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La Marra M, Messina A, Ilardi CR, Staiano M, Di Maio G, Messina G, Polito R, Valenzano A, Cibelli G, Monda V, Chieffi S, Iavarone A, Villano I. Factorial Model of Obese Adolescents: The Role of Body Image Concerns and Selective Depersonalization-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11501. [PMID: 36141782 PMCID: PMC9517425 DOI: 10.3390/ijerph191811501] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The relationship binding body weight to psychological well-being is unclear. The present study aims at identifying the contribution, and specificity, of some dimensions (i.e., eating-related symptoms, body image disorders, eating habits, personality traits, and emotional difficulties) characterizing the psychological profile of obese adolescents (749 participants, 325 females; 58.3% normal-weight, 29.9% overweight, and 11.7% obese; mean age = 16.05, SD = 0.82). METHODS By introducing the scores obtained by standardized self-report tools into a generalized linear model, a factorial reduction design was used to detect the best fitting discriminant functions and the principal components explaining the higher proportion of the variance. RESULTS We found two discriminant functions correctly classifying 87.1% of normal-weight, 57.2% of overweight, and 68.2% of obese adolescents. Furthermore, two independent factors, explaining 69.68% of the total variance, emerged. CONCLUSIONS The first factor, "Body Image Concerns", included the drive for thinness, body dissatisfaction, and interpersonal distrust. The second factor, "Selective Depersonalization", included a trend toward depersonalization and dissatisfaction with the torso. The neurophysiological implications of our findings will be discussed.
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Affiliation(s)
- Marco La Marra
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Ciro Rosario Ilardi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
- Department of Psychology, University of Campania “Luigi Vanvitelli”, 81100 Caserta, Italy
| | - Maria Staiano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Girolamo Di Maio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71100 Foggia, Italy
| | - Vincenzo Monda
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, 80133 Naples, Italy
| | - Sergio Chieffi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
| | - Alessandro Iavarone
- Neurological Unit, CTO Hospital, AORN “Ospedali dei Colli”, 80131 Naples, Italy
| | - Ines Villano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy
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La Marra M, Ilardi CR, Villano I, Polito R, Sibillo MR, Franchetti M, Caggiano A, Strangio F, Messina G, Monda V, Di Maio G, Messina A. Higher general executive functions predicts lower body mass index by mitigating avoidance behaviors. Front Endocrinol (Lausanne) 2022; 13:1048363. [PMID: 36440204 PMCID: PMC9681800 DOI: 10.3389/fendo.2022.1048363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 10/20/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The present study examines the relationship between obesity, executive functions, and body image in a nonclinical population from southern Italy. METHODS General executive functioning (Frontal Assessment Battery-15), and body image disturbances (Body Uneasiness Test) were assessed in a sample including 255 participants (138 females, M age = 43.51 years, SD = 17.94, range = 18-86 years; M body mass index (BMI) = 26.21, SD = 4.32, range = 18.03-38.79). FINDINGS Multiple Linear Regression Analysis indicated that age, years of education, FAB15 score, body image concerns, and avoidance predicted the variance of BMI. A subsequent mediation analysis highlighted that the indirect effect of FAB15 on BMI through avoidance was statistically significant. INTERPRETATION Our results suggest that more performing executive functioning predicts a decrease in BMI that is partially due to the mitigation of avoidance behaviors.
