Gender and binge eating among bariatric surgery candidates

Gender differences in individuals with obesity and binge eating disorder: A retrospective comparison of phenotypical features and treatment outcomes

OBJECTIVE

Phenotypical comparisons between individuals with obesity without binge eating disorder (OB) and individuals with obesity and comorbid binge eating disorder (OB + BED) are subject to ongoing investigations. At the same time, gender-related differences have rarely been explored, raising the question whether men and women with OB and OB + BED may require differently tailored treatments.

METHOD

We retrospectively compared pre- versus post-treatment data in a matched sample of n = 180 men and n = 180 women with OB or OB + BED who received inpatient treatment.

RESULTS

We found that men displayed higher weight loss than women independent of diagnostic group. In addition, men with OB + BED showed higher weight loss than men with OB after 7 weeks of treatment.

CONCLUSIONS

The present findings add to an emerging yet overall still sparse body of studies comparing phenotypical features and treatment outcomes in men and women with OB and OB + BED; implications for further research are discussed.

CLINICAL TRIAL REGISTRATION

The study was prospectively registered with the German Clinical Trial Register as part of application DRKS00028441.

Binge Eating Before and After Bariatric Surgery

PURPOSE OF REVIEW

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

RECENT FINDINGS

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

Eating Disorder Symptomatology Among Adolescents Presenting for Bariatric Surgery Candidacy: Examining Differences by Sex and Racial Minority Status

BACKGROUND

Research on adolescent bariatric surgery candidates is limited by insufficient inclusion of ethnic minorities and males, and lack of consideration of the full spectrum of disordered eating behaviors (i.e., restriction, compensatory behaviors [e.g., purging], overeating/binge eating behaviors).

OBJECTIVES

The current study investigated differences in the full range of disordered eating behaviors across sex and ethnicity among adolescents seeking bariatric surgery.

SETTING

Teaching hospital, United States.

METHODS

Data were collected using retrospective chart review of 79 adolescent bariatric surgery candidates (59% female, 46.8% Hispanic, MBMI = 50.2, SDBMI = 10.0, Mage = 17.3, SDage = 2.02) who had completed the self-reported Eating Disorder Diagnostic Scale for DSM-5 at intake.

RESULTS

Approximately 33% of study participants met self-reported criteria for an eating disorder, with 35% endorsing binge eating behaviors and 50% endorsing compensatory behaviors. Few differences in behavior frequencies were observed across sex or racial/ethnic status.

CONCLUSIONS

Findings underscore the importance of assessing the full spectrum of disordered eating behaviors among adolescent bariatric surgery candidates.

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

BACKGROUND

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

OBJECTIVES

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

SETTING

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

RESULTS

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

CONCLUSION

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

Disordered eating following bariatric surgery: a review of measurement and conceptual considerations

Eating disorders are associated with significant medical morbidity and mortality and serious psychological impairment. Individuals seeking bariatric surgery represent a high-risk group for evidencing disordered eating and eating disorders, with some patients experiencing the persistence or onset of disordered eating postsurgery. This review synthesizes the available literature on problematic or disordered eating in the bariatric field, followed by a review of measurement and conceptual considerations related to the use of eating disorder assessment tools within the bariatric population.

Update on Binge Eating Disorder

Binge eating disorder (BED) is the most common eating disorder and an important public health problem. Lifetime prevalence of BED in the United States is 2.6%. In contrast to other eating disorders, the female to male ratio in BED is more balanced. BED co-occurs with a plethora of psychiatric disorders, most commonly mood and anxiety disorders. BED is also associated with obesity and its numerous complications. Although BED is similar in men and women in presentation and treatment outcomes, there are some key neurobiological differences that should be taken in consideration when personalizing treatment.

Momentary predictors of binge eating: An attachment perspective

INTRODUCTION

According to attachment theory, individuals who are preoccupied with the possibility of rejection are prone to emotion dysregulation, which research has found to be related to disordered eating. The current study examined naturalistic momentary relationships between binge eating, depressive symptoms, emotion dysregulation, and attachment anxiety.

METHOD

Participants were 55 undergraduate women who owned a mobile phone and who had binge eaten at least once during the past 28 days. All participants were screened to confirm the presence of binge eating and then completed trait measures of attachment anxiety. Participants then received seven text messages per day for 14 days. Texts contained links to state measures of depressive symptoms, state emotion dysregulation, and recent binge eating.

