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Sarwer DB, Wadden TA, Ashare R, Spitzer JC, McCuen-Wurst C, LaGrotte C, Williams N, Soans R, Tewksbury C, Wu J, Tajeu G, Allison KC. Psychopathology, disordered eating, and impulsivity as predictors of weight loss 24 months after metabolic and bariatric surgery. Surg Obes Relat Dis 2024; 20:634-642. [PMID: 38480031 PMCID: PMC11193608 DOI: 10.1016/j.soard.2024.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/21/2023] [Accepted: 01/28/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND The relationship between theoretically relevant psychosocial and behavioral variables and outcomes of metabolic and bariatric surgery remains unclear. Some studies have found that the presence of psychopathology, disordered eating, and impulsivity, either before surgery or during the early postoperative period, is associated with suboptimal postoperative weight loss. Other studies have not found these relationships. OBJECTIVE Examine the relationship between psychopathology, disordered eating, impulsivity, and weight loss 24 months postoperatively. SETTING Two large, urban university health systems. METHODS Participant characteristics were collected using validated interviews, patient-reported outcome measures, and computerized assessment methods. Linear mixed effect models were used to test the association of the variables of interest on percent weight loss (%WL). RESULTS Three hundred participants were enrolled at baseline; weight data at 24 months were available for 227 participants; between 181 and 53 individuals completed other outcome measures. The mean %WL was 23.3 ± 9.9% at 24 months. Patients who underwent Roux-en-Y gastric bypass lost more weight than those who underwent sleeve gastrectomy. The presence of subjective binge episodes at baseline was related to a greater %WL at 24 months; there were no other baseline predictors. The presence of eating disorder diagnoses and disordered eating symptoms after surgery were associated with smaller weight losses over 24 months. Current and lifetime psychopathology and impulsivity were unrelated to %WL at 24 months. CONCLUSION Disordered eating after bariatric surgery was associated with a smaller %WL at postoperative year 2. Additional monitoring of these symptoms in the early postoperative period is recommended. Psychotherapeutic and/or dietary interventions may promote more optimal weight loss outcomes.
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Affiliation(s)
- David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania.
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychology, College of Arts and Sciences, University at Buffalo, Buffalo, New York
| | - Jacqueline C Spitzer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Courtney McCuen-Wurst
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caitlin LaGrotte
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Noel Williams
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rohit Soans
- Department of Surgery, Lewis Katz School of Medicine, Temple University
| | - Colleen Tewksbury
- Department of Surgery, Lewis Katz School of Medicine, Temple University
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Gabriel Tajeu
- Department of Health Services Administration and Policy, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Kelly C Allison
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Xie J, Wang Y. Multidisciplinary combined treatment based on bariatric surgery for metabolic syndrome: a review article. Int J Surg 2024; 110:3666-3679. [PMID: 38489549 PMCID: PMC11175773 DOI: 10.1097/js9.0000000000001320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 02/26/2024] [Indexed: 03/17/2024]
Abstract
As a chronic, multifactorial disease, obesity is associated with a global social and economic burden. This condition significantly affects normal daily life and healthy social interactions, and shortens the life expectancy of patients. Compared with traditional weight-loss methods, the emergence of bariatric surgery has effectively improved the management of obesity. Furthermore, bariatric surgery can also inhibit the progression of multiple metabolic diseases. Despite its potential advantages, bariatric surgery cannot completely eliminate the possibility of weight regain and inadequate weight loss following the procedure. For super-obese patients, bariatric surgery still remains a surgical risk. In addition, the psychological problems and poor eating habits of obese patients also affect the weight loss effect and daily life. Thus, various adjuvant therapies involving multiple disciplines have attracted people's attention. Recently, it has been recognized that the combination of multiple interventions based on bariatric surgery is more advantageous than a single intervention in alleviating the complex and diverse metabolic diseases associated with obesity. The combined therapy considerably enhances the long-term efficacy of bariatric surgery and plays a positive role in the mental health and social lives of patients. In this article, the authors review this multidisciplinary combination therapy to enhance the current understanding of the treatment of obesity.
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Affiliation(s)
| | - Yong Wang
- Center of Bariatric and Metabolic Surgery, Fourth Affiliated Hospital of China Medical University, Liaoning, People’s Republic of China
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Ivezaj V, Dilip A, Duffy AJ, Grilo CM. Racial differences after bariatric surgery: 24-month follow-up of a randomized, controlled trial for postoperative loss-of-control eating. Surg Obes Relat Dis 2024; 20:261-266. [PMID: 37949690 PMCID: PMC10922356 DOI: 10.1016/j.soard.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/01/2023] [Accepted: 09/10/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND While some bariatric surgery outcomes vary by race/ethnicity, less is known about racial/ethnic differences in loss-of-control (LOC) eating and psychosocial outcomes post-surgery. OBJECTIVE This prospective study examined and extended initial short-term findings regarding racial differences in post-bariatric surgery LOC eating and weight loss to longer-term outcomes through 24-month follow-ups. SETTING Academic medical center in the United States. METHODS Participants were 140 patients (46.4% non-White) in a 3-month randomized, controlled trial for LOC eating performed about 6 months after bariatric surgery. Participants were reassessed at 6, 12, 18, and 24 months after treatment ended (about 33 mo after surgery). Doctoral assessors administered the Eating Disorder Examination-Bariatric Surgery Version interview to assess LOC eating and eating-disorder psychopathology at 12- and 24-month follow-ups. The Beck Depression Inventory II was repeated, and measured weight was obtained at all follow-ups. RESULTS White patients had significantly greater percent excess weight loss at all follow-ups than non-White patients (p < .03). White patients reported significantly more LOC eating at 12- (p = .004) and 24-month (p = .024) follow-ups and significantly greater eating disorder psychopathology at 12-month follow-up (p < .028). Racial groups did not differ significantly in eating disorder psychopathology at 24-month follow-ups or in Beck Depression Inventory II depression scores at any follow-ups. CONCLUSIONS Our findings suggest that among patients with LOC eating after bariatric surgery, non-White patients attain a lower percent excess weight loss than White patients but have comparable or better outcomes in LOC eating, associated eating disorder psychopathology, and depression over time.
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Affiliation(s)
- Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Abhaya Dilip
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Andrew J Duffy
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Psychology, Yale University, New Haven, Connecticut
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Dunford A, Ivezaj V, Grilo CM. Shape discrepancy, weight bias internalization, and eating-disorder psychopathology in patients with loss-of-control eating after bariatric surgery. Surg Obes Relat Dis 2024; 20:291-296. [PMID: 37926627 PMCID: PMC10922050 DOI: 10.1016/j.soard.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Postoperative loss-of-control (LOC) eating is associated with eating-disorder psychopathology, poorer weight loss, and mental health outcomes following bariatric surgery. The nature and significance of shape discrepancy has not been examined in patients with LOC eating following bariatric surgery. OBJECTIVES To examine shape discrepancy, WBI (weight bias internalization) and ED (eating-disorder) psychopathology in patients with LOC eating after bariatric surgery. SETTING Yale University School of Medicine, United States. METHODS Participants (N = 148, 84.5% female) seeking treatment for eating and weight concerns and with recurrent LOC eating approximately 6 months after bariatric surgery were assessed with the Eating Disorder Examination-Bariatric Surgery Version Interview and completed questionnaires measuring WBI and depression. Participants selected body shapes representing their current and ideal shapes, and a shape discrepancy score was calculated. RESULTS Most participants (N = 142/148) reported an ideal shape smaller than their current shape; shape discrepancy scores ranged from 0 to 5 (M = 1.89, SD = .82). Greater shape discrepancy was significantly correlated with greater current body mass index (BMI; r = .271, p=<.001) and percent weight loss (%WL) since surgery (r = -.19, p = .023). After adjusting for %WL, shape discrepancy was significantly correlated with greater WBI (r = .37, p < .001), depression (r = .27, p < .001), and ED psychopathology (r = .25, p = .002). CONCLUSIONS Nearly all participants preferred a significantly smaller shape than their current shape. Greater discrepancy between current and ideal shape was associated with higher levels of a range of behavioral (ED psychopathology), cognitive (WBI), and psychological/somatic (depression) concerns. These findings, which persisted after adjusting for %WL, highlight the importance of addressing body image in postoperative interventions.
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Affiliation(s)
- Ashley Dunford
- Department of Psychiatry, Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, New Haven, Connecticut.
| | - Valentina Ivezaj
- Department of Psychiatry, Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, New Haven, Connecticut
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Müller A, Efeler S, Laskowski NM, Pommnitz M, Mall JW, Meyer G, Wunder R, Köhler H, Hüttl TP, de Zwaan M. Postoperative Dumping Syndrome, Health-Related Quality of Life, Anxiety, Depression, and Eating Disturbances: Results of a Longitudinal Obesity Surgery Study. Obes Facts 2024; 17:201-210. [PMID: 38320543 PMCID: PMC10987184 DOI: 10.1159/000536602] [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: 09/12/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Given the lack of research on the relationship of post-surgery dumping syndrome and eating disturbances, the purpose of the present longitudinal study was to investigate whether dumping after obesity surgery is associated with pre-/postoperative eating disorder symptoms or addiction-like eating beyond the type of surgery, gender, health-realted quality of life (HRQoL) and anxiety/depressive symptoms. METHODS The study included 220 patients (76% women) before (t0) and 6 months after (t1) obesity surgery (sleeve gastrectomy [n = 152], Roux-en-Y gastric bypass [n = 53], omega loop gastric bypass [n = 15]). The Sigstad Dumping Score was used to assess post-surgery dumping syndrome. Participants further answered the Eating Disorder Examination Questionnaire (EDE-Q), Yale Food Addiction Scale 2.0 (YFAS 2.0), Short-Form Health Survey (SF-12), and Hospital Anxiety and Depression Scale (HADS) at t0 and t1. RESULTS The point prevalence of symptoms suggestive of post-surgery dumping syndrome was 33%. Regression analyses indicate an association of dumping with surgical procedure (bypass), female gender, reduced HRQoL, more anxiety/depressive symptoms, and potentially with binge eating but not with eating disorder symptoms in general or with addiction-like eating. CONCLUSION The current study failed to show a close relationship between the presence of self-reported dumping syndrome and eating disorder symptoms or addiction-like eating following obesity surgery. Further studies with longer follow-up periods should make use of clinical interviews to assess psychosocial variables and of objective measures to diagnose dumping in addition to standardized self-ratings.
