (BMI) at 1 year (P < .001) and 2 years (P < .0001). Baseline and postoperative depression were associated with lower patient satisfaction at both postoperative time points. CONCLUSIONS This study suggests improvements in depression up to 2 years postbariatric surgery, although it appears that the prevalence of depression increases after the first year. Depression, both pre- and postbariatric surgery, may impact weight loss and patient satisfaction.
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Affiliation(s)
- Kellie Martens
- Department of Surgery, Henry Ford Health System, Detroit, Michigan; Behavioral Health, Henry Ford Health System, Detroit, Michigan.
| | - Aaron Hamann
- Department of Surgery, Henry Ford Health System, Detroit, Michigan; Behavioral Health, Henry Ford Health System, Detroit, Michigan
| | - Lisa R Miller-Matero
- Behavioral Health, Henry Ford Health System, Detroit, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Chazlyn Miller
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Aaron J Bonham
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Amir A Ghaferi
- Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Arthur M Carlin
- Department of Surgery, Henry Ford Health System, Detroit, Michigan
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Marek RJ, Martin-Fernandez K, Ben-Porath YS, Heinberg LJ. Psychosocial Functioning of Bariatric Surgery Patients 6-Years Postoperative. Obes Surg 2020; 31:712-724. [PMID: 33040294 DOI: 10.1007/s11695-020-05025-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Mental health professionals routinely assess psychosocial risk factors prior to bariatric surgery to help identify factors that may impede surgical outcomes. Data regarding longer-term psychosocial functioning postoperatively are needed. PURPOSE Assess the psychosocial functioning of patients who obtained bariatric surgery approximately 6 years ago. METHODS A total of 161 patients consented to participate in the outcome study. Participants were compensated for their time and participation. Participants were weighed by the research/clinical staff and asked to complete a battery of self-report measures, including the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF). Other measures targeted adherence, eating behaviors/body image, alcohol use, and quality of life. RESULTS Postoperative MMPI-2-RF scores indicate psychosocial functioning is largely similar to previously published pre-surgical functioning data. Six-year weight loss outcomes were lower than previous studies reported for a similar postoperative time period (mean %total weight loss = 22.98%; standard deviation = 11.71), though quality of life scores were relatively high. Postoperative MMPI-2-RF scale scores were associated with poorer psychosocial functioning, reduced adherence, greater eating behaviors/body image concerns, greater alcohol use severity, lower quality of life, and less overall weight loss. CONCLUSIONS Psychological dysfunction 6 years after surgery is associated with various adverse outcomes. Ongoing, postoperative treatment may result in better long-term functioning for patients.
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Affiliation(s)
- Ryan J Marek
- Department of Clinical, Health, and Applied Sciences, University of Houston-Clear Lake, Houston, TX, 77058, USA.
| | | | - Yossef S Ben-Porath
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
| | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, 9500 Euclid Avenue/M61, Cleveland, OH, 44195, USA
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Braun TD, Quinn DM, Stone A, Gorin AA, Ferrand J, Puhl RM, Sierra J, Tishler D, Papasavas P. Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients. Obesity (Silver Spring) 2020; 28:1974-1983. [PMID: 32808737 PMCID: PMC8650800 DOI: 10.1002/oby.22920] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC). METHODS BSC recruited from a surgical clinic (N = 213, 82.2% women, 43 [SD 12] years, mean BMI: 49 [SD 9] kg/m2 ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms. RESULTS After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion. CONCLUSIONS The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.