RESULTS

Momentary depressive symptoms predicted subsequent binge eating. Aspects of emotion dysregulation (i.e., nonacceptance of emotional responses and difficulty modulating one's emotions) mediated the relationship between attachment anxiety and binge eating.

DISCUSSION

Depressed mood often triggers binge eating. Additionally, attachment anxiety seems to predict binge eating through emotion dysregulation. Interventions for binge eating should address both attachment anxiety and emotion dysregulation in order to maximize therapeutic benefit.

Sex differences in the relationships among weight stigma, depression, and binge eating

Weight stigma and weight discrimination are prevalent in the United States and binge eating has been found to be associated with these experiences in numerous studies. One issue with the current literature on weight stigma and binge eating, however, is that study samples are primarily female, resulting in a lack of understanding of this relationship among males. To address this gap, we examined potential sex differences in the association between weight stigma and binge eating, as well as mediators of this relationship. Specifically, we examined experiences of weight discrimination and weight stigma consciousness as predictors of binge eating, and we assessed whether these relationships were mediated by depression, perceived stress, and/or perceived control. Results showed that, among females and males, experiences of weight discrimination significantly predicted binge eating and depression mediated this relationship; perceived stress also mediated this association, but only among males, and perceived control did not mediate for either sex. Results also showed that, among males, the relationship between weight stigma consciousness and binge eating was mediated by depression and perceived control, but not perceived stress. Weight stigma consciousness was unrelated to binge eating among females. Together, these findings suggest that weight stigma constructs differentially impact females and males, thereby illuminating the possible need for consideration of sex as an important component of efforts to reduce weight stigma.

Self-Reported Hedonism Predicts 12-Month Weight Loss After Roux-en-Y Gastric Bypass

Introduction

Research regarding psychological risk factors for reduced weight loss after bariatric surgery has yielded mixed results, especially for variables measured prior to surgery. More profound personality factors have shown better promise and one such factor that may be relevant in this context is time perspective, i.e., the tendency to focus on present or future consequences. The aim of this study was to investigate the predictive value of time perspective for 12-month weight loss after Roux-en-Y gastric bypass surgery.

Methods

A total of 158 patients were included and completed self-report instruments prior to surgery. Weight loss was measured after 12 months by medical staff. Background variables as well as self-reported disordered eating, psychological distress, and time perspective were analyzed with regression analysis to identify significant predictors for 12-month weight loss.

Results

The mean BMI loss at 12 months was 14 units, from 45 to 30 kg/m². Age, sex, and time perspective could significantly predict weight loss but only male sex and self-reported hedonism were independent risk factors for reduced weight loss in the final regression model.

Conclusion

In this study, self-reported hedonistic time perspective proved to be a better predictor for 12-month weight loss than symptoms of disordered eating and psychological distress. It is possible that a hedonistic tendency of focusing on immediate consequences and rewards is analogous to the impaired delay discounting seen in previous studies of bariatric surgery candidates. Further studies are needed to identify whether these patients may benefit from extended care and support after surgery.

Relation of binge eating disorder with impulsiveness in obese individuals

AIM

To investigate the levels of impulsiveness, and the relationship between the binge eating disorder (BED) and the levels of impulsiveness in obese individuals.

METHODS

Two hundred and forty-one obese patients who were included in the study and candidate for bariatric surgery (weight loss surgery) were clinically interviewed to identify the BED group, and patients were divided into two groups: Those with BED and those without BED. The comorbidity rate of groups was determined by using structured clinical interview for DSM-IV (SCID-I). A sociodemographic data form including the story of previous psychiatric treatment, structured clinical interview for DSM-IV (SCID-I), Beck Anxiety Inventory, Beck Depression Inventory (BDI) and Barratt Impulsiveness Scale-11 were applied to both of the groups.

RESULTS

In regard to 241 obese individuals included in the study, total score and score of attention subscale for BED (+) group were significantly high (P < 0.05). In addition, suicide attempt, story of psychiatric consultation, and score for BDI were again significantly high in the BED (+) group (P < 0.05).

CONCLUSION

In assessment of obese individuals, assessment of associated psychopathology such as impulsive characteristics and suicide attempt in addition to disrupted eating behaviors will allow to have a more extensive view.

Binge Eating Disorder

Binge eating disorder (BED) is the most common eating disorder and an important public health problem. Lifetime prevalence of BED in the United States is 2.6%. In contrast to other eating disorders, the female to male ratio in BED is more balanced. BED co-occurs with a plethora of psychiatric disorders, most commonly mood and anxiety disorders. BED is also associated with obesity and its numerous complications. Although BED is similar in men and women in presentation and treatment outcomes, there are some key neurobiological differences that should be taken in consideration when personalizing treatment.