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Affiliation(s)
- Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Salih Efeler
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Nora M. Laskowski
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
- University Clinic for Psychosomatic Medicine and Psychotherapy, Medical Faculty, Campus East-Westphalia, Ruhr-University Bochum, Luebbecke, Germany
| | - Melanie Pommnitz
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Julian W. Mall
- Department of General, Visceral, Vascular, and Bariatric Surgery, Klinikum Nordstadt, Hanover, Germany
| | - Günther Meyer
- Department of General, Visceral, and Bariatric Surgery, AMC-WolfartKlinik, Graefeling, Germany
| | - Ruth Wunder
- Department of General, Visceral, and Bariatric Surgery, DRK-Krankenhaus Clementinenhaus, Hanover, Germany
| | - Hinrich Köhler
- Department of General, Visceral, and Bariatric Surgery, Herzogin Elisabeth Hospital, Brunswick, Germany
| | - Thomas P. Hüttl
- Department of General, Visceral, and Bariatric Surgery, Dr. Lubos Kliniken Bogenhausen, Munich, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany
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Khalaj A, Barzin M, Ebadinejad A, Mahdavi M, Ebrahimi N, Valizadeh M, Hosseinpanah F. Revisional Bariatric Surgery due to Complications: Indications and Outcomes. Obes Surg 2023; 33:3463-3471. [PMID: 37770774 DOI: 10.1007/s11695-023-06832-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 09/06/2023] [Accepted: 09/15/2023] [Indexed: 09/30/2023]
Abstract
BACKGROUND The increasing prevalence of bariatric procedures has led to a surge in revisional surgeries. Failure of bariatric surgery can be attributed to inadequate weight loss or complications necessitating revisional surgery. In this study, we investigated the indications and outcomes of revisional surgery due to complications following primary bariatric surgery. MATERIALS AND METHODS A retrospective study was conducted using data from the Tehran Obesity Treatment Study, which included patients who underwent revisional bariatric surgery between March 2013 and September 2021 due to complications following primary bariatric surgery. RESULTS Of the 5382 patients who underwent primary bariatric surgery (sleeve gastrectomy, one-anastomosis gastric bypass, and Roux-en-Y gastric bypass), 203 (3.70%) required revisional surgery, with 37 cases performed due to surgical complications. The indications of revisional operations were gastroesophageal reflux disease (GERD) (n=17, 45.9%), protein-calorie malnutrition (PCM) (n=14, 37.8%), unexplained abdominal pain (n=5, 13.5%), and phytobezoar (n=1, 0.03%). In the postoperative follow-up, most patients exhibited improvement in signs and symptoms related to underlying causes. However, eight patients experienced early or late complications of grade III or higher according to the Clavien-Dindo classification, with one death resulting from liver failure. CONCLUSION Revisional bariatric surgery may effectively address complications from primary bariatric surgery, with the majority of patients experiencing improvements in symptoms. While the overall incidence of revisional surgery due to complications is relatively low, our findings suggest that GERD and PCM are the most common indications for revisional surgery.
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Affiliation(s)
- Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Amir Ebadinejad
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran.
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Navid Ebrahimi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran
| | - Farhad Hosseinpanah
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O. Box: 19395-476, Tehran, Iran.
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Mendes C, Carvalho M, Oliveira L, Rodrigues LM, Gregório J. Nurse-led intervention for the management of bariatric surgery patients: A systematic review. Obes Rev 2023; 24:e13614. [PMID: 37607837 DOI: 10.1111/obr.13614] [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: 11/02/2022] [Revised: 06/16/2023] [Accepted: 06/24/2023] [Indexed: 08/24/2023]
Abstract
The prevalence of obesity has become a global health concern, and severe obesity is associated with various chronic diseases and decreased quality of life. Bariatric surgery has shown success in treating obesity. Nevertheless, some patients experience weight regain and unsatisfactory outcomes. Multidisciplinary interventions have been shown to improve postoperative outcomes. Case managers, often specialized nurses, play a crucial role in patient support and coordination of care. However, the diverse design of case-managing interventions hinders the assessment of their success. Thus, the aim of this review is to identify the most successful structural characteristics of case-managing interventions, with or without the support of e-Health, in the process of perioperative management of bariatric surgery patients. A systematic literature review was conducted following the PRISMA guidelines. PubMed, MEDLINE, EBSCOhost, and CINAHL databases were searched for relevant studies published in the last 10 years. Eligible studies included randomized controlled trials, controlled clinical studies, case studies, or observational studies that evaluated perioperative care in bariatric surgery. The PICO framework was used to frame the search strategy. The initial search yielded 225 articles, of which 10 studies met the inclusion criteria. Nurse-led case-managing interventions with a multidisciplinary approach showed positive results in weight loss, physical activity, and quality of life. Patient-centered care models were found to promote adherence to treatment and patient satisfaction. E-Health technologies improved quality of life but not weight loss. The duration of behavioral interventions and the long-term outcomes after surgery remained unclear. Nurse-led case-management interventions, with a focus on behavioral change and multidisciplinary approaches, show promise in improving outcomes in bariatric surgery patients. Patient-centered care models and longer term interventions may contribute to sustained weight loss and better postoperative outcomes. Further research is needed to determine the optimal duration of interventions and the long-term effects on weight maintenance.
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Affiliation(s)
- Cláudia Mendes
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
- Escuela de Doctorado, Programa de Ciencias de la Salud, Universidade de Alcalá, Madrid, Spain
| | - Manuel Carvalho
- Hospital Espírito Santo de Évora, EPE, Évora, Portugal
- CRI.COM-Centro Responsabilidade Integrada de Cirurgia da Obesidade e Metabólica, Évora, Portugal
| | - Leandro Oliveira
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - Luís Monteiro Rodrigues
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
| | - João Gregório
- CBIOS-Universidade Lusófona's Research Center for Biosciences and Health Technologies, Lisbon, Portugal
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Nicanor-Carreón JG, Seyedsadjadi N, Rowitz B, Pepino MY. Weight Regain and Ingestive Behavior in Women after Metabolic Surgery. Nutrients 2023; 15:3670. [PMID: 37686704 PMCID: PMC10490188 DOI: 10.3390/nu15173670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 08/15/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023] Open
Abstract
This study investigated associations between maladaptive ingestive behaviors and weight regain in women who underwent metabolic surgery 2-10 years ago. Using a web-based survey, we assessed emotional, external, and restrained eating (Dutch Eating Behavior Questionnaire-DEBQ), food cravings (Food-Craving Inventory-FCI), and other behaviors (e.g., Eating Disorder Examination Questionnaire-EDE-Q; Alcohol Use Disorder Identification Test-Concise-AUDIT-C) in 36 women (42.9 ± 9.5 years old) post-surgery. We found that weight regain was specifically associated with increased frequency of cravings for sweets (r = 0.43), higher global scores in the EDE-Q (r = 0.38), and time elapsed since surgery (r = 0.35; all p's < 0.04). Multiple regression analysis revealed that the association between weight regain and sweet cravings interacted with time after surgery (p = 0.04), with the strongest association observed in women assessed closer to the surgery (i.e., 2.0-2.8 years). The combination of time after surgery and its interaction with sweet cravings accounted for 31% of the individual variations in weight regain (p = 0.005). Notably, among participants who reported alcohol consumption (31 of 36), 55% had an AUDIT-C score indicating hazardous drinking. These findings highlight the relevance of attending to patients' reports of frequent sweet cravings and screening for alcohol use to enhance strategies tailored to prevent weight regain and alcohol-related health problems post-surgery.
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Affiliation(s)
- Jessica G. Nicanor-Carreón
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
| | - Neda Seyedsadjadi
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
| | - Blair Rowitz
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
- Carle Illinois College of Medicine, Urbana, IL 61801, USA
- Department of Surgery, Carle Foundation Hospital, Urbana, IL 61801, USA
| | - Marta Yanina Pepino
- Division of Nutritional Sciences, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA; (J.G.N.-C.)
- Department of Food Science and Human Nutrition, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA
- Carle Illinois College of Medicine, Urbana, IL 61801, USA
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Smith CE, Dilip A, Ivezaj V, Duffy AJ, Grilo CM. Predictors of early weight loss in post-bariatric surgery patients receiving adjunctive behavioural treatments for loss-of-control eating. Clin Obes 2023; 13:e12603. [PMID: 37257889 PMCID: PMC10524670 DOI: 10.1111/cob.12603] [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: 11/23/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
This study examined baseline patient characteristics as predictors of early weight loss, defined as any weight loss within the first month of treatment, among patients receiving adjunctive behavioural treatments for loss-of-control (LOC) eating about 6 months after bariatric surgery. Participants were 126 patients in a treatment trial for LOC-eating (roughly 6 months postoperatively) categorized by early weight change following 1 month of treatment. Early weight-loss, defined as any weight loss following 1 month of treatment, and weight-gain, defined as any weight gain, groups were compared on sociodemographic and clinical variables assessed using a battery of reliably administered diagnostic and clinical interviews and established self-report measures, and on surgery-related variables (time since surgery, percent total [%TWL], and percent excess weight loss). Most patients (n = 99; 78.6%) lost weight after the first month of adjunctive treatments. Black patients (n = 24; 61.5%) were significantly less likely to achieve early weight loss compared to patients identifying as White (n = 60; 83%) or 'other' (n = 15; 100%) which was not predicted by any other sociodemographic variable. Severity of eating-disorder psychopathology, psychiatric comorbidity, and a broad range of psychosocial measures were not significantly predictive of early weight changes. Duration since surgery and percent weight loss from time of surgery to study enrolment 6-months post-surgery differed by early weight-loss and weight-gain groups. Findings suggest that among post-bariatric surgery patients receiving adjunctive behavioural treatments for LOC-eating, baseline patient characteristics, aside from race and surgery-related variables, do not predict early weight loss.
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Affiliation(s)
- Caitlin E. Smith
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Abhaya Dilip
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Andrew J. Duffy
- Yale School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Carlos M. Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
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D'hoedt A, Vanuytsel T. Dumping syndrome after bariatric surgery: prevalence, pathophysiology and role in weight reduction - a systematic review. Acta Gastroenterol Belg 2023; 86:417-427. [PMID: 37814558 DOI: 10.51821/86.3.11476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/11/2023]
Abstract
Background Dumping syndrome is a frequent and wellknown adverse event after bariatric surgery and covers a dynamic spectrum of early and late dumping. Accelerated gastric emptying is generally considered to be the cause of gastrointestinal and vasomotor complaints. However, there is much uncertainty regarding the exact pathophysiology of dumping. It has been speculated that the syndrome is a desired consequence of bariatric surgery and contributes to more efficient weight loss, but supporting data are scarce. Methods A systematic search was conducted in PubMed in July-August 2021. The prevalence of dumping after the most frequently performed bariatric procedures was analyzed, as well as underlying pathophysiology and its role in weight reduction. Results Roux-en-Y gastric bypass (RYGB) is associated with the highest postoperative prevalence of dumping. The fast transit induces neurohumoral changes which contribute to an imbalance between postprandial glucose and insulin levels, resulting in hypoglycemia which is the hallmark of late dumping. Early dumping can, when received in a positive way, become a tool to maintain a strict dietary pattern, but no significant relationship to the degree of weight loss has been shown. However, late dumping is detrimental and promotes overall higher caloric intake. Conclusion Dumping syndrome is common after bariatric surgery, especially after RYGB. The pathophysiology is complex and ambiguous. Currently available data do not support dumping as a necessary condition to induce weight loss after bariatric surgery.
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Affiliation(s)
- A D'hoedt
- Faculty of Medicine, KULeuven, Leuven, Belgium
| | - T Vanuytsel
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium. Translational Research Center for Gastrointestinal Disorders (TARGID), Department of Chronic Diseases and Metabolism (ChroMeta) KULeuven, Leuven, Belgium
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11
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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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12
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Parker MN, Lavender JM, Schvey NA, Tanofsky-Kraff M. Practical Considerations for Using the Eating Disorder Examination Interview with Adolescents. Adolesc Health Med Ther 2023; 14:63-85. [PMID: 36860931 PMCID: PMC9969870 DOI: 10.2147/ahmt.s220102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 02/14/2023] [Indexed: 02/24/2023] Open
Abstract
Approximately 35 years after its initial publication, the Eating Disorder Examination (EDE) remains one of the most widely used semi-structured interviews for assessing eating disorder diagnoses and symptomatology. Although the interview provides certain advantages over other common measurement approaches (ie, questionnaires), there are particular considerations regarding the EDE that warrant attention, including in its use with adolescents. The aims of this paper are therefore to: 1) provide a brief overview of the interview itself, as well as a description of its origin and underlying conceptual framework; 2) describe relevant factors for administering the interview with adolescents; 3) review potential limitations regarding use of the EDE with adolescents; 4) address considerations for using the EDE with pertinent subpopulations of adolescents who may experience distinct eating disorder symptoms and/or risk factors; and 5) discuss the integration of self-report questionnaires with the EDE. Advantages of using the EDE include the ability for interviewers to clarify complex concepts and mitigate inattentive responding, enhanced orientation to the interview timeframe to improve recall, increased diagnostic accuracy compared to questionnaires, and accounting for potentially salient external factors (eg, food/eating rules imposed by a parent/guardian). Limitations include more extensive training requirements, greater assessment burden, variable psychometric performance across subgroups, lack of items evaluating muscularity-oriented symptoms and avoidant/restrictive food intake disorder diagnostic criteria, and lack of explicit consideration for salient risk factors other than weight and shape concerns (eg, food insecurity).