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Affiliation(s)
- Tosca D Braun
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert Medical School of Medicine, Brown University, Providence, Rhode Island, USA
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Diane M Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Andrea Stone
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Jennifer Ferrand
- Institute of Living, Division of Health Psychology, Hartford Hospital, Hartford, Connecticut, USA
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, Connecticut, USA
| | - Jessica Sierra
- Institute of Living, Division of Health Psychology, Hartford Hospital, Hartford, Connecticut, USA
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
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Weight loss expectations and weight loss after surgery: the mediating role of body image and weight concerns. Surg Obes Relat Dis 2020; 16:932-939. [DOI: 10.1016/j.soard.2020.03.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/28/2020] [Accepted: 03/05/2020] [Indexed: 12/13/2022]
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Predictors of weight loss after bariatric surgery-a cross-disciplinary approach combining physiological, social, and psychological measures. Int J Obes (Lond) 2020; 44:2291-2302. [PMID: 32327722 DOI: 10.1038/s41366-020-0576-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 03/11/2020] [Accepted: 03/27/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Bariatric surgery leads to a substantial weight loss (WL), however, a subset of patients undergoing surgery fails to achieve adequate WL. The reason for the individual variation in WL remains unexplained. Using an exploratory cross-disciplinary approach, we aimed to identify preoperative and early postoperative factors explaining the variation in WL after bariatric surgery. METHODS Sixty-one subjects were recruited. Eighteen subjects did not receive surgery and three subjects dropped out, leaving a total sample of 40 subjects. Physiological, social, and psychological data were collected before and 6 months after surgery. All variables were analyzed in combination using a least absolute shrinkage and selection operator (LASSO) regression to explain the variation in WL 18 months after Roux-en-Y gastric bypass (n = 30) and sleeve gastrectomy (n = 10). RESULTS Mean WL was 31% (range: 10-52%). The following preoperative factors predicted 59% of the variation in WL: type of surgery (14%), diabetes status (12%), economic resources (9%), sex (7%), binge eating disorder (7%), degree of depression (5%), household type (3%), and physical activity (1%). Including information on early responses after surgery increased the ability to predict WL to 78% and was explained by early WL (47%), changes in energy density of food consumed from a buffet meal (9%), changes in glicentin (5%), degree of depression (5%), sex (5%), type of surgery (2%), economic resources (2%), and changes in drive for thinness (1%). CONCLUSIONS Using a cross-disciplinary approach, a substantial part of the individual variation in WL was explained by a combination of basic patient characteristics, psychological profile, and social conditions as well as physiological, psychological and behavioral responses to surgery. These results suggest that patient characteristics collected in a cross-disciplinary approach may help determine predictors for less successful WL after bariatric surgery. If verified in larger cohorts this may form the basis for individualized postoperative support to optimize WL outcome.
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Brunault P, Berthoz S, Gearhardt AN, Gierski F, Kaladjian A, Bertin E, Tchernof A, Biertho L, de Luca A, Hankard R, Courtois R, Ballon N, Benzerouk F, Bégin C. The Modified Yale Food Addiction Scale 2.0: Validation Among Non-Clinical and Clinical French-Speaking Samples and Comparison With the Full Yale Food Addiction Scale 2.0. Front Psychiatry 2020; 11:480671. [PMID: 33033480 PMCID: PMC7509420 DOI: 10.3389/fpsyt.2020.480671] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 08/14/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES The modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) was designed to assess food addiction using a shorter version than the YFAS 2.0. We lack data about the psychometric properties of the mYFAS 2.0 in patients with obesity, as well as studies comparing the psychometric properties of the mYFAS 2.0 versus the full YFAS 2.0. This study aimed to validate the French-language mYFAS 2.0 in a non-clinical population (study 1, n = 250), to determine the yet unknown psychometric properties of this scale in patients with obesity (study 2, n = 345), and to compare the full YFAS 2.0 and the mYFAS 2.0 in terms of food addiction (FA) prevalence and symptoms detection in both populations. METHOD Study 1 included 250 non-clinical individuals (non-underweight and non-obese persons screened negative for eating disorders). Study 2 included 345 bariatric surgery candidates recruited in three centers (Québec, Canada; Reims and Tours, France). The mYFAS 2.0 structure was investigated using confirmatory factorial analyses with tetrachoric correlations. Convergent validity was tested using the full YFAS 2.0, the Binge Eating Scale (both studies), the revised 18-item Three Factor Eating Questionnaire (study 1), the Beck Depression Inventory (study 2), and the body mass index (BMI; both studies). RESULTS The mYFAS 2.0 was unidimensional, and had adequate (study 1: KR-20 = .78) and acceptable (study 2: KR-20 = .73) internal consistency. In study 1, the mYFAS 2.0 had good convergent validity with the YFAS 2.0, BMI, binge eating, cognitive restraint, uncontrolled eating and emotional eating; in study 2, the mYFAS 2.0 had good convergent validity with the YFAS 2.0, binge eating, depression, but not BMI. Participants endorsed fewer symptoms with the mYFAS 2.0 than with the YFAS 2.0; FA prevalences were similar between questionnaires in the non-clinical, but not in the clinical sample. A FA 'diagnosis' and risk of binge eating disorder were associated but did not completely overlap. CONCLUSIONS The mYFAS 2.0 has close psychometric properties to the YFAS 2.0 in non-clinical and clinical samples. However, the use of the mYFAS 2.0 in bariatric surgery candidates might lead to a significant underestimation of FA prevalence and number of FA symptoms.