Cirurgia bariátrica e transtornos alimentares: uma revisão integrativa

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

The relation of anxiety, depression, and stress to binge eating behavior

This study aimed to extend the literature by examining several psychological factors (i.e. depression, anxiety, and stress) in relation to binge eating. Data were collected via online surveys from a community sample of men and women of diverse backgrounds. The main study hypotheses were supported, indicating a unique relation between anxiety and binge eating, and between stress and binge eating, independent of the impact of depression. Gender differences are discussed. The results of this study suggest a need for a more detailed examination of negative affect in binge eating. Furthermore, the role of anxiety may be important for future research.

Patient and Referring Practitioner Characteristics Associated With the Likelihood of Undergoing Bariatric Surgery: A Systematic Review

IMPORTANCE

Although bariatric surgery is the most cost-effective treatment for severe obesity, less than 1% of severely obese patients undergo it. Reasons for this low use are unclear.

OBJECTIVES

To identify patient and referring practitioner characteristics associated with the likelihood of undergoing bariatric surgery.

EVIDENCE REVIEW

The PubMed, PsycINFO, CINAHL, and Cochrane databases were searched for articles published from January 1, 1998, through December 31, 2014. Studies were eligible if they presented descriptive data regarding facilitators or barriers to bariatric surgery or if they reported statistical associations between patient or practitioner characteristics and referral to or receipt of bariatric surgery. Frequency effect sizes were calculated as the proportion of studies reporting a finding.

FINDINGS

Of the 7212 records identified in the initial search, 53 were included in full-text review. Nine studies met our inclusion criteria and were included in analyses. Of those, 4 included descriptive findings, 6 reported statistical associations, and 1 included both. One study included practitioners as participants, whereas 8 included patients. Four of 9 studies identified an association between female sex and a greater willingness to undergo bariatric surgery. Lack of knowledge about bariatric surgery was a barrier in 2 studies. Five of 9 cited patient concerns about the outcomes and safety of bariatric surgery as a barrier to undergoing it. Patients were more likely to pursue bariatric surgery when it was recommended by referring practitioners. Practitioners who believed that obesity treatment should be covered by insurance were more likely to recommend bariatric surgery.

CONCLUSIONS AND RELEVANCE

Limited patient and referring practitioner knowledge about the safety and effectiveness of bariatric surgery are important barriers to bariatric surgery use. Future efforts focused on improving knowledge and identification of the critical determinants of obesity treatment decision making from the practitioner and patient perspectives would have an important effect on public health.

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

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

Is age a better predictor of weight loss one year after gastric bypass than symptoms of disordered eating, depression, adult ADHD and alcohol consumption?

INTRODUCTION

Findings regarding psychological risk factors for low weight loss after bariatric surgery have been inconsistent. The association between gender and weight outcome is unclear while younger age has been consistently shown to be associated with better weight outcome. The aim of this study was to analyze the interactions between gender and age on the one hand and symptoms of disordered eating, depression, adult ADHD and alcohol consumption on the other hand in regard to weight loss after gastric bypass.

METHODS

Bariatric surgery patients were recruited and asked to fill out self-report questionnaires regarding behavioral risk factors before and twelve months after surgery. Data from one hundred and twenty-nine patients were analyzed.

RESULTS

After controlling for age, no psychological variable measured prior to surgery could predict weight loss after twelve months. After surgery, there was an interaction effect between age, gender and specific eating disorder symptoms. Specifically, loss of control over eating was a risk factor for low weight loss among older, but not among younger, female participants. Symptoms of adult ADHD were associated with elevated alcohol consumption after surgery.

DISCUSSION

These results indicate that age and gender may moderate the effects of potential risk factors for inferior weight outcome. This interaction could potentially be one of the reasons behind the mixed findings in this field. Thus, there are important gender differences in the bariatric population that should be considered. The present study is the first to show that symptoms of adult ADHD may not be a risk factor for inferior weight loss but for alcohol risk consumption after gastric bypass.