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Affiliation(s)
- Marco La Marra
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Ciro Rosario Ilardi
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- Department of Psychology, University of Campania “Luigi Vanvitelli”, Caserta, Italy
| | - Ines Villano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
- *Correspondence: Ines Villano,
| | - Rita Polito
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Maria Raffella Sibillo
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Marina Franchetti
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Angela Caggiano
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Francesca Strangio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Vincenzo Monda
- Department of Movement Sciences and Wellbeing, University of Naples “Parthenope”, Naples, Italy
| | - Girolamo Di Maio
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Antonietta Messina
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy
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Li MK, Sathiyamoorthy T, Regina A, Strom M, Toulany A, Hamilton J. "Your own pace, your own path": perspectives of adolescents navigating life after bariatric surgery. Int J Obes (Lond) 2021; 45:2546-2553. [PMID: 34385587 PMCID: PMC8359630 DOI: 10.1038/s41366-021-00928-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/19/2021] [Accepted: 07/23/2021] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Bariatric surgery, an established weight-loss tool, may be offered to some adolescents with severe obesity. However, few studies explore adolescents' postoperative experiences beyond physical and metabolic outcomes and quality-of-life measures. METHODS Between 2016 and 2021, 45 semi-structured interviews were conducted with adolescents (16-20 years) at 6 months (N = 15), 12 months (N = 15), and 24 months (N = 15) following bariatric surgery. A deductive thematic analysis framework was applied by two independent coders (Cronbach's α = 0.84). Themes were identified and refined iteratively, and discrepancies were resolved through discussion. RESULTS Five major themes emerged related to: (1) weight-loss expectations vs. reality, (2) social landscape, (3) body image, (4) eating and moving, and (5) challenges for long-term success. The pace of and satisfaction with weight loss and side effects was heterogenous among participants, with most changes occurring early and stabilizing by 24 months. Adolescents adapted over time to their new social landscapes (e.g., relationships) and reported improved body image and confidence, yet persistently struggled to reconcile their internal identity with evolving external perceptions and discomfort with new attention. Participants experienced changes to lifestyle routines after surgery (e.g., eating, moving, habits), which introduced distress at 6 months but resolved over time. Life transitions in early adulthood (e.g., moving away, university/college, employment), concurrent with their evolving and increasing autonomy, physical, social, and financial independence, imposed unexpected challenges to postoperative routines and support systems. Participants unanimously reaffirmed that bariatric surgery is a lifelong journey and that they were committed to long-term success. CONCLUSION Our findings provide insight into optimizing adolescent selection for bariatric surgery and perioperative support. Specifically, important life transitions during this developmental period impact postoperative experiences and outcomes and adolescents may benefit from postoperative counseling focused on managing weight-loss expectations and adapting to evolving nutritional needs and changing social circumstances.
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Affiliation(s)
- Ming K Li
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Andrea Regina
- Department of Psychology, The Hospital for Sick Children, Toronto, ON, Canada.,Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Michele Strom
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada
| | - Alene Toulany
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Adolescent Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jill Hamilton
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada. .,Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.
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Moore JM, Glover JJ, Jackson BM, Coughlin CR, Kelsey MM, Inge TH, Boles RE. Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation. Surg Obes Relat Dis 2021; 17:425-433. [PMID: 33191162 PMCID: PMC7880864 DOI: 10.1016/j.soard.2020.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 08/16/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND As severe obesity continues to rise among youth, metabolic and bariatric surgery (MBS) will increasingly be used as a treatment of choice for durable weight loss and improvement of obesity-related complications. MBS for youth with intellectual and developmental disabilities (IDD) and for preadolescents has raised ethical questions. OBJECTIVES The purpose of this article is to present the creation and application of an ethical framework that supports why MBS should be considered in pediatrics based on the principle of justice without automatic exclusions. This framework also provides a guide for how to conduct a robust, ethically grounded evaluation of pediatric patients presenting for MBS in general, and among subpopulations including youth with IDD and preadolescents. SETTING Academic medical center, United States. METHODS An ethical framework was developed and applied through a collaboration between an MBS center at a children's hospital and the institution's ethics consult service. RESULTS Application of the ethical framework to address 4 core ethical questions is illustrated using 2 hypothetical cases: 1 that highlights an adolescent with IDD and 1 that highlights a preadolescent. CONCLUSIONS We have demonstrated the application of a novel, overarching framework to conduct the ethical evaluation of youth presenting for MBS. This framework resulted from a collaboration between MBS and ethics consult teams and has the potential to be used as a prototype for other youth-focused MBS programs. Next steps include prospective data collection to test the framework and determine its validity in the target population.