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Affiliation(s)
- Paul Brunault
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France.,Qualipsy EE 1901, Université de Tours, Tours, France
| | - Sylvie Berthoz
- Univ. Bordeaux, CNRS, EPHE, INCIA, UMR 5287, Bordeaux, Paris, France.,Département de Psychiatrie de l'Adolescent et du Jeune Adulte, Institut Mutualiste Montsouris, Paris, France
| | - Ashley N Gearhardt
- Department of Psychology, University of Michigan, Ann Arbor, MI, United States
| | - Fabien Gierski
- CHU de Reims, Pôle de Psychiatrie adulte, Hôpital Robert Debré, Reims, France.,Université Reims Champagne-Ardenne (URCA), laboratoire C2S (EA 6291), Reims, France
| | - Arthur Kaladjian
- CHU de Reims, Pôle de Psychiatrie adulte, Hôpital Robert Debré, Reims, France.,Université Reims Champagne-Ardenne (URCA), laboratoire C2S (EA 6291), Reims, France
| | - Eric Bertin
- CHU de Reims, Service d'Endocrinologie-Diabète-Nutrition, Hôpital Robert-Debré, Reims, France
| | - André Tchernof
- Institut de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Laurent Biertho
- Institut de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Arnaud de Luca
- CHRU de Tours, Service de Médecine Interne-Nutrition, Tours, France.,Université de Tours, Inserm, UMR 1069, Tours, France
| | - Régis Hankard
- CHRU de Tours, Service de Médecine Interne-Nutrition, Tours, France.,Université de Tours, Inserm, UMR 1069, Tours, France
| | - Robert Courtois
- Qualipsy EE 1901, Université de Tours, Tours, France.,CHRU de Tours, Clinique Psychiatrique Universitaire, CRIAVS, Tours, France
| | - Nicolas Ballon
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France.,CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France
| | - Farid Benzerouk
- CHU de Reims, Pôle de Psychiatrie adulte, Hôpital Robert Debré, Reims, France.,Université Reims Champagne-Ardenne (URCA), laboratoire C2S (EA 6291), Reims, France
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Abstract
As nearly one third of transgender individuals in the USA are obese, more transgender patients may pursue bariatric surgery as a means of sustaining weight loss. Transgender individuals, like bariatric surgery patients, have high rates of mood pathology, substance use, abuse, and self-harm behaviors. However, there is no research on transgender bariatric surgery candidates. The aim of this review is to elucidate potential psychosocial risk factors, including sex hormone management, which may impact surgical clearance, presurgical psychosocial assessment, and treatment recommendations.