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Affiliation(s)
- Megan N Parker
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA,The Metis Foundation, San Antonio, TX, USA,Correspondence: Jason M Lavender, Military Cardiovascular Outcomes Research Program, 4301 Jones Bridge Road, Building 17, Suite 2A, Bethesda, MD, 20814, USA, Email
| | - Natasha A Schvey
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Marian Tanofsky-Kraff
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA,Military Cardiovascular Outcomes Research (MiCOR) Program, Bethesda, MD, USA
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13
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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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Grilo CM, Ivezaj V, Duffy AJ, Gueorguieva R. 24-Month follow-up of randomized controlled trial of guided-self-help for loss-of-control eating after bariatric surgery. Int J Eat Disord 2022; 55:1521-1531. [PMID: 36054766 DOI: 10.1002/eat.23804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/10/2022] [Accepted: 08/10/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Loss-of-control (LOC)-eating postoperatively predicts suboptimal longer-term outcomes following bariatric surgery. This study examined longer-term effects through 24-month follow-ups after completing treatments in a randomized controlled trial testing guided-self-help treatments (cognitive-behavioral therapy [gshCBT] and behavioral weight-loss [gshBWL]) and control (CON) delivered postoperatively for LOC-eating. METHODS 140 patients with LOC-eating 6 months after bariatric surgery were randomized (5:5:2 ratio) to 3-months of gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24) delivered by trained allied-health clinicians. Independent assessments were performed throughout/after treatments and at 6-, 12-, 18-, and 24-month follow-ups; 83% of patients were assessed at 24-month follow-up. RESULTS Intention-to-treat analyses comparing the three groups (gshCBT vs. gshBWL vs. CON) in LOC-eating abstinence at posttreatment (30%, 27%, 38%), 12-month follow-up (34%, 32%, 42%), and 24-month follow-up (45%, 32%, 38%) revealed no significant differences. Mixed-models revealed significantly reduced LOC-eating frequency through posttreatment, no significant changes in LOC-eating frequency during follow-up, and no differences between the three groups. Weight reduced significantly, albeit modestly, through posttreatment but increased significantly and substantially during follow-ups, with no differences between groups. CONCLUSIONS Overall, the 12-week scalable guided-self-help treatments did not differ from each other or control, were associated with significantly reduced frequency of LOC-eating and modest weight loss at posttreatment but were followed by significant weight gain during the 24-month follow-up. Weight gain was substantial and nearly universal whereas the frequency of LOC-eating did not change over time (i.e., LOC-eating reductions and abstinence rates were well maintained through 24-moth follow-ups). Patients with postoperative LOC-eating require more intensive adjunctive treatments. PUBLIC SIGNIFICANCE Loss-of-control (LOC) eating postoperatively predicts poorer bariatric surgery outcomes and the longer-term effects of postoperative adjunctive postoperative interventions for LOC eating are unknown. In this 24-month follow-up of a controlled study of scalable guided-self-help treatments and a control condition, improvements in LOC-eating frequency, eating-disorder psychopathology, and depression during treatment were maintained well, with no differences between the three groups. Proportion of patients achieving abstinence from LOC-eating at the 24-month follow-up ranged from 38% to 45% across the three groups. In contrast, weight increased significantly during the 24-month follow-ups, with no differences between the three groups. Findings suggest LOC-eating following bariatric surgery might represent a "marker" for a subgroup of patients that are at risk for substantial weight gains over time. LOC eating following bariatric surgery is challenging to treat with low-intensity scalable treatments and may require more intensive specialist treatments.
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Affiliation(s)
- Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
| | - Andrew J Duffy
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Ralitza Gueorguieva
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
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15
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Decker KM, Reiter‐Purtill J, Bejarano CM, Goldschmidt AB, Mitchell JE, Jenkins TM, Helmrath M, Inge TH, Michalsky MP, Zeller MH. Psychosocial predictors of problematic eating in young adults who underwent adolescent bariatric surgery. Obes Sci Pract 2022; 8:545-555. [PMID: 36238228 PMCID: PMC9535670 DOI: 10.1002/osp4.590] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/18/2021] [Accepted: 12/23/2021] [Indexed: 11/08/2022] Open
Abstract
Introduction This study examined problematic eating and eating-related psychopathology among young adults who underwent adolescent bariatric surgery including concurrent and prospective associations with psychosocial factors and weight change. Methods VIEW point is a 6-year follow-up study within a prospective observational study series observing adolescents with severe obesity who had bariatric surgery (n = 139) or who presented to nonsurgical lifestyle modification programs (n = 83). Participants completed height/weight measurements, questionnaires, and diagnostic interviews. Regression analyses compared problematic eating across groups and examined Year 6 correlates (i.e., psychosocial factors and weight change) and baseline predictors (i.e., psychosocial factors) of eating-related psychopathology. Results Compared to the nonsurgical group, the surgical group reported lower eating-related psychopathology, objective binge eating, and grazing at Year 6. While chewing/spitting out and vomiting for weight/shape-related reasons were very infrequent for the surgical group, self-induced vomiting for other reasons (e.g., avoid plugging) was more common. For the surgical group, lower self-worth, greater internalizing symptoms, and higher weight-related teasing in adolescence predicted increased eating-related psychopathology in young adulthood. Year 6 eating-related psychopathology was concurrently associated with lower percent weight loss for the surgical group and greater percent weight gain for the nonsurgical group. Conclusion Undergoing adolescent bariatric surgery appears to afford benefit for problematic eating and eating-related psychopathology. Current findings suggest that the clinical intervention related to problematic eating and associated psychosocial concerns may be needed for young adults with obesity, regardless of surgical status.
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Affiliation(s)
- Kristina M. Decker
- Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jennifer Reiter‐Purtill
- Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Carolina M. Bejarano
- Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Andrea B. Goldschmidt
- Department of Psychiatry and Human BehaviorWarren Alpert Medical SchoolBrown University and Weight Control and Diabetes Research CenterThe Miriam HospitalProvidenceRhode IslandUSA
- Department of PsychiatryUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - James E. Mitchell
- Department of Clinical NeuroscienceSchool of Medicine and Health SciencesUniversity of North DakotaGrand ForksNorth DakotaUSA
| | - Todd M. Jenkins
- Division of Pediatric General and Thoracic SurgeryCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Michael Helmrath
- Division of Pediatric General and Thoracic SurgeryCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Thomas H. Inge
- Department of SurgeryUniversity of ColoradoAnschutz Medical Campusand Children's Hospital ColoradoAuroraColoradoUSA
| | | | - Meg H. Zeller
- Behavioral Medicine and Clinical PsychologyCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
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Ghizoni CM, Brasil F, Taconeli CA, Carlos LDO, Saboia F, Baretta GAP, da Cruz MRR, Campos ACL. DEVELOPMENT AND VALIDATION OF A PSYCHOLOGICAL SCALE FOR BARIATRIC SURGERY: THE BARITEST. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2022; 35:e1682. [PMID: 36102490 PMCID: PMC9462854 DOI: 10.1590/0102-672020220002e1682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 06/22/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND It is recommended that bariatric surgery candidates undergo psychological assessment. However, no specific instrument exists to assess the psychological well-being of bariatric patients, before and after surgery, and for which all constructs are valid for both genders. AIMS This study aimed to develop and validate a new psychometric instrument to be used before and after bariatric surgery in order to assess psychological outcomes of patients. METHODS This is a cross-sectional study that composed of 660 individuals from the community and bariatric patients. BariTest was developed on a Likert scale consisting of 59 items, distributed in 6 constructs, which assess the psychological well-being that influences bariatric surgery: emotional state, eating behavior, quality of life, relationship with body weight, alcohol consumption, and social support. Validation of BariTest was developed by the confirmatory factor analysis to check the content, criteria, and construct. The R statistical software version 3.5.0 was used in all analyses, and a significance level of 5% was used. RESULTS Adjusted indices of the confirmatory factor analysis model indicate adequate adjustment. Cronbach's alpha of BariTest was 0.93, which indicates good internal consistency. The scores of the emotional state, eating behavior, and quality of life constructs were similar between the results obtained in the community and in the postoperative group, being higher than in the preoperative group. Alcohol consumption was similar in the preoperative and postoperative groups and was lower than the community group. CONCLUSIONS BariTest is a reliable scale measuring the psychological well-being of patients either before or after bariatric surgery.
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Affiliation(s)
| | - Fábio Brasil
- Universidade Federal do Paraná, Pharmaceutical Sciences – Curitiba (PR), Brazil
| | | | | | - Flávia Saboia
- Prometheus Institute, Analytical Psychology – Maringá (PR), Brazil
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Drakos P, Volteas P, Seeras K, Humayon S, Flink B, Yang J, Zhu C, Spaniolas K, Talamini M, Pryor A. S157-a structured early intervention program in patients with predicted poor long-term outcome following bariatric surgery: a prospective randomized study. Surg Endosc 2022; 36:6903-6914. [PMID: 35075525 DOI: 10.1007/s00464-022-09029-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/03/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Early postoperative weight loss can be predictive of one-year outcomes. It is unclear if poor performers identified in the first post-operative month can have improvement in outcomes with additional support and education. PURPOSE To evaluate the impact of a structured targeted support program for patients with lower-than-average early post-operative weight loss on 1-year outcomes. METHODS This was a prospective randomized study of bariatric surgery patients who experienced less than 50th percentile excess body weight loss (%EWL) at 3 weeks. Subjects with EWL < 18% were randomized into two groups: an intervention (IV) arm or a control (NI, no intervention) arm. The IV arm was offered a program with 7-weekly behavioral support sessions, while the NI patients received routine post-operative care. RESULTS A total of 128 patients were randomized: 65 NI and 63 IV. In the IV group, 20 attended all sessions, 7 attended < 4, and 36 did not participate. There was no difference in baseline demographics, procedure type, or BMI. At 1 year, there was no difference in %EWL (ratio 0.993, 95% CI 0.873, 1.131), %EBMIL (ratio 0.997, 95% CI 0.875, 1.137), and %TWL (ratio 1.016, 95% CI 0.901, 1.146) between groups. A subgroup analysis including only the subjects who participated in all seven sessions showed similar results. CONCLUSION Patients who present with suboptimal weight loss early after bariatric surgery do not experience a significant weight loss improvement with a structured behavioral support program. Importantly, despite being alerted to their poor early weight loss, patients demonstrated poor adherence to the proposed interventions.