Antécédents psychotraumatiques et psychopathologie de 767 patients obèses candidats à la chirurgie bariatrique réalisée au CHU de Nancy

Nous présentons une étude rétrospective sur l’évaluation psychiatrique pré-chirurgicale de 767 patients obèses (610 femmes et 157 hommes) conduite entre 1997 et 2012 et effectuée par le même psychiatre. Notre étude confirme les données de la littérature en ce qui concerne les variables sociodémographiques, la prévalence des troubles psychiatriques et celles des troubles de la personnalité. D’autres résultats sont néanmoins divergents, notamment les prévalences des addictions et des différents troubles alimentaires, qui sont plus élevées dans notre étude. les liens entre les psychotraumatismes et les troubles psychiatriques comorbides, ainsi qu’entre les psychotraumatismes et l’hyperphagie boulimique sont confirmés dans notre travail. L’intérêt de cette étude tient à son effectif qui autorise une bonne puissance statistique et permet d’étudier les deux sexes séparément. les résultats les plus significatifs sont les suivants :

– le sexe masculin est associé aux antécédents personnels d’addictions au tabac et à l’alcool alors que le sexe féminin est corrélé aux troubles de l’humeur et aux tentatives de suicide ;

– les antécédents de psychotraumatismes sont associés dans les deux sexes aux addictions, aux troubles de l’humeur et aux tentatives de suicide, auxquels s’ajoutent les troubles anxieux chez les femmes ;

– le début de l’obésité est plus précoce chez les femmes (avant l’âge adulte) ;

– le sexe féminin est associé à l’hyperphagie boulimique et le sexe masculin à l’hyperphagie prandiale ;

– chez les femmes, l’hyperphagie boulimique est associée aux antécédents d’addictions, de troubles de l’humeur, de troubles anxieux, de tentatives de suicide, aux différents types de traumatisme (carences affectives, violences directes et indirectes, abus sexuels) et au cumul des traumatismes ;

– chez les hommes, l’hyperphagie boulimique est uniquement associée aux antécédents d’addiction et aux carences affectives ;

Nous envisageons ensuite l’impact des évènements de vie stressants sur le comportement alimentaire de ces sujets et comment l’analyse bénéfice-risque conditionne la décision chirurgicale.

Sex differences in the physiology of eating

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

The Role of Anxiety in Binge Eating Behavior: A Critical Examination of Theory and Empirical Literature

The purpose of this manuscript is to expand the understanding of binge eating by reviewing the role of aspects of negative affect. Specifically, this paper will present evidence for further investigation of the bearing that anxiety may have in binge eating development and maintenance. A comprehensive review of the literature regarding the relation of binge eating and anxiety was performed. Valuable contributions have been made to the binge eating literature regarding some aspects of negative affect (i.e., depression); however, outside of bulimia nervosa studies, much of the theoretical and empirical binge eating research to date has not directly addressed the role of anxiety. Research supports expansion of investigations of negative emotionality and binge eating to include specific study of anxiety. Greater inclusivity and specificity in the unique contributions of various negative emotions may further the development of temporal models and intervention efforts.

A comparative analysis of Type 2 diabetes and binge eating disorder in a bariatric sample

An emerging literature has illuminated an important link between Type 2 diabetes mellitus (DM) and binge eating disorder (BED) within obese cohorts. However, prior work has not examined this relationship specifically in a weight loss surgery (WLS) sample or fully explored potential psychosocial factors associated with this co-occurrence. Therefore, the present investigation sought to identify socio-demographic (i.e. age, education, BMI, ethnicity, gender, age of obesity onset) and psychological (i.e. depressive symptoms, hedonic hunger/food locus of control beliefs, severity of binge eating-related cognitions) correlates of the co-occurrence of Type 2 DM and BED among bariatric surgery candidates. An archival sample of 488 patients seeking surgical treatment for clinical obesity completed a standard battery of pre-operative psychosocial measures. The presence of BED was evaluated using a semi-structured clinical interview based on the DSM-IV TR (APA, 2000) and was further corroborated by responses on the Questionnaire on Eating and Weight Patterns-Revised (QEWP-R; Spitzer, Yanovski, & Marcus, 1993). Results indicated that 8.2% of the sample was classified as having both Type 2 DM and BED concurrently. A multivariate logistic regression model revealed that in addition to other psychological (e.g., binge eating-related cognitions, hedonic hunger) and demographic variables (i.e. male gender), African American ethnicity (OR=3.3: 1.41-7.73) was a particularly robust indicator of comorbid status. Findings support and extend previous health disparity research urging greater attention to the needs of traditionally underserved, at-risk populations seeking treatment for obesity complicated by dysregulated eating and metabolism. Additionally, these preliminary results underscore the relevance of considering the potential benefits of providing quality comprehensive pre- and post-operative psychological care among bariatric patients towards optimizing both short- and long-term health and well-being.