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Gender-related patterns of psychiatric disorder clustering among bariatric surgery candidates: A latent class analysis. J Affect Disord 2018; 240:72-78. [PMID: 30056172 DOI: 10.1016/j.jad.2018.07.036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Revised: 05/31/2018] [Accepted: 07/14/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychiatric disorders tend to distribute unevenly in women and men with severe obesity. The current research aimed to identify homogeneous clusters of concurrent psychiatric disorders among patients seeking bariatric surgery, by gender. METHODS We recruited a consecutive sample of 393 candidates with obesity (311 women and 82 men) in a university-based bariatric center. Trained clinicians assessed psychiatric disorders through the Structured Clinical Interview for DSM-IV (SCID). Latent class analysis categorized pre-surgical patients into uniform clusters of co-occurring psychiatric disorders. RESULTS For both genders, the 3-class psychopathological clustering was the best-fitting solution. Among women, the latent classes were: (1) "oligosymptomatic", wherein 42% of patients showed low probability of psychiatric disorders; (2) "bipolar with comorbidities", in 33%; and (3) "anxiety/depression", in 25%. Among men, (1) "bipolar with comorbidities" was found in 47% of patients; (2) "oligosymptomatic", in 40%; and (3) "anxiety/depression", in 13%. For both genders, the probability of presenting eating disorders was higher in both "bipolar" and "anxiety/depression" classes. Substance use disorders was prominent among "bipolar" men. In comparison with "oligosymptomatic" class, the likelihood of higher BMI was observed among "bipolar" men and poorer work attainment among men with "anxiety/depression". LIMITATION Participants was cross-sectionally drawn from a single bariatric center. CONCLUSIONS Pre-surgical men and women with severe obesity were distributed in three comorbidity profiles and revealed analogous psychopathological patterns. The class of "bipolar disorders" most likely presented comorbidity with eating and substance use disorder. This natural clustering of psychiatric disorders among bariatric patients suggests gender-related therapeutic approaches and surgical outcomes.
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Borgès Da Silva V, Borgès Da Silva R, Prud'homme A, Campan P, Azorin JM, Belzeaux R. Association between binge eating disorder and psychiatric comorbidity profiles in patients with obesity seeking bariatric surgery. Compr Psychiatry 2018; 87:79-83. [PMID: 30253268 DOI: 10.1016/j.comppsych.2018.09.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Eating disorders could be an important factor in the development of obesity, but psychiatric comorbidities are very heterogeneous in patients with obesity. Moreover, relationship between binge eating disorder and other psychiatric comorbidities is not clear. Our objective was to identify psychiatric comorbidity profiles of bariatric surgery candidates and to analyze the association between these profiles and binge-eating disorder. METHODS Our sample consisted of bariatric surgery candidates (n = 92) with mean Body Mass Index at 41.3 ± 0.6 kg/m2. To construct profiles, we classified patients according to their psychiatric comorbidities using cluster analysis techniques. We used logistic regression modelling to analyze associations between the presence of binge-eating disorder and the psychiatric comorbidity profiles. RESULTS We identified four profiles of psychiatric phenotypes. One of these profiles was not associated with any psychiatric disorder. Binge eating disorder was significantly associated with two profiles (p < 0.05): a profile with bipolar and obsessive-compulsive disorder (OR = 7.7 [1.7; 35.1]), and a profile with bipolar and panic disorder (OR = 20.7 [3.1; 137.5]). CONCLUSIONS Our multidimensional approach identified certain profiles specifically associated with binge-eating disorder in patients with obesity seeking bariatric surgery. These results may lead to a better understanding of the relationship between obesity and psychiatric disorders.