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Affiliation(s)
- Panagiotis Drakos
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA.
| | - Panagiotis Volteas
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
| | - Kevin Seeras
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Shabana Humayon
- Department of Biostatistics, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Benjamin Flink
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Jie Yang
- Division of Preventive Medicine, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Chencan Zhu
- Department of Biostatistics, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Konstantinos Spaniolas
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
| | - Mark Talamini
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
| | - Aurora Pryor
- Department of Surgery, Stony Brook Medicine, Renaissance School of Medicine, Health Sciences Center, Stony Brook, NY, T19-05311794 8191, USA
- Division of Bariatric, Foregut, and Advanced Gastrointestinal Surgery, Department of Surgery, Renaissance School of Medicine, Stony Brook, NY, USA
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Ivezaj V, Kalarchian MA, King WC, Devlin MJ, Mitchell JE, Crosby RD. Interrater reliability and internal consistency of the eating disorder examination in the longitudinal assessment of bariatric surgery study. Surg Obes Relat Dis 2022; 18:1015-1022. [PMID: 35691868 PMCID: PMC9357064 DOI: 10.1016/j.soard.2022.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 04/05/2022] [Accepted: 04/17/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Psychometric studies of eating disorder measures within bariatric surgery populations are limited. OBJECTIVES To examine the interrater reliability and internal consistency of the Eating Disorder Examination (EDE) among patients before and after bariatric surgery. SETTING Three clinical centers of the Longitudinal Assessment of Bariatric Surgery Research Consortium. METHODS The EDE-Bariatric Surgery Version was administered and audio-recorded by trained interviewers before and at annual assessments after bariatric surgery. Approximately 20% of interviews were randomly selected for rating by a second interviewer. Reliability of the original and brief EDE subscales was examined. RESULTS Interrater reliability of the EDE subscales ranged from .86-.97 for the original subscales and .83-.95 for brief subscales before surgery, and .90-.98 for the original subscales and .92-.97 for brief subscales after bariatric surgery. Interrater agreement (based on kappa) was almost perfect for overeating and binge-eating behaviors and substantial for loss-of-control eating before surgery. Similar interrater agreements (based on kappa) were observed after surgery for subjective overeating and binge-eating episodes. Internal consistency of the subscale and global scores was variable, ranging from .41-.97. CONCLUSION Findings provide support of the interrater reliability of the EDE, albeit with variable internal consistency, before and after bariatric surgery. Despite support for trained raters to reliably assess EDE constructs, variability in internal consistency suggests that further psychometric testing and rigorous scale development of disordered eating may be needed for the bariatric surgery population.
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Affiliation(s)
| | | | - Wendy C King
- University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Michael J Devlin
- Columbia University Vagelos College of Physicians and Surgeons/New York State Psychiatric Institute, New York, New York
| | - James E Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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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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Lynch A, Kozak AT, Zalesin KC. “The stomach I have now has a brain connection:” changes in experiences of hunger and fullness following bariatric surgery. Appetite 2022; 179:106271. [DOI: 10.1016/j.appet.2022.106271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 11/28/2022]
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21
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Ivezaj V, Lawson JL, Lydecker JA, Duffy AJ, Grilo CM. Examination of night eating and loss-of-control eating following bariatric surgery. Eat Weight Disord 2022; 27:207-213. [PMID: 33730344 PMCID: PMC8925302 DOI: 10.1007/s40519-021-01156-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/18/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Post-operative loss-of-control (LOC)-eating is a negative prognostic indicator for long-term outcomes following bariatric surgery. Emerging research suggests that night eating might also be associated with poorer post-operative outcomes. This study examined the co-occurrence and clinical features of night eating in patients with LOC-eating following bariatric surgery. METHODS Participants were 131 adults who sought treatment for eating/weight concerns 6 months following sleeve gastrectomy. The Eating Disorder Examination (EDE) interview (Bariatric-Surgery-Version) assessed LOC-eating, regular night eating (at least weekly), and eating-disorder psychopathology. Participants completed the Night Eating Questionnaire (NEQ), Beck Depression Inventory (BDI-II), and the Pittsburgh Sleep Quality Index (PSQI). RESULTS Approximately, 15% met screening criteria for night-eating syndrome based on the NEQ. Greater NEQ scores were associated significantly with race, lower percent total weight loss (%TWL), and greater EDE, BDI-II, and PSQI scores. Similar results were observed when comparing groups with regular night eating (21.4%) versus without (78.6%); adjusting for race and %TWL revealed similar findings. DISCUSSION In post-bariatric patients with LOC-eating, 15% likely had night-eating syndrome and 21.4% engaged in regular night-eating behavior. The co-occurrence of LOC-eating and regular night eating following sleeve gastrectomy may represent a more severe subgroup with elevated psychopathology, poorer sleep and %TWL. LEVEL OF EVIDENCE Level III, evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.
| | - Jessica L Lawson
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Janet A Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Andrew J Duffy
- Department of Surgery, Yale School of Medicine, New Haven, CT, USA
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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22
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Prevention of eating disorders in obesity. NUTR HOSP 2022; 39:121-127. [DOI: 10.20960/nh.04187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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23
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Schaefer LM, Crosby RD, Machado PP. A systematic review of instruments for the assessment of eating disorders among adults. Curr Opin Psychiatry 2021; 34:543-562. [PMID: 34475351 PMCID: PMC8645259 DOI: 10.1097/yco.0000000000000746] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW The availability of psychometrically sound assessment instruments for assessing eating disorder symptomatology is crucial for both clinical practice and research. The purpose of the current review is to provide the reader with a list of psychometrically validated assessments for adults that are available within the field of eating disorders. Eating disorder interviews and self-report questionnaires were identified using online literature searches, reviewing previous review articles, and via research and/or clinical experience of the authors. The focus of the review was on (1) standard assessments that were frequently used in eating disorder research (such as the Eating Disorder Examination and Eating Attitudes Test), and (2) newer assessments that were developed over the past 5 years. Information compiled on each instrument included the purpose of the assessment, scores that can be derived, psychometric information, translations in other languages, and availability for use in research and clinical settings. RECENT FINDINGS Several recent trends in assessment instruments were identified including updates based upon Diagnostic and Statistical Manual criteria, briefer assessments, assessments for specific populations, and assessment of specific clinical features observed in people with eating disorders. SUMMARY The current review provides eating disorder clinicians and researchers a guide for making informed decisions about the selection of eating disorder assessments.
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Affiliation(s)
- Lauren M. Schaefer
- Sanford Center for Bio-behavioral Research, Fargo, ND, USA
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Ross D. Crosby
- Sanford Center for Bio-behavioral Research, Fargo, ND, USA
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA
| | - Paulo P.P. Machado
- Psychotherapy and Psychopathology Research Unit – Psychology Research Centre, School of Psychology, University of Minho, Braga, Portugal
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24
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Lawson JL, LeCates A, Ivezaj V, Lydecker J, Grilo CM. Internalized weight bias and loss-of-control eating following bariatric surgery. Eat Disord 2021; 29:630-643. [PMID: 32182194 PMCID: PMC7494529 DOI: 10.1080/10640266.2020.1731920] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Internalized weight bias (IWB), or negative weight related self-evaluation, is associated with eating-disorder psychopathology and common among patients seeking bariatric surgery, but little is known about the clinical presentation of IWB post-operatively. This study examined IWB and clinical correlates among adult patients with loss-of-control (LOC) eating post-sleeve gastrectomy surgery. METHODS Participants (N = 145) were sleeve gastrectomy patients seeking treatment for eating/weight concerns and experiencing regular LOC eating approximately 6 months following surgery. Eating-disorder features were assessed with the Eating Disorder Examination-Bariatric Surgery Version interview (EDE-BSV) and participants completed established measures assessing IWB, depression, and mental and physical components of quality of life. RESULTS IWB was not associated significantly with percent excess weight loss, age, or gender, but White participants reported significantly greater IWB than Non-White participants. IWB was significantly associated with greater eating-disorder psychopathology, depression, and lower perceived mental quality of life. Hierarchical regression analysis revealed that IWB significantly predicted variance in eating-disorder psychopathology above and beyond other related variables. CONCLUSIONS Findings suggest that IWB is common and associated with a range of heightened eating-disorder and psychosocial difficulties among patients experiencing LOC eating following bariatric surgery. Future research exploring the longitudinal post-operative prognostic significance of IWB is recommended.
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Affiliation(s)
- Jessica L Lawson
- Psychology Service, VA Connecticut Healthcare System, West Haven, Connecticut, USA.,Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Abigail LeCates
- Psychology Department, Amherst College, Amherst, Massachusetts, USA
| | - Valentina Ivezaj
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Janet Lydecker
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA
| | - Carlos M Grilo
- Psychiatry Department, Yale School of Medicine, New Haven, Connecticut, USA.,Psychiatry Department, Yale University, New Haven, Connecticut, USA
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25
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D'Alessio R, Watanabe M, Gallo IF, Manfrini S, Tuccinardi D, Bruni V. The gastro-jejunal anastomosis site influences dumping syndrome and weight regain in patients with obesity undergoing Laparoscopic Roux-en-Y Gastric Bypass. Eat Weight Disord 2021; 26:1871-1880. [PMID: 33044727 DOI: 10.1007/s40519-020-01030-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/22/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The Laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is an effective weight loss procedure. The gastro-jejunal (GJ) anastomosis required can be performed on the anterior or posterior gastric pouch wall. No studies have compared these variants in terms of efficacy and onset of dumping syndrome (DS) and weight regain (WR). We aimed at assessing the prevalence of DS in relation to the site of anastomosis together with identifying prognostic factors of DS and WR. METHODS Patients who had undergone LRYGB with anterior (AGJ) or posterior (PGJ) anastomosis in 2010-2019 were retrospectively analyzed. We collected demographic data, medical history and the prevalence of DS evaluated through the Sigstad Score, together with WR data. RESULTS 213 patients were enrolled, of which 51.6% had an AGJ and 48.4% had a PGJ. The mean follow-up time was 81 ± 18 and 27 ± 13 months in the AGJ and PGJ group, respectively (p < 0.0001). Excess weight loss was 77.59% and 94.13% in patients with AGJ and PGJ, respectively (p < 0.001). WR rate was 16% and 4% in the AGJ and PGJ population, respectively (p < 0.001). DS prevalence was 38% and 76% in the AGJ and the PGJ population, respectively (p < 0.0001). The site of anastomosis was identified as an independent predictor of DS (OR5.15; 95% CI 2.82-9.41; p < 0.0001) and WR (OR5.31; 95% CI 2.32-12.15; p < 0.0001). Obesity-related complications significantly improved after surgery independent of the anastomosis site. CONCLUSION LRYGB is effective in determining long-term weight loss and improvement of complications. AGJ is associated with lower prevalence of DS but more frequent WR. The anastomosis site is a factor to be considered when performing LRYGB. LEVEL OF EVIDENCE Level V, cross-sectional descriptive study.