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Affiliation(s)
- Jaime M Moore
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
| | - Jacqueline J Glover
- Department of Pediatrics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
| | - Brian M Jackson
- Department of Pediatrics, Section of Pediatric Critical Care, Center for Bioethics and Humanities, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Curtis R Coughlin
- Department of Pediatrics, Center for Bioethics and Humanities, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan M Kelsey
- Department of Pediatrics, Section of Endocrinology, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Thomas H Inge
- Department of Surgery, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Richard E Boles
- Department of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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Gero D, File B, Hinrichs N, Mueller M, Ulbert I, Somogyvári Z, Bueter M. Mental and emotional representations of "weight loss": free-word association networks in members of bariatric surgery-related social media communities. Surg Obes Relat Dis 2020; 16:1312-1320. [PMID: 32665114 DOI: 10.1016/j.soard.2020.05.032] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 04/02/2020] [Accepted: 05/21/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Mindset and communication barriers may hinder the acceptance of bariatric surgery (BS) by the eligible patient population. OBJECTIVES To improve the understanding of expectations, opinions, emotions, and attitudes toward weight loss among patients with obesity. SETTING Switzerland, Germany, Austria. METHODS Survey data collected from BS-related social media communities (n = 1482). Participants were asked to write 5 words that first came to their mind about "weight loss," and to select 2 emotions, which best described their corresponding feelings. Demographic and obesity-related data were collected. Cognitive representations were constructed based on the co-occurrence network of associations, using validated data-driven methodology. RESULTS Respondents were Caucasian (98%), female (94%), aged 42.5 ± 10.1 years, current/highest lifetime body mass index = 36.9 ± 9/50.7 ± 8.7 kg/m2. The association network analysis revealed the following 2 cognitive modules: benefit-focused (health, attractiveness, happiness, agility) and procedure-focused (effort, diet, sport, surgery). Patients willing to undergo BS were more benefit-focused (odds ratio [OR] = 2.4, P = .02) and expressed more "hope" (OR = 142, P < .001). History of BS was associated with higher adherence to the procedure-focused module (OR = 2.3, P < .001), and with increased use of the emotions "gratitude" (OR = 107, P < .001), "pride" (OR = 15, P < .001), and decreased mention of "hope" (OR = .03, P < .001). CONCLUSION Patients with obesity in our study tend to think about weight loss along 2 cognitive schemes, either emphasizing its expected benefits or focusing on the process of achieving it. Benefit-focused respondents were more likely to consider BS, and to express hope rather than gratitude or pride. Novel communication strategies may increase the acceptance of BS by incorporating weight loss-related cognitive and emotional content stemming from patients' free associations.
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Affiliation(s)
- Daniel Gero
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Bálint File
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary; Wigner Research Centre for Physics, Hungarian Academy of Sciences, Budapest, Hungary
| | - Noreen Hinrichs
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Matteo Mueller
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - István Ulbert
- Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary; Institute of Cognitive Neuroscience and Psychology, Research Centre for Natural Sciences, Budapest, Hungary
| | - Zoltán Somogyvári
- Wigner Research Centre for Physics, Hungarian Academy of Sciences, Budapest, Hungary
| | - Marco Bueter
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.
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Psychosocial Outcomes Following Adolescent Metabolic and Bariatric Surgery: a Systematic Review and Meta-Analysis. Obes Surg 2020; 29:3653-3664. [PMID: 31388963 DOI: 10.1007/s11695-019-04048-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Metabolic and bariatric surgery is an effective strategy to curb the natural history of obesity progression and improve psychosocial status in the short term for adolescents with severe obesity. The medium- and long-term psychosocial impact of bariatric surgery in this population is not established. METHODS We searched MEDLINE (Ovid), EMBASE, Web of Science, PsycInfo, and the Cochrane Libraries through October 2017 for reports of weight loss surgery (roux-en-Y gastric bypass, sleeve gastrectomy, and adjustable gastric banding) on adolescents with severe obesity (age ≤ 21 years) having ≥ 6 months of follow-up. The primary outcome for inclusion in systematic review was use of a validated quality of life (QoL) or other psychosocial instrument at baseline and postoperatively. We used standardized mean difference (SMD) and random-effects modeling to provide summary estimates across different instruments. RESULTS We reviewed 5155 studies, of which 20 studies met inclusion criteria for qualitative synthesis. There were 14 studies and 9 unique cohorts encompassing 573 patients which were eligible for meta-analysis regarding postoperative change in QoL. Across surgical procedures, there was significant improvement in QoL of 1.40 SMD (95% confidence interval 0.95 to 1.86; I2 = 89%; p < 0.001) at last follow-up (range 9-94 months). Trends in QoL improvement demonstrated the greatest improvement at 12 months; however, significant improvement was sustained at longest follow-up of 60+ months. CONCLUSIONS Weight loss surgery is associated with sustained improvement in QoL for adolescents with severe obesity across surgical procedures. Long-term data for psychosocial outcomes reflecting other mental health domains is lacking.