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Affiliation(s)
- Virginie Borgès Da Silva
- Centre Hospitalier Édouard Toulouse, Assistance publique des hôpitaux de Marseille, Marseille, France.
| | - Roxane Borgès Da Silva
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, P.O. Box 6128, Downtown Station Montréal, H3C3J7 Québec, Canada; University of Montreal Public Health Research Institute, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C3J7, Canada; Center for Interuniversity Research and Analysis of Organizations, 1130 Rue Sherbrooke O #1400, Montréal, Québec H3A 2M8, Canada.
| | - Alexandre Prud'homme
- University of Montreal Public Health Research Institute, C.P. 6128, Succ. Centre-ville, Montréal, Québec, H3C3J7, Canada; Center for Interuniversity Research and Analysis of Organizations, 1130 Rue Sherbrooke O #1400, Montréal, Québec H3A 2M8, Canada.
| | - Pierre Campan
- Hôpital de La Conception, Assistance publique des hôpitaux de Marseille, Marseille, France.
| | - Jean Michel Azorin
- Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique des hôpitaux de Marseille, 270 Boulevard de Sainte-Marguerite, 13009 Marseille, France.
| | - Raoul Belzeaux
- Pôle de psychiatrie, Hôpital Sainte Marguerite, Assistance Publique des hôpitaux de Marseille, 270 Boulevard de Sainte-Marguerite, 13009 Marseille, France; INT-UMR7289, CNRS Aix-Marseille Université; Fondation FondaMental, Créteil, France.
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Oterdoom DLM, van Dijk G, Verhagen MHP, Jiawan VCR, Drost G, Emous M, van Beek AP, van Dijk JMC. Therapeutic potential of deep brain stimulation of the nucleus accumbens in morbid obesity. Neurosurg Focus 2018; 45:E10. [DOI: 10.3171/2018.4.focus18148] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVEMorbid obesity is a growing problem worldwide. The current treatment options have limitations regarding effectiveness and complication rates. New treatment modalities are therefore warranted. One of the options is deep brain stimulation (DBS) of the nucleus accumbens (NAC). This review aims to summarize the current knowledge on NAC-DBS for the treatment of morbid obesity.METHODSStudies were obtained from multiple electronic bibliographic databases, supplemented with searches of reference lists. All animal and human studies reporting on the effects of NAC-DBS on body weight in morbidly obese patients were included. Articles found during the search were screened by 2 reviewers, and when deemed applicable, the relevant data were extracted.RESULTSFive relevant animal experimental papers were identified, pointing toward a beneficial effect of high-frequency stimulation of the lateral shell of the NAC. Three human case reports show a beneficial effect of NAC-DBS on body weight in morbidly obese patients.CONCLUSIONSThe available literature supports NAC-DBS to treat morbid obesity. The number of well-conducted animal studies, however, is very limited. Also, the optimal anatomical position of the DBS electrode within the NAC, as well as the optimal stimulation parameters, has not yet been established. These matters need to be addressed before this strategy can be considered for human clinical trials.
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Affiliation(s)
| | - Gertjan van Dijk
- 2Department of Behavioral Neurosciences, University of Groningen, Groningen Institute for Evolutionary Life Sciences (GELIFES), Cluster Neurobiology, Groningen
| | - Martijn H. P. Verhagen
- Departments of 1Neurosurgery,
- 3Department of Neurosurgery, Noordwest Ziekenhuisgroep, Alkmaar; and
| | | | | | - Marloes Emous
- 6Department of Bariatric and Metabolic Surgery, Medical Center Leeuwarden, The Netherlands
| | - André P. van Beek
- 7Endocrinology, University of Groningen, University Medical Center Groningen