Binge eating disorder and depression: a systematic review

The purpose of this systematic literature review is to examine previous studies that investigated the relation between depression and binge eating disorder (BED). Medline/PubMed published data from 1980 through 2006 was tracked using the following keywords: "binge eating disorder and depression", "periodic binge eating and depression", "binge eating disorder" and "periodic binge eating". The findings of 14 studies were successfully highlighted: one cohort, four cross-sectional and nine case-control studies. Most studies (7/14) were conducted in the United States, with missing data varying between 2.3 and 44.32%, and seven studies emphasizing the most important variables. The majority of the studies (10/14) showed an association between depression and binge eating disorder, but carefully designed studies are required to minimize the limitations found in these studies.

Chronic dieting among extremely obese bariatric surgery candidates

BACKGROUND

Extremely obese bariatric surgery candidates report numerous episodes of both successful and unsuccessful dieting attempts, but little is known about the clinical significance of frequent dieting attempts in this patient group.

METHODS

The current study examined psychological and weight-related correlates of self-reported dieting frequency in 219 bariatric surgery candidates (29 men and 190 women). Prior to surgery, patients completed a battery of established self-report assessments. Patients were dichotomized into chronic dieters (n=109) and intermittent dieters (n=110) based on a median split of self-reported percent time spent dieting during adulthood. The two dieting groups were compared on demographics, eating and weight history, eating disorder psychopathology, and global functioning.

RESULTS

Chronic dieters had significantly lower pre-operative body mass indexes (BMIs), lower highest-ever BMIs, more episodes of weight cycling, and earlier ages of onset for overweight and dieting than intermittent dieters. After controlling for differences in BMI, chronic dieters were found to have statistically but not clinically significant elevations in eating concerns, dietary restraint, and body dissatisfaction than infrequent dieters. The two groups, however, did not differ significantly on depressive symptoms, self-esteem, or health-related quality of life; nor did they differ in binge-eating status.

CONCLUSIONS

Chronic dieting is commonly reported among extremely obese bariatric candidates and is not associated with poorer psychological functioning or binge eating and may be beneficial in attenuating even greater weight gain. Our findings provide preliminary data to suggest that requiring additional presurgical weight loss attempts may not be warranted for the vast majority of extremely obese bariatric candidates.

Brief, four-session group CBT reduces binge eating behaviors among bariatric surgery candidates

BACKGROUND

The objective of this study was to evaluate the effectiveness of a brief, 4-session cognitive behavioral, group psychotherapy for binge eating among bariatric surgery candidates at an academic medical center. Binge eating behaviors have been linked to poorer outcomes among bariatric surgery patients, and binge eating disorder have be considered a contraindication in surgery programs, some of which have mandated preoperative binge eating treatment. However, no previous studies have examined whether a preoperative binge eating intervention could successfully reduce binge eating behaviors among severely obese bariatric surgery candidates.

METHODS

A total of 243 bariatric surgery candidates completed a brief cognitive behavioral group treatment for binge eating behaviors and were administered the Binge Eating Scale and reported the number of weekly binge eating episodes at the initial psychological evaluation and again after the group sessions. The study used a pre-post intervention design.

RESULTS

The results suggested significant reductions in both binge eating behaviors and cognitions and binge eating episodes after the group intervention. The intervention's effectiveness did not differ according to gender or ethnicity (black versus white).

CONCLUSION

A brief cognitive behavioral intervention can reduce binge eating behaviors among bariatric surgery candidates. Given the potential influence of binge eating on outcomes, bariatric surgery programs could benefit by treating binge eating before surgery.

Sex differences in the relation of weight loss self-efficacy, binge eating, and depressive symptoms to weight loss success in a residential obesity treatment program

The aim of the current study was to examine whether weight loss self-efficacy, binge eating, and depressive symptoms predicted weight loss during treatment, and whether gender moderates these associations with prospective data from 297 participants (223 women and 74 men) enrolled in a residential obesity treatment program. Men reported higher initial levels of self-efficacy than women, whereas women reported greater pre-treatment levels of binge eating and depressive symptoms. Higher pre-treatment levels of weight control self-efficacy, binge eating, and depressive symptoms predicted greater weight loss in men, but not in women. Results suggest that certain psychological and behavioral factors should be considered when implementing weight loss interventions, and indicate a need to consider gender differences in predictors of weight loss treatment. Future research should seek to identify predictors of weight loss among women.