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Affiliation(s)
| | - Mikiko Watanabe
- Department of Experimental Medicine, Section of Medical Pathophysiology, Food Science and Endocrinology, Sapienza University of Rome, Rome, Italy
| | | | - Silvia Manfrini
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy
| | - Dario Tuccinardi
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Via Alvaro del Portillo, 21, 00128, Rome, Italy.
| | - Vincenzo Bruni
- Obesity Surgery Unit, Campus Bio-Medico University of Rome, Rome, Italy
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Aouad P, Stedal K, Walø-Syversen G, Hay P, Lindvall Dahlgren C. Chew and spit (CHSP) in bariatric patients: a case series. J Eat Disord 2021; 9:89. [PMID: 34289898 PMCID: PMC8296715 DOI: 10.1186/s40337-021-00441-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Studies into the disordered eating behaviour of chew and spit have alluded to several cohorts more likely to engage in the behaviour, one such group being bariatric surgery candidates and patients. Weight-loss surgery candidates have received little to no attention regarding engaging in chew and spit behaviour. Changes in pre- and post- surgery eating pathology related to chew and spit behaviour has yet to be explored and described in academic literature. CASE PRESENTATION The current study reports on three cases of individual women, aged 30, 35, and 62 respectively, who indicated engagement in chew and spit. All three cases underwent bariatric surgery (two underwent gastric bypass, one underwent vertical sleeve gastrectomy). Eating pathology-including chew and spit behaviour, anxiety and depression, and adherence to the Norwegian nutritional guidelines were examined pre-operatively and post-operatively (one and two-year follow-up). At baseline (pre-surgery), two participants reported that they engaged in chew and spit, compared to one patient post-surgery. All three cases reported that they, to at least some extent, adhered to dietary guidelines post-surgery. Subjective bingeing frequency appeared to be relatively low for all three cases, further declining in frequency at one-year follow-up. At baseline, one participant reported clinically significant depression and anxiety, with no clinically significant depression or anxiety reported at follow-ups in participants that chew and spit. CONCLUSIONS The current study provides a starting point for the exploration of chew and spit as a pathological symptom of disordered eating in bariatric patients. It highlights the need to further explore chew and spit before and after weight-loss surgery.
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Affiliation(s)
- Phillip Aouad
- InsideOut Institute, University of Sydney, Sydney, Australia. .,School of Medicine, Western Sydney University, Penrith, NSW, Australia.
| | - Kristin Stedal
- Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Gro Walø-Syversen
- Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway
| | - Phillipa Hay
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Camilla Lindvall Dahlgren
- Regional Department for Eating Disorders, Oslo University Hospital, Oslo, Norway.,Department of Psychology, Bjørknes University College, Oslo, Norway
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27
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The Development of Feeding and Eating Disorders after Bariatric Surgery: A Systematic Review and Meta-Analysis. Nutrients 2021; 13:nu13072396. [PMID: 34371904 PMCID: PMC8308796 DOI: 10.3390/nu13072396] [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] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 07/11/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Patients in the postoperative period following bariatric surgery are at risk of developing eating disorders. This study aims to analyze the relation between bariatric surgery and the development and recurrence of eating disorders. Material and methods: A literature review was carried out on 15 November 2020. Fourteen studies that met the eligibility criteria were included for qualitative synthesis, and 7 studies for meta-analysis. Results: The prevalence of eating disorders in the postoperative period was 7.83%, based on the 7 studies in the meta-analysis. Binge eating disorder alone was 3.81%, which was the most significant factor, and addressed in 6 of these studies. Conclusion: The investigated studies have significant methodological limitations in assessing the relation between bariatric surgery and eating disorders, since they mostly present data on prevalence. PROSPERO CRD42019135614.
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28
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Grilo CM, Ivezaj V, Duffy AJ, Gueorguieva R. Randomized Controlled Trial of Treatments for Loss-of-Control Eating Following Bariatric Surgery. Obesity (Silver Spring) 2021; 29:689-697. [PMID: 33694287 PMCID: PMC7995173 DOI: 10.1002/oby.23124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/15/2020] [Accepted: 12/23/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Loss-of-control (LOC) eating postoperatively is a consistent predictor of suboptimal longer-term bariatric surgery outcomes. This randomized controlled trial examined the effectiveness of two guided self-help treatments (cognitive behavioral therapy [gshCBT] and behavioral weight loss [gshBWL]) compared with a control (CON) for reducing LOC eating and weight. METHODS A total of 140 patients with recurrent LOC eating approximately 6 months after bariatric surgery were randomly assigned (5:5:2 ratio) to one of three conditions: gshCBT (n = 56), gshBWL (n = 60), or CON (n = 24). Three-month treatments were delivered by trained allied health clinicians to increase generalizability to bariatric surgery settings. Independent assessments were performed by doctoral research-clinicians using established interviews/measures; posttreatment outcomes were obtained for 89% of patients. RESULTS Mixed models revealed significant improvements for LOC eating frequency and weight loss but no significant differences between treatments; race neither predicted (main effect) nor moderated (interaction effect) treatment outcomes. Intent-to-treat categorical analyses of abstinence from LOC eating (30% for gshCBT, 27% for gshBWL, 38% for CON) and proportion attaining 5% weight loss (20%, 22%, 17%) revealed no significant differences between treatments; non-White participants had a higher proportion achieving LOC eating abstinence but a lower proportion attaining 5% weight loss compared with White participants. CONCLUSIONS In this 12-week randomized controlled trial following bariatric surgery, significant LOC eating reductions and weight loss did not differ significantly between treatments. Race was associated with posttreatment categorical outcomes.
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Affiliation(s)
- Carlos M. Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
- Yale University, Department of Psychology, New Haven, CT, USA
| | - Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Andrew J Duffy
- Yale School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Ralitza Gueorguieva
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
- Yale School Public Health, Department of Biostatistics, New Haven, CT, USA
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29
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Ivezaj V, Carr MM, Brode C, Devlin M, Heinberg LJ, Kalarchian MA, Sysko R, Williams-Kerver G, Mitchell JE. Disordered eating following bariatric surgery: a review of measurement and conceptual considerations. Surg Obes Relat Dis 2021; 17:1510-1520. [PMID: 34083136 DOI: 10.1016/j.soard.2021.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 02/24/2021] [Accepted: 03/13/2021] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
| | - Meagan M Carr
- Yale University School of Medicine, New Haven, Connecticut
| | - Cassie Brode
- West Virginia University School of Medicine, West Virginia
| | - Michael Devlin
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York; New York State Psychiatric Institute, New York, New York
| | | | | | - Robyn Sysko
- Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - James E Mitchell
- University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota
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30
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Globus I, Kissileff HR, Hamm JD, Herzog M, Mitchell JE, Latzer Y. Comparison of Interview to Questionnaire for Assessment of Eating Disorders after Bariatric Surgery. J Clin Med 2021; 10:jcm10061174. [PMID: 33799746 PMCID: PMC7999484 DOI: 10.3390/jcm10061174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/22/2021] [Accepted: 02/25/2021] [Indexed: 11/16/2022] Open
Abstract
The Eating Disorder Examination Interview Bariatric Surgery Version (EDE-BSV) assesses eating pathology after bariatric surgery but requires significant training and time to administer. Consequently, we developed a questionnaire format called the Eating Disorders After Bariatric Surgery Questionnaire (EDABS-Q). This study evaluates the consistency of responsiveness between the two formats. After surgery, 30 patients completed the EDE-BSV and EDABS-Q in a restricted randomized design. Patient reported behavior for each item which was converted to a score following the Eating Disorder Examination-Questionnaire (EDE-Q) scoring scheme. Responses fell into three distributions: (1) dichotomous, (2) ordinal, or (3) unimodal. Distributions of items were not different between the two formats and order did not influence response. Tests of agreement (normal approximation of the binomial test) and association (χ2 analyses on binary data and spearman rank order correlations on ordinal items) were performed. Percent concordance was high across items (63-100%). Agreement was significant in 31 of 41 items (Bonferroni-P < 0.001). Association was significant in 10 of 21 in χ2-appropriate items (Bonferroni-P < 0.002), and the ordinal items had highly significant correlations between formats (Bonferroni-P < 0.0125). The EDABS-Q is an adequate substitute for the EDE-BSV and may be useful for research and clinical evaluation of eating pathology after bariatric surgery.
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Affiliation(s)
- Inbal Globus
- School of Public Health, University of Haifa, 199 Aba Khoushy Ave., Mount Carmel, Haifa 3498838, Israel;
- Maccabi Healthcare Services, Hamered 27, Tel-Aviv 6812509, Israel
| | - Harry R. Kissileff
- Mount Sinai Morningside Hospital, 1111 Amsterdam Avenue, New York, NY 10025, USA; (H.R.K.); (J.D.H.)
- Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
| | - Jeon D. Hamm
- Mount Sinai Morningside Hospital, 1111 Amsterdam Avenue, New York, NY 10025, USA; (H.R.K.); (J.D.H.)
- Diabetes, Obesity, and Metabolism Institute, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Pl, New York, NY 10029, USA
- Institute of Human Nutrition, Vagelos College of Physicians & Surgeons, Columbia University, 630 W 168th Street #1512, New York, NY 10032, USA
| | - Musya Herzog
- Department of Counseling & Clinical Psychology, Teachers College, Columbia University, 525 W 120th Street, New York, NY 10027, USA;
| | - James E. Mitchell
- University of North Dakota School of Medicine, 1244 Wildwood Way, Chaska, MN 55318, USA;
| | - Yael Latzer
- Faculty of Social Welfare and Health Sciences, University of Haifa, 199 Aba Khoushy Avenue, Mount Carmel, Haifa 3498838, Israel
- Eating Disorders Institution, Rambam Health Care Campus, HaAliya HaShniya St. 8, Haifa 3109601, Israel
- Correspondence: ; Tel.: +972-54-4736673 or +1-917-935-1824
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Associations between binge eating, depressive symptoms and anxiety and weight regain after Roux-en-Y gastric bypass surgery. Eat Weight Disord 2021; 26:191-199. [PMID: 31898239 DOI: 10.1007/s40519-019-00839-w] [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: 10/24/2019] [Accepted: 12/17/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Weight regain (WR) after bariatric surgery (BS) is frequent. OBJECTIVE The aim of this study was to evaluate whether the occurrence of psychiatric disorders would be associated with short- and long-term WR after BS. METHODS Ninety-six patients (77.6% female, age 40.2 ± 10.1 years, BMI of 50 ± 8.2 kg/m2) from the Obesity and Bariatric Surgery Outpatient Clinic of the Universidade Federal São Paulo completed the Questionnaire on Eating and Weight Patterns-Revised, the Beck Depression Inventory and an anxiety inventory to assess the occurrence of binge eating, depressive symptoms (DS) and anxious symptoms (AS) before and after short-term and long-term BS. RESULTS Twenty-four months after BS, the prevalence of binge eating, depression and anxiety decreased from 100 to 13%, 100 to 15% and 43 to 4%, respectively. The mean WR of 35.2 ± 17.3% of weight loss occurred in nine patients after 24 months and was associated with binge eating (p = 0.002) but not with DS or AS. At long-term follow-up (12 ± 1.5 years), 67% had a mean WR of 50.3 ± 24.9%. The prevalence of binge eating, DS and AS were 48%, 46% and 63%, respectively, in this group, and significant associations were observed between WR and binge eating (p = 0.001), DS (p = 0.029) and AS (p = 0.001). Furthermore, the number of psychiatric disorders was inversely associated with the percentage of weight loss (p < 0.05) and positively associated with WR (p < 0.05). CONCLUSION Weight regain was associated with the occurrence of binge eating in the short and long term after BS, whereas the occurrence of depressive and anxious symptoms was associated with WR only in the long term. LEVEL III Evidence obtained from well-designed cohort or case-control analytic studies.