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Health-Related Quality of Life, Anxiety, and Depression in Bariatric Surgery Candidates Compared to Patients from a Psychosomatic Inpatient Hospital. Obes Surg 2018; 27:2378-2387. [PMID: 28285469 DOI: 10.1007/s11695-017-2629-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND AIM Past research indicated high psychiatric comorbidity and poor health-related quality of life (HRQOL) in patients seeking surgical treatment for obesity. This study investigated if preoperative bariatric surgery patients perceive equally poor HRQOL and increased levels of anxiety and depression as mentally ill patients. METHODS The study included four groups: 192 bariatric surgery candidates (PRE, 71% women, BMI 48.35 ± 8.98 kg/m2), 96 psychotherapy inpatients with mental disorders (PSY, 77% women, BMI 27.12 ± 9.17 kg/m2), 103 postoperative bariatric surgery patients (POST, 78% women, BMI 30.38 ± 2.88 kg/m2), and a convenience sample of 96 non-clinical volunteers with pre-obesity or obesity grade 1 (CG, 52% women, BMI 29.22 ± 2.64 kg/m2). HRQOL was measured using the 12-item short form health survey (SF-12), and psychopathology was assessed with the hospital anxiety and depression scale (HADS). RESULTS The PRE group exhibited the lowest physical HRQOL, and the PSY group the lowest mental HRQOL. The highest mental/physical HRQOL was reported by the POST group and the CG, without significant differences between these two groups. While the PSY group scored higher on HADS-anxiety scale than the PRE group, neither group differed with regards to symptoms of depression. The lowest levels of HADS-depression were found in the POST group and the CG. CONCLUSIONS The present findings suggest that bariatric surgery candidates may suffer from equally high levels of depression as psychotherapy inpatients, but they perceive better mental well-being. Routine mental health evaluation should incorporate assessments for both psychopathology and HRQOL. TRIAL REGISTRATION DRKS00009901.
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Abstract
OBJECTIVE The aim of this study is to identify psychosocial variables associated with the relationship between weight loss and change in depressive symptoms following gastric banding surgery. METHODS Ninety-nine adults completed self-report questionnaires assessing depressive symptoms and other psychosocial variables (self-esteem, body image dissatisfaction, perceived physical health, and perceived weight-based stigmatisation) prior to gastric-band surgery and monthly for 6-month post-surgery. RESULTS Weight, depressive symptoms, and other psychosocial variables improved significantly 1-month post-surgery and remained lower to 6 months. Weight loss from baseline to 1- and 6-months post-surgery significantly correlated with change in depressive symptoms. Body image dissatisfaction and self-esteem accounted for some of the variance in change in depressive symptoms from baseline to 1-month and baseline to 6-months post-surgery. CONCLUSIONS Depressive symptoms improved significantly and rapidly after bariatric surgery, and body image dissatisfaction and self-esteem predicted change in depressive symptoms. Interventions targeting body image and self-esteem may improve depressive symptoms for those undergoing weight loss interventions.
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Tronnier VM, Rasche D, Thorns V, Alvarez-Fischer D, Münte TF, Zurowski B. Massive weight loss following deep brain stimulation of the nucleus accumbens in a depressed woman. Neurocase 2018; 24:49-53. [PMID: 29388475 DOI: 10.1080/13554794.2018.1431678] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Obese individuals share behavioral characteristics with drug/alcohol addicts as well as obsessive compulsive disease. Deep brain stimulation (DBS) has been used successfully in these disorders, thus warranting an evaluation in obesity. A woman with treatment-resistant depression as well as severe obesity was selected for DBS of the nucleus accumbens (NAcc) bilaterally with depression being the primary and obesity being the secondary target of treatment. Compared to earlier bariatric surgery, the patient showed accelerated weight loss after DBS. Also, depression was significantly reduced. The current case suggests that DBS of the NAcc warrants further evaluation in patients unresponsive to other treatments.