Gender differences in early outcomes following hand-assisted laparoscopic Roux-en-Y gastric bypass surgery : gender differences in bariatric surgery

BACKGROUND

Male gender has been associated with a higher morbidity and mortality rate after bariatric surgery including laparoscopic and open procedures. This study focused on hand-assisted laparoscopic Roux-en-Y gastric bypass and morbidity and mortality among genders.

METHODS

Hand-assisted laparoscopic Roux-en-Y gastric bypass operations (N = 319) were evaluated from October 2003 to March 2006. Comparison between males (N = 54) and females (N = 265) were conducted using t test or Fishers exact test and chi-square analysis.

RESULTS

Patients' average age was 42.3 +/- 10.3 and the average body mass index (BMI) was 49.2 +/- 7.9. There was no significant difference between males and females in age or BMI. Males had a significantly greater average weight than females (p < 0.001) and were significantly more likely to experience sleep apnea (p = 0.006) and have heart disease (p = 0.017). For operative risk factors, males had a significantly longer anesthesia time (p = 0.003), operative time (p = 0.027), and length of roux limb (p = 0.038). At 6 and 12 months postsurgery, there was no significant difference between males and females with complications. Although BMI did not differ significantly, males continued to weigh significantly more than females and lost significantly more pounds than did females at both 6 and 12 months postoperation.

CONCLUSION

Given their larger size and tendency to accumulate fat in the abdominal compartment that increases the technical difficulty of the procedure, males are historically associated with a higher morbidity and mortality following bariatric surgery. Based on the current study, however, there is no difference in outcome among genders following hand-assisted laparoscopic Roux-en-Y gastric bypass.

Bariatric surgery in Australia: who, why and how?

A review of published reports was conducted to identify gaps in the research regarding bariatric surgery. Much of the research that has been conducted is clinical outcome based; however, little research has been conducted in many key areas. Data on the demographics of the bariatric surgery group are patchy at best. The role of best practice and evidence-based medicine in bariatric surgery seems to be poorly understood, and equity issues and the role of clinical pathways in bariatric surgery need to be clarified. Significant gaps were identified in the published reports regarding pathways to bariatric surgery and multidisciplinary team use. Additionally, much of the published report and research data were from US studies, as few Australian studies have been conducted. Further research and policy and practice developments in bariatric surgery are needed, especially with regard to the Australian context.

Depressed mood in class III obesity predicted by weight-related stigma

BACKGROUND

Greater depressed mood in Class III obese surgery-seeking clients may be due to weight-related stigma, weight-related physical disability (e.g. mobility) or the presence of binge-eating (BE).

METHODS

60 Class III obese surgery-seeking adults were administered the Beck Depression Inventory (BDI), weight-related physical disability (IWQOL-PF) and another weight-related stigma (IWQOL-PD), and assessed for BE (SCID-1 or Questionnaire of Eating and Weight Patterns) before surgery.

RESULTS

In a hierarchical regression analysis, BMI, gender, and age of obesity onset did not account for a significant portion of the variance in BDI scores in the first step. The second step of the model was statistically significant (F(3,53)=8.469, P<0.000), accounting for 33.6% of the variance in BDI scores. IWQOL-PD scores were the only significant predictor of BDI scores (b=0.518, P=0.001), and this independently contributed to 32.6% of the variance in BDI scores.

CONCLUSION

This suggests that depressed mood seen in Class III obese surgery-seeking individuals may be most related to weight-related stigma rather than BE status, or weight-related physical disability.

Comparison of obese men and women with binge eating disorder seeking weight management

OBJECTIVE

This study examined whether obese males with binge eating disorder (BED) seeking weight loss treatment differed significantly from obese females with BED seeking weight loss treatment in developmental variables, weight loss history, current and lifetime prevalence of psychiatric disorders, and metabolic abnormalities.

METHODS

Psychiatric (using the Structural Clinical Interview for DSM-IV), medical, and laboratory assessments of 44 obese males with BED were compared with assessments from 44 age- and race-matched obese females with BED seeking weight loss treatment.

RESULTS

High rates of mood disorders, anxiety disorders, and metabolic syndrome were observed in the population as a whole. Obese males with BED had attempted significantly fewer diets, medications and supplements for weight loss before seeking weight loss treatment. The two genders did not differ significantly in any other of the examined variables.

CONCLUSIONS

Our results suggest that while obese men and women with BED who present for weight management are very similar, males had fewer previous attempts at weight loss, possibly related to their less pronounced body dissatisfaction or fewer help-seeking behaviors as compared to females. Our results also support findings of substantial comorbidity among obesity, BED, mood and anxiety disorders, and metabolic syndrome in weight loss seeking populations, in men as well as women.