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32
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Gradaschi R, Molinari V, Sukkar SG, De Negri P, Adami GF, Camerini G. Disordered eating and weight loss after bariatric surgery. Eat Weight Disord 2020; 25:1191-1196. [PMID: 31302883 DOI: 10.1007/s40519-019-00749-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 07/04/2019] [Indexed: 12/23/2022] Open
Abstract
PURPOSES Aberrant eating patterns are frequently observed in bariatric patients. Since bariatric operations produce alterations in food transit and in appetite/satiety balance, postoperative eating behavior changes are not surprising. METHODS 88 consecutive obese patients undergoing Roux-en-Y gastric bypass (RYGBP, 50 cases) and Sleeve Gastrectomy (SG, 38 cases) were retrospectively evaluated. Beside anthropometric data measurement, eating behavior was assessed by direct interview prior to the operation and at the first and second postoperative years: patients were considered as eating disordered (ED) when referred habitual occurrence of binge eating and nibbling/grazing. Weight loss was assessed by percent of BMI loss (% Δ BMI). Together with standard follow-up, patients received additional behavioral/dietetic support upon request. RESULTS Postoperative ED patients showed lower % Δ BMI than the not ED ones at one (30.7% ± 8,5 vs. 26.8% ± 10, p < 0.02) and two (32% ± 10.3 vs. 27.4% ± 12.9, p < 0.05) years after operation, the follow-up rate being 82% and 76%, respectively, without differences between RYGBP and SG group. After RYGBP, an improvement of eating behavior was observed (ED patients from 75 to 28% at 1 year and to 27% at 2 years), while no changes were observed after SG. In SG patients, the number of additional behavioral/dietetic support sessions throughout the follow-up was positively associated with % Δ BMI. DISCUSSION The postoperative normalization of eating pattern has a role in weight loss after bariatric surgery. Behavioral/dietetic support is indicated in all SG patient, while after RYGBP is useful only when weight loss is unsatisfactory. LEVEL OF EVIDENCE III: retrospective cohort study.
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Affiliation(s)
- Raffaella Gradaschi
- Nutritional Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Virginia Molinari
- Nutritional Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Samir Giuseppe Sukkar
- Nutritional Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Paola De Negri
- Nutritional Unit, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Gian Franco Adami
- Department of Internal Medicine, University of Genova, Largo Benzi 8, Genova, 16132, Italy.
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33
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Ivezaj V, Lydecker JA, Wiedemann AA, Duffy AJ, Grilo CM. Does Bariatric Binge-Eating Size Matter? Conceptual Model and Empirical Support. Obesity (Silver Spring) 2020; 28:1645-1651. [PMID: 32729221 PMCID: PMC7484317 DOI: 10.1002/oby.22876] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 04/09/2020] [Accepted: 05/01/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Bariatric surgery affects the quantity of food individuals can eat, yet some individuals still experience loss of control (LOC) while eating. This cross-sectional study examined a new classification system for binge/LOC eating following bariatric surgery. METHODS A total of 168 individuals who underwent bariatric surgery 6 months earlier and reported LOC eating were administered the Eating Disorder Examination-Bariatric Surgery Version interview and self-report measures of depressive symptoms, functional impairment, and physical and mental health-related quality of life. Three groups were created based on the largest LOC-eating episode determined by the Eating Disorder Examination-Bariatric Surgery Version interview as follows: (1) "traditional" objective binge-eating episodes, defined as eating unusually large quantities of food while having LOC; (2) "bariatric-objective binge eating," meaning unusually large quantities for postsurgical bariatric patients with LOC; and (3) "bariatric-subjective binge eating," meaning small quantities of food with LOC after surgery. RESULTS In total, 75% (n = 126) met criteria for the bariatric-objective binge episodes group, 10% (n = 17) met criteria for the traditional objective binge-eating group, and 15% (n = 25) met criteria for the bariatric-subjective binge episodes group. The three groups differed significantly, with a graded pattern by binge size, in global eating-disorder psychopathology, depressive symptoms, and functional impairment but not quality of life. CONCLUSIONS These findings provide empirical support for a new classification system for bariatric binge/LOC eating. Binge size was associated with distinct psychopathology. Longitudinal follow-up is needed to ascertain effects on clinical outcomes.
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Affiliation(s)
- Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Janet A. Lydecker
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | | | - Andrew J Duffy
- Yale School of Medicine, Department of Surgery, 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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Mou D, DeVries CEE, Pater N, Poulsen L, Makarawung DJS, Wiezer MJ, van Veen RN, Hoogbergen MM, Sorensen JA, Klassen AF, Pusic AL, Tavakkoli A. BODY-Q patient-reported outcomes measure (PROM) to assess sleeve gastrectomy vs. Roux-en-Y gastric bypass: eating behavior, eating-related distress, and eating-related symptoms. Surg Endosc 2020; 35:4609-4617. [PMID: 32815020 DOI: 10.1007/s00464-020-07886-w] [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: 04/09/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Post-operative changes in eating behavior, eating-related distress and eating-related symptoms play an important role in the lives of bariatric surgery patients. However, there are no studies that assess these outcomes using a specifically designed patient-reported outcome measure (PROM) for patients undergoing bariatric surgery. We use our newly developed and validated scales as part of the well-established BODY-Q PROMs to compare laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass patients (LRYGB). METHODS We analyzed data from an international multi-center prospective cohort study of patients over 18 who underwent bariatric surgery. We used multivariable linear regression models to assess the difference between LRYGB and LSG for the new BODY-Q scales, which include eating behavior, eating-related distress and eating-related symptoms. All analyses were corrected for significant confounding variables. RESULTS Out of 1420 patients, 920 underwent LRYGB and 500 underwent LSG. The LRYGB group had a higher percentage total weight loss (p < 0.001). There was no significant difference in eating behavior (e.g., stop eating before feeling full, avoiding unhealthy snacks, etc.) or eating-related distress (e.g., feeling ashamed or out of control after eating). Patients who underwent LSG scored significantly better on the post-prandial eating-related symptoms scale (e.g., vomiting, reflux; p < 0.001). Symptoms more prevalent in the LRYGB patients were related to dumping syndrome whereas symptoms more prevalent in LSG patients were related to reflux. CONCLUSION Patients who underwent LRYGB had a significantly better weight loss after surgery, but they scored worse on post-prandial symptoms in comparison to LSG patients. This information may be relevant for patients in the pre-operative counseling setting, as it may influence their decision for surgical procedure selection.
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Affiliation(s)
- Danny Mou
- Department of Surgery, Brigham and Women's Hospital, 75 Francs St., Boston, MA, 02115, USA.
| | - Claire E E DeVries
- Department of Surgery, Brigham and Women's Hospital, 75 Francs St., Boston, MA, 02115, USA
| | - Nena Pater
- Maastricht University Medical School, Maastricht, The Netherlands
| | - Lotte Poulsen
- Department of Plastic Surgery, University of Southern Denmark, Odense, Denmark
| | | | - Marinus J Wiezer
- Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Jens A Sorensen
- Department of Plastic Surgery, Odense University Hospital, Odense, Denmark
| | - Anne F Klassen
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Andrea L Pusic
- Department of Surgery, Brigham and Women's Hospital, 75 Francs St., Boston, MA, 02115, USA
| | - Ali Tavakkoli
- Department of Surgery, Brigham and Women's Hospital, 75 Francs St., Boston, MA, 02115, USA
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Wiedemann AA, Ivezaj V, Lawson JL, Lydecker JA, Cooper Z, Grilo CM. Interrater reliability of the Eating Disorder Examination among postbariatric patients. Surg Obes Relat Dis 2020; 16:1988-1993. [PMID: 32933867 DOI: 10.1016/j.soard.2020.07.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/15/2020] [Accepted: 07/31/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Clinical assessment of eating behaviors with patients who undergo bariatric surgery is challenging because of the complexity of symptom presentation postoperatively. The Eating Disorder Examination (EDE) is a widely-used semistructured clinical interview of eating-disorder psychopathology, yet no studies have examined the interrater reliability among postoperative bariatric surgery patients. OBJECTIVES The present study aimed to examine the interrater reliability of the EDE, and an alternative classification of size-specific thresholds of binge-eating episodes in a postoperative bariatric surgery sample. SETTING University School of Medicine, United States. METHODS Participants interviewed were a randomly selected subset (n = 20) from a consecutive series of adults seeking treatment for eating concerns after bariatric surgery. Audio-taped interviews were rated independently by 1 of 4 expert raters. Interrater reliability was assessed using intraclass correlation coefficients (ICC) and kappa statistic. RESULTS ICCs for the original 4 EDE subscales were excellent, ranging from .88 to .98. ICCs for the alternative brief 3 subscales were also excellent, with a range of .78 to .97. ICCs for bariatric loss-of-control eating episodes were in the good to excellent range, with a range of .66 to .99. Kappa agreement for bariatric overeating episodes was moderate (.60). CONCLUSIONS These findings, based on 4 expert raters, suggest that complex eating-disorder psychopathology, as well as the newly proposed eating behavior with size thresholds relevant to bariatric patients, can be reliably assessed. To our knowledge, this is the first study to provide initial evaluation and support for the interrater reliability of the original EDE with additional modified eating categories developed for postbariatric surgery patients.
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Affiliation(s)
- Ashley A Wiedemann
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Jessica L Lawson
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, Orange, New Haven, Connecticut
| | - Janet A Lydecker
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Zafra Cooper
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Psychology, Yale University, New Haven, Connecticut
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Robitzsch A, Schweda A, Hetkamp M, Niedergethmann M, Dörrie N, Herpertz S, Hasenberg T, Tagay S, Teufel M, Skoda EM. The Impact of Psychological Resources on Body Mass Index in Obesity Surgery Candidates. Front Psychiatry 2020; 11:649. [PMID: 32754062 PMCID: PMC7365886 DOI: 10.3389/fpsyt.2020.00649] [Citation(s) in RCA: 5] [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: 01/16/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Obesity surgery is the therapy of choice for severely obese patients. The results are promising, but at the same time obesity surgery represents a physical and psychological challenge for patients and care givers. In order to give psychosocial support adequately, more knowledge of effects of psychological profiles is required. Research is often deficit and symptom oriented. Psychological resources (competences) of individuals are often neglected. However, after surgery patients have to cope with the altered anatomic condition and therefore psychological resources are essential for a successful development and my influence also the surgical outcome. The interplay of eating behavior, depression, and psychological resources and their influence on weight are yet undetermined. METHODS A cross-sectional study in consecutive obesity surgery candidates was performed. One hundred twenty-seven participants were included (90 female, 37 male; mean BMI 49.85 kg/m²; range 36.7-84.2 kg/m²). After conducting semi-structured clinical interviews psychological resources, depression and eating behavior were assessed via three questionnaires: Essener Ressourcen-Inventar (ERI), Patient Health Questionnaire depression module (PHQ-d), and Eating Disorder Examination-Questionnaire (EDE-Q). To evaluate the influence of psychological resources on BMI mediation models and path analyses were performed. RESULTS Psychological resources do not influence BMI directly. Path analyses revealed depression as well as depression/eating behavior as mediating dimension. A first path showed that higher psychological resources are associated with less depressive symptoms and lower BMI. On the other side, a second path showed that higher psychological resources are related to less depression and by means of more conscious and controlled eating behavior to a lower BMI. CONCLUSION Psychological resources seem to be relevant in the context of obesity surgery. Good psychological resources show plausible associations with less depression and a more adequate eating behavior. The evaluation of psychological resources in obesity surgery candidates allows the identification of patients at risk. Competences of patients should be addressed in the context of surgery. Our findings build a foundation for a more individualized supportive treatment for obesity surgery candidates. Improving impaired psychological resources may help in the coping process after surgery and is supposed to lead to an even higher weight loss.