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Affiliation(s)
- Volker M Tronnier
- a Department of Neurosurgery , University of Lübeck , Lübeck , Germany
| | - Dirk Rasche
- a Department of Neurosurgery , University of Lübeck , Lübeck , Germany
| | - Veronika Thorns
- b Department of Psychiatry , University of Lübeck , Lübeck , Germany
| | - Daniel Alvarez-Fischer
- b Department of Psychiatry , University of Lübeck , Lübeck , Germany.,c Institute of Neurogenetics , University of Lübeck , Lübeck , Germany
| | - Thomas F Münte
- d Department of Neurology , University of Lübeck , Lübeck , Germany.,e Institute of Psychology II , University of Lübeck , Lübeck , Germany
| | - Bartosz Zurowski
- b Department of Psychiatry , University of Lübeck , Lübeck , Germany
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Surgical Management of Obesity Among People with Schizophrenia and Bipolar Disorder: a Systematic Review of Outcomes and Recommendations for Future Research. Obes Surg 2018; 27:1889-1895. [PMID: 28508277 DOI: 10.1007/s11695-017-2715-5] [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: 12/11/2022]
Abstract
BACKGROUND People with schizophrenia or bipolar disorder (BD) exhibit very high levels of obesity. Little is known about the potential benefits/risks of obesity surgery. We conducted a narrative review to summarize the available knowledge on bariatric surgery in people with schizophrenia or BD. METHODS A systematic search was conducted of major electronic databases from inception to October 2016 for studies investigating bariatric surgery among people with schizophrenia or BD. Data were presented in a narrative synthesis and future research strategies proposed. RESULTS The electronic database searches identified 44 records. Eight studies (BD, n = 265; schizophrenia: n = 14) were included with a mean study length of 15.7 months (12-24). Seven found that bariatric surgery resulted in weight loss in those with psychiatric disorders with an excess weight loss ranging -31 to -70%. Six studies found that weight loss from bariatric surgery was similar in people with schizophrenia or BD versus controls. However, most of the studies limited their outcomes to only weight loss and did not measure whether obesity surgery affected the status and treatment of psychiatric symptoms. Although few adverse events were reported among patients with BD, data from two studies demonstrated no significant deterioration of psychiatric symptoms post-surgery in people with schizophrenia. CONCLUSIONS Growing evidence suggests that bariatric surgery may improve short-term weight status among people with BD. However, given the paucity of studies for schizophrenia, and the lack of information on medium-to long-term results, future large-scale high-quality studies are required.
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Müller A, Claes L, Smits D, Schag K, de Zwaan M. Lifetime Self-Harm Behaviors Are Not More Prevalent in Bariatric Surgery Candidates than in Community Controls with Obesity. Obes Facts 2018; 11:109-115. [PMID: 29631270 PMCID: PMC5981630 DOI: 10.1159/000486484] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/11/2017] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE The study aimed at investigating the lifetime prevalence of 22 self-harm behaviors in bariatric surgery candidates (pre-bariatric surgery group; PSG) compared to community controls with obesity (obese community group; OCG). METHODS The Self-Harm Inventory (SHI) was administered to the PSG (n = 139, BMI ≥ 35 kg/m2) and to the OCG (n = 122, BMI ≥ 35 kg/m2). RESULTS Group comparison of cumulative SHI scores indicated a trend towards less endorsed SHI items in the PSG compared to the OCG (medianPSG = 1.00, IQRPSG = 2.00, medianOCG = 1.00, IQROCG = 2.25, U = 7.241, p = 0.033, η2 = 0.02). No significant group differences were found with regard to the rate of suicide attempts (12.4% vs. 9.4% for OCG vs. PSG). At least one type of lifetime self-harm behavior was admitted by 51.8% of the PSG and 63.9% of the OCG (χ2(1) = 3.91, p = 0.048). The results of logistic regressions using Firth's bias reduction method with at least one SHI item endorsed as dependent variable, group as categorical predictor (PSG as baseline), and age or BMI or PHQ-4 as continuous control variable indicated that only PHQ-4 had a positive effect on the odds ratio. CONCLUSION The results suggest that self-harm (including suicidal attempts) is not more prevalent in bariatric surgery candidates than in community control participants with obesity. Further studies are needed to investigate self-harm in bariatric surgery patients, prior and following surgery, compared to non-operated patients with obesity.
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Affiliation(s)
- Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
- *Astrid Müller, Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Straße 1, 30265 Hanover, Germany,
| | - Laurence Claes
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University Antwerp, Antwerp, Belgium
| | - Dirk Smits
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Odisee University College, Brussels, Belgium
| | - Kathrin Schag
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
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