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Affiliation(s)
- Anita Robitzsch
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR Clinic Essen, Essen, Germany
| | - Adam Schweda
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR Clinic Essen, Essen, Germany
| | - Madeleine Hetkamp
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR Clinic Essen, Essen, Germany
| | | | - Nora Dörrie
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR Clinic Essen, Essen, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University, Ruhr-University Bochum, Bochum, Germany
| | - Till Hasenberg
- Helios Obestiy Center West, Helios St. Elisabeth Hospital Oberhausen, Witten/Herdecke University, Helios Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Sefik Tagay
- Faculty of Applied Social Sciences, Technical University of Köln, Köln, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR Clinic Essen, Essen, Germany
| | - Eva-Maria Skoda
- Department of Psychosomatic Medicine and Psychotherapy, University of Duisburg-Essen, LVR Clinic Essen, Essen, Germany
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Spirou D, Raman J, Smith E. Psychological outcomes following surgical and endoscopic bariatric procedures: A systematic review. Obes Rev 2020; 21:e12998. [PMID: 31994311 DOI: 10.1111/obr.12998] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 11/25/2019] [Accepted: 12/12/2019] [Indexed: 12/16/2022]
Abstract
Obesity is a leading global epidemic. Bariatric surgery is the only treatment demonstrating substantial long-term weight loss and medical benefits. However, there is limited research on the psychological outcomes following surgery. Therefore, the primary aim of this study was to systematically review depression, anxiety, and binge eating outcomes at different time points following bariatric surgery and identify whether bariatric surgery significantly reduces psychological symptoms over time. These outcomes were also examined among endoscopic bariatric procedures as a secondary aim. Forty-eight studies met inclusion criteria. Findings suggested that most patients experience a short-term reduction in anxiety and depression symptoms from pre-surgery. Over time, however, these symptoms increase and may even return to pre-surgery levels. Furthermore, while binge eating was uncommon after surgery, other disordered eating patterns may emerge. Binge eating may also restart over time as the stomach enlarges again. Overall, the complex psychological difficulties faced by individuals with obesity continue after surgery and may contribute to longer-term weight recidivism. More comprehensive and standardised psychological assessment procedures, including clinical interviews and longer-term follow-up, may provide insight into the psychological mechanisms maintaining weight management issues, and may serve as a starting point for improving the long-term success of patients with obesity.
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Affiliation(s)
- Dean Spirou
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Jayanthi Raman
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Evelyn Smith
- School of Social Sciences and Psychology, Western Sydney University, Sydney, NSW, Australia.,Translational Health Research Institute, Western Sydney University, Sydney, NSW, Australia
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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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Ivezaj V, Wiedemann AA, Lawson JL, Grilo CM. Food Addiction in Sleeve Gastrectomy Patients with Loss-of-Control Eating. Obes Surg 2020; 29:2071-2077. [PMID: 30847764 DOI: 10.1007/s11695-019-03805-8] [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] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Food addiction and binge eating share overlapping and non-overlapping features; the presence of both may represent a more severe obesity subgroup among treatment-seeking samples. Loss-of-control (LOC) eating, a key marker of binge eating, is one of the few consistent predictors of suboptimal weight outcomes post-bariatric surgery. This study examined whether co-occurring LOC eating and food addiction represent a more severe variant post-bariatric surgery. METHODS One hundred thirty-one adults sought treatment for weight/eating concerns approximately 6 months post-sleeve gastrectomy surgery. The Eating Disorder Examination-Bariatric Surgery Version assessed LOC eating, picking/nibbling, and eating disorder psychopathology. Participants completed the Yale Food Addiction Scale (YFAS), the Beck Depression Inventory-Second Edition (BDI-II), and the Short-Form Health Survey-36 (SF-36). RESULTS 17.6% met food addiction criteria on the YFAS. Compared to those without food addiction, the LOC group with food addiction reported significantly greater eating disorder and depression scores, more frequent nibbling/picking and LOC eating, and lower SF-36 functioning. CONCLUSION Nearly 18% of post-operative patients with LOC eating met food addiction criteria on the YFAS. Co-occurrence of LOC and food addiction following sleeve gastrectomy signals a more severe subgroup with elevated eating disorder psychopathology, problematic eating behaviors, greater depressive symptoms, and diminished functioning. Future research should examine whether this combination impacts long-term bariatric surgery outcomes.
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Affiliation(s)
- Valentina Ivezaj
- Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA.
| | | | - Jessica L Lawson
- Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA
| | - Carlos M Grilo
- Yale School of Medicine, 301 Cedar Street, New Haven, CT, 06519, USA.,Yale University, New Haven, CT, 06511, USA
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40
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Ahmad A, Kornrich DB, Krasner H, Eckardt S, Ahmad Z, Braslow A, Broggelwirth B. Prevalence of Dumping Syndrome After Laparoscopic Sleeve Gastrectomy and Comparison with Laparoscopic Roux-en-Y Gastric Bypass. Obes Surg 2020; 29:1506-1513. [PMID: 30635813 DOI: 10.1007/s11695-018-03699-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Dumping syndrome is a well-known side effect of laparoscopic gastric bypass (LRYGB), and it is commonly believed that dumping syndrome is less likely to occur after laparoscopic sleeve gastrectomy (LSG), due to the preservation of the pyloric sphincter. However, it is not uncommon for patients undergoing LSG at our center to report symptoms suggestive of dumping syndrome. OBJECTIVE To assess the prevalence of symptoms of dumping syndrome after LSG compared with LRYGB. SETTING A single surgical group at a high-volume (700 cases per year) Bariatric and Metabolic Surgery Center of Excellence. METHODS One thousand four hundred seventy-one LRYGB (366) and LSG (1105) patients received a questionnaire to assess symptoms of dumping syndrome, utilizing a modified version of the Sigstad scoring system. Dumping syndrome was considered to be present when the questionnaire score exceeded a threshold value. RESULTS A total of 360 responses were received (249 LSG, 111 LRYGB). 26.5% (66) LSG and 41.4% (46) LRYGB exceeded the threshold for dumping syndrome (p < 0.01). 84.8% (56) LSG and 84.7% (39) LRYGB reported early dumping syndrome (p > 0.05). Thirty-six percent (24) LSG and 28% (13) LRYGB reported late dumping syndrome (p > 0.05). Twenty-seven percent (62) LSG and 44.4% (44) LRYGB reported at least one symptom of dumping syndrome with sweets (p < 0.05). 34.3% (85) LSG and 35.5% (39) LRYGB reported symptoms when drinking with or within 30 min of a meal (p > 0.05). 14.5% (36) LSG and 17.3% (19) LRYGB reported symptoms after alcohol consumption (p > 0.05). CONCLUSION Dumping syndrome after LSG is prevalent but has not been widely reported. This finding may impact clinicians and patients in their choice of procedure and has relevance in post-operative education and care.
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Affiliation(s)
- Arif Ahmad
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA.
| | | | - Helaine Krasner
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
| | - Sarah Eckardt
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
| | - Zoha Ahmad
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
| | - AnnaMarie Braslow
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
| | - Barbara Broggelwirth
- Mather Hospital Northwell Health, 625 Belle Terre Road, Port Jefferson, NY, 11777, USA
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Janmohammadi P, Sajadi F, Alizadeh S, Daneshzad E. Comparison of Energy and Food Intake Between Gastric Bypass and Sleeve Gastrectomy: a Meta-analysis and Systematic Review. Obes Surg 2020; 29:1040-1048. [PMID: 30610675 DOI: 10.1007/s11695-018-03663-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AbstractObesity is a developed nutritional problem, and today, surgery is one of the approaches to cure it. A good understanding of the variations in food intake will be beneficial for sustaining long-term weight loss post-surgery and for improving nutrition care strategies. The purpose of this review was the comparison of the impact of two methods of gastric bypass (GBP) and sleeve gastrectomy (SG) on dietary intake. Databases of PubMed, Embase, Scopus, Google Scholar, and Web of science were used for the literature search up to June 2018. We concluded the studies that measured mean daily energy intake and the percent of macronutrients from total calorie intake of before and after GBP and SG. A total of 18 studies were finally included in the meta-analysis for the effect of bariatric surgery on food intake. Bariatric surgery significantly decreased energy intake by 1050.04 kcal/day (p < 0.001) compared with the baseline values of energy intake. The pooled effect of bariatric surgery on protein intake was 0.82 g/day (p = 0.004) compared with the baseline values. The pooled analysis found no significant impact of bariatric surgery on carbohydrate intake (WMD = 0.56 g/day; p = 0.40) compared with the baseline values. The pooled estimate of effect for bariatric surgery on fat intake was - 1.34 g/day (p = 0.006). This study demonstrates that bariatric surgery might be effective on energy and fat intake; however, there was no effect on carbohydrate intake.
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Affiliation(s)
- Parisa Janmohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Forough Sajadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Shahab Alizadeh
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Elnaz Daneshzad
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran.
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Rudolph A, Hilbert A. Cognitive-Behavioral Therapy for Postbariatric Surgery Patients With Mental Disorders: A Pilot Study. Front Psychiatry 2020; 11:14. [PMID: 32116836 PMCID: PMC7028699 DOI: 10.3389/fpsyt.2020.00014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/07/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Binge-eating disorder (BED) and major depressive disorder (MDD) following bariatric surgery are significant predictors for less post-operative weight loss and/or weight regain, however, cognitive-behavioral therapy (CBT) addressing these disorders following surgery has not been investigated so far. OBJECTIVE This study examined feasibility of a short-term CBT based on evidence-based manuals for BED and MDD that were adapted to patients following bariatric surgery, and investigated its effectiveness in improving weight loss outcome, psychopathology, and psychosocial functioning. MATERIALS AND METHODS In an uncontrolled proof-of-concept study, the CBT manual was piloted in N = 7 patients who had undergone roux-en-Y gastric bypass surgery at least 6 months before. Weight loss, eating disorder psychopathology, depressive symptoms, and self-esteem were assessed using clinical interviews and self-report questionnaires at pre-treatment, post-treatment, and in a 3-month follow-up. RESULTS A significant reduction of body weight was found as well as medium to large effects in the improvement of eating disorder psychopathology, depressive symptoms, and self-esteem from pre-treatment to post-treatment were found. Most of those changes remained stable during the 3-month follow-up period. Study retention was 71.4%. CONCLUSIONS Feasibility and effectiveness of CBT were documented for patients with BED or MDD following bariatric surgery. Adaptations of the study procedure for proof-of-efficacy in randomized-controlled studies are discussed.
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Affiliation(s)
- Almut Rudolph
- Clinical Psychology and Psychotherapy, Department of Psychology, Faculty of Life Sciences, University of Leipzig, Leipzig, Germany
| | - Anja Hilbert
- Integrated Research and Treatment Center Adiposity Diseases, Departments of Medical Psychology and Medical Sociology and Psychosomatic Medicine and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
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Lavender JM, King WC, Kalarchian MA, Devlin MJ, Hinerman A, Gunstad J, Marcus MD, Mitchell JE. Examining emotion-, personality-, and reward-related dispositional tendencies in relation to eating pathology and weight change over seven years in the Longitudinal Assessment of Bariatric Surgery (LABS) study. J Psychiatr Res 2020; 120:124-130. [PMID: 31670260 PMCID: PMC6901114 DOI: 10.1016/j.jpsychires.2019.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 12/28/2022]
Abstract
This study examined dispositional emotion-, personality/temperament-, and reward-related variables in relation to post-surgery eating pathology and weight-change among 107 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB). As part of a prospective cohort study, annual post-surgical assessments were conducted to evaluate eating pathology, using the Eating Disorder Examination-Bariatric Surgery Version, and percent weight change from pre-surgery. Dispositional measures were administered at the 6- or 7-year assessment and included the Affect Intensity Measure, Difficulties in Emotion Regulation Scale, UPPS-P Impulsive Behavior Scale, Adult Temperament Questionnaire-Effortful Control Scale, and Sensitivity to Punishment/Sensitivity to Reward Questionnaire. Results from a series of linear mixed models revealed significant associations of emotion dysregulation, affect intensity, positive and negative urgency, effortful control, and reward sensitivity with eating pathology severity across 7 years; additionally, all but two of the subscales comprising the total scores were also significantly associated. Fewer statistically significant results were found in relation to weight change; emotion dysregulation and affect intensity (along with several subscales) were significantly associated with lower percent weight change (i.e., less weight loss), but of the reward-related and personality/temperament variables, only total effortful control emerged as significant. However, the associations of the other variables with both outcomes were consistently in the expected direction. Associations also appeared consistent across surgical procedures. Taken together, findings suggest that certain dispositional tendencies may relate to less optimal long-term outcomes following bariatric surgery and thus may be useful to assess in pre-surgical or early post-surgical evaluations to inform targeted recommendations.
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Affiliation(s)
- Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Military Cardiovascular Outcomes Research Program (MiCOR), Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Metis Foundation, San Antonio, TX, USA.
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Michael J Devlin
- Columbia University Vagelos College of Physicians and Surgeons / New York State Psychiatric Institute, New York, NY, USA
| | - Amanda Hinerman
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Sekuła M, Boniecka I, Paśnik K. Bulimia nervosa in obese patients qualified for bariatric surgery - clinical picture, background and treatment. Wideochir Inne Tech Maloinwazyjne 2019; 14:408-414. [PMID: 31534571 PMCID: PMC6748054 DOI: 10.5114/wiitm.2019.81312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/27/2018] [Indexed: 11/17/2022] Open
Abstract
Eating is a basic human physiological need which is necessary to keep the body alive. Eating disorders are diagnosed when eating (or not eating) and associated body weight gain anxiety become the main interest of an individual and all other spheres of life depend on it. Bulimia nervosa is a psychiatric disorder which is more and more commonly diagnosed in patients suffering from obesity and in patients after surgical treatment of obesity. In patients eligible for bariatric surgery this disorder should be diagnosed appropriately early and treated successfully before the procedure, because bulimia nervosa does not regress spontaneously. When untreated, it may last for years, reducing the efficacy of a surgical treatment of obesity, or even lead to complications that are health- and life-threatening for patients.
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Affiliation(s)
- Marzena Sekuła
- University of Social Sciences and Humanities, University of Social Psychology, Warsaw, Poland
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
| | - Iwona Boniecka
- Department of Clinical Dietetics, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Paśnik
- Department of General, Oncological, Metabolic and Thoracic Surgery, Military Institute of Medicine, Warsaw, Poland
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Schreyer CC, Guarda AS, Pletch AW, Redgrave GW, Salwen-Deremer JK, Coughlin JW. A modified inpatient eating disorders treatment protocol for postbariatric surgery patients: patient characteristics and treatment response. Surg Obes Relat Dis 2019; 15:1612-1619. [DOI: 10.1016/j.soard.2019.06.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/07/2019] [Accepted: 06/26/2019] [Indexed: 12/26/2022]
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Gradaschi R, Molinari V, Sukkar SG, De Negri P, Adami GF, Camerini G. Effects of the Postoepartive Dietetic/Behavioral Counseling on the Weight Loss After Bariatric Surgery. Obes Surg 2019; 30:244-248. [PMID: 31444774 DOI: 10.1007/s11695-019-04146-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Weight outcomes after bariatric surgery are due to an adequate adjustment of eating behavior to the new gastrointestinal conditions created by operation. The efficacy of dietary/behavior counseling for promoting weight loss and maintenance in a growing number of bariatric patients was investigated. MATERIAL AND METHODS One hundred seventy-six non-diabetic obese patients undergoing Roux-en-Y gastric bypass (RYGBP) and sleeve gastrectomy (SG) were investigated. The first group (CO, 88 subjects, 16 male) attended a standard surgical follow-up, while in the second (DIET, 88 subjects, 15 male) the surgeon was supported by a dietitian, and patients received behavioral-dietary sessions on individual request. Data prior to the operation and at 2 years were considered, the weight outcome being regarded as successful when postoperative body mass index (BMI) value was lower than 30 kg/m2. RESULTS Weight results were better (p < 0.01) in the RYGBP than in the SG patients. In comparison to CO, in the DIET group a greater adherence to the bariatric program was observed (76% vs. 41%, < 0.01), while body weight data and prevalence of successful cases at 2 years (87 ± 23 vs. 83 ± 16 kg and 27% vs.33%, respectively) were similar. CONCLUSIONS After RYSG and SG, postoperative dietetic/behavioral sessions delivered on patient's request does not influence weight results. The dietetic intervention promotes the adherence to bariatric program and prevents postoperative follow-up loss. In a dietitian/behavioral strategy after RYGBP and SG, a cognitive reinforcement of the compliance to bariatric program and a strengthening of the motivation to changes could promote better weight results.
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Affiliation(s)
| | | | | | | | - Gian Franco Adami
- Ospedale Policlinico San Martino, Department of Internal Medicine, University of Genova, Largo Benzi 8, 16132, Genoa, Italy.
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Abstract
PURPOSE OF REVIEW The goal of this paper was to extend the prior literature on eating pathology following bariatric surgery by highlighting themes in data published over the past 3 years and identifying limitations and future directions for research. RECENT FINDINGS Changes in eating pathology after bariatric surgery remain consistent with previous research. Specifically, diagnostic prevalence rates and incidence of related behaviors generally decrease following surgery. However, some research supports that these factors increase and/or remit over time following surgery, and that they subsequently have a negative impact on weight loss outcomes. While recent findings have extended knowledge on eating pathology following bariatric surgery, the overall body of literature is still relatively limited. Additional research is needed, including work focusing on the standardization of eating pathology definitions, development/validation of standardized eating pathology instruments for bariatric surgery patients, and predictors of risk for continued or new onset eating pathology following surgery.
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Ivezaj V, Wiedemann AA, Grilo CM. Overvaluation of Weight or Shape and Loss-of-Control Eating Following Bariatric Surgery. Obesity (Silver Spring) 2019; 27:1239-1243. [PMID: 31207166 PMCID: PMC6656616 DOI: 10.1002/oby.22514] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 04/08/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Little is known regarding overvaluation of weight or shape, a key cognitive feature of eating disorders, among individuals with disordered eating following bariatric surgery. This study examined the significance of overvaluation of weight or shape among post-bariatric surgery patients with loss-of-control (LOC) eating. METHODS Participants were 145 individuals who had undergone sleeve gastrectomy within the previous 6 months and reported regular LOC eating. Overvaluation of weight or shape, LOC eating, and eating disorder psychopathology were assessed using the Eating Disorder Examination (EDE)-Bariatric Surgery Version interview; depressive symptoms and disability were assessed by the Beck Depression Inventory (BDI-II) and the Sheehan Disability Scale (SDS), respectively. RESULTS Overvaluation of weight or shape, examined continuously, was correlated significantly with higher levels of eating disorder psychopathology (EDE), depression (BDI-II), and disability (SDS). Categorically, using established clinical cut points, relative to the subclinical overvaluation group (n = 70 [48.3%]), the clinical overvaluation group (n = 75 [51.7%]) reported significantly greater frequency of LOC eating episodes and higher EDE, BDI-II, and SDS scores. The two groups did not differ significantly in current BMI or percent weight loss following surgery. CONCLUSIONS These findings, which highlight the clinical significance of overvaluation of weight or shape among patients with LOC eating following bariatric surgery, are similar to those previously reported for binge-eating disorder. Postoperatively, overvaluation of weight or shape was associated with greater eating disorder psychopathology, depression, and disability.
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Affiliation(s)
| | | | - Carlos M. Grilo
- Yale School of Medicine, New Haven, CT, 06519
- Yale University, New Haven, CT, 06511
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Lydecker JA, Ivezaj V, Grilo CM. Secretive eating and binge eating following bariatric surgery. Int J Eat Disord 2019; 52:935-940. [PMID: 31033037 PMCID: PMC6687553 DOI: 10.1002/eat.23089] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 04/12/2019] [Accepted: 04/20/2019] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Some individuals eat furtively and conceal evidence of eating, and this seems to occur beyond binge-eating episodes. This type of secretive eating is common among youth and emerging evidences suggests that it is a relevant marker of eating disorder psychopathology among adults with significant eating and weight concerns. METHOD We assessed secretive eating, loss-of-control (LOC) eating, and eating disorder psychopathology using investigator-based interviews among treatment-seeking adults experiencing LOC eating following bariatric surgery (N = 168). Participants also completed an established depression measure; height and weight were measured. RESULTS Overall, 37% of patients reported secretive eating: 54% of patients who met criteria for binge-eating disorder except for the size criterion ("bariatric BED") and 25% of patients with subthreshold bariatric BED reported secretive eating. Many clinical variables were higher among patients with secretive eating compared to those without secretive eating; however, only eating disorder psychopathology severity and body dissatisfaction remained significantly higher among patients with secretive eating compared to those without when bariatric BED status was also included as a variable in the model. DISCUSSION Findings suggest that among post-bariatric surgery patients with LOC eating, secretive eating signals more severe eating disorder psychopathology overall and specifically related to dissatisfaction with weight and shape. Bariatric BED status, however, has a stronger association than secretive eating with many clinical variables. Secretive eating should be assessed and considered when addressing weight and shape concerns among patients experiencing LOC eating after bariatric surgery.
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Affiliation(s)
| | | | - Carlos M. Grilo
- Yale School of Medicine, New Haven, CT, 06519
- Yale University, New Haven, CT, 06511
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Psychometric properties of the eating loss of control scale among postbariatric patients. Surg Obes Relat Dis 2019; 15:1829-1835. [PMID: 31494065 DOI: 10.1016/j.soard.2019.06.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 06/03/2019] [Accepted: 06/30/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Assessing the complexities of eating behaviors in patients who undergo bariatric surgery is challenging. The Eating Loss of Control Scale (ELOCS), a measure of loss-of-control (LOC) eating, has not yet been evaluated psychometrically among bariatric surgery patients. OBJECTIVE This study presents a psychometric examination of the ELOCS in postoperative bariatric surgery patients. SETTING Academic medical center in the United States. METHODS One hundred seventy-one postbariatric treatment-seeking adults (82.5% female, 52.4% white) with LOC eating completed the ELOCS and measures assessing eating psychopathology and mood. Confirmatory factor analysis (CFA) was used to test fit for a 1-factor solution. Exploratory factor analysis (EFA) examined alternative factor structures. RESULTS CFA revealed poor fit for a 1-factor structure (χ2 = 220.375, degrees of freedom = 135, P < .001, comparative fit index = .917, Tucker-Lewis index = .906, root mean square error of approximation = .067). EFA data suggested an alternative factor solution (χ2 = 157.76, degrees of freedom = 118, P = .009, comparative fit index = .965, Tucker-Lewis index = .955, root mean square error of approximation = .047). Factor 1 (α = .88) reflected behavioral aspects and factor 2 (α = .92) reflected cognitive/emotional aspects of LOC eating. Bivariate correlations with measures of eating and other psychopathology suggested good construct validity for factors. CONCLUSIONS Findings suggest possible differences in the construct validity of the ELOCS among postbariatric patients. The 1-factor solution previously supported in clinical and nonclinical groups demonstrated poor fit. EFA revealed a possible alternative 2-factor solution that aligns with emerging literature, suggesting that LOC eating presents differently in postbariatric patients. Researchers interested in LOC eating among bariatric patients should consider use of the ELOCS and testing the proposed alternative factor structure.
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