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Viner RM, Kinra S, Christie D, Cole TJ, Costa S, Croker H, Fry T, Hsia Y, Hudson L, Kessel AS, Morris S, Nazareth I, Nicholls D, Park MH, Saxena S, Taylor B, White B, Wong IC. Improving the assessment and management of obesity in UK children and adolescents: the PROMISE research programme including a RCT. PROGRAMME GRANTS FOR APPLIED RESEARCH 2020. [DOI: 10.3310/pgfar08030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BackgroundFive linked studies were undertaken to inform identified evidence gaps in the childhood obesity pathway.Objectives(1) To scope the impact of the National Child Measurement Programme (NCMP) (study A). (2) To develop a brief evidence-based electronic assessment and management tool (study B). (3) To develop evidence-based algorithms for identifying the risk of obesity comorbidities (study B). (4) To conduct an efficacy trial of the Healthy Eating and Lifestyle Programme (HELP) (study C). (5) To improve the prescribing of anti-obesity drugs in UK adolescents (study D). (6) To investigate the safety, outcomes and predictors of outcome of adolescent bariatric surgery in the UK (study E).MethodsFive substudies – (1) a parental survey before and after feedback from the National Childhood Measurement Programme, (2) risk algorithm development and piloting of a new primary care management tool, (3) a randomised controlled trial of the Healthy Eating and Lifestyle Programme, (4) quantitative and qualitative studies of anti-obesity drug treatment in adolescents and (5) a prospective clinical audit and cost-effectiveness evaluation of adolescent bariatric surgery in one centre.ResultsStudy A – before the National Childhood Measurement Programme feedback, three-quarters of parents of overweight and obese children did not recognise their child to be overweight. Eighty-seven per cent of parents found the National Childhood Measurement Programme feedback to be helpful. Feedback had positive effects on parental knowledge, perceptions and intentions. Study B – risk estimation models for cardiovascular and psychosocial comorbidities of obesity require further development. An online consultation tool for primary care practitioners is acceptable and feasible. Study C – the Healthy Eating and Lifestyle Programme, when delivered in the community by graduate mental health workers, showed no significant effect on body mass index at 6 months (primary outcome) when compared with enhanced usual care. Study D – anti-obesity drugs appear efficacious in meta-analysis, and their use has expanded rapidly in the last decade. However, the majority of prescriptions are rapidly discontinued after 1–3 months of treatment. Few young people described positive experiences of anti-obesity drugs. Prescribing was rarely compliant with the National Institute for Health and Care Excellence guidance. Study E – bariatric surgery appears safe, effective and highly cost-effective in adolescents in the NHS.Future work and limitationsWork is needed to evaluate behaviour and body mass index change in the National Childhood Measurement Programme more accurately and improve primary care professionals’ understanding of the National Childhood Measurement Programme feedback, update and further evaluate the Computer-Assisted Treatment of CHildren (CATCH) tool, investigate delivery of weight management interventions to young people from deprived backgrounds and those with significant psychological distress and obtain longer-term data on anti-obesity drug use and bariatric surgery outcomes in adolescence.Trial registrationCurrent Controlled Trials ISRCTN99840111.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 8, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Russell M Viner
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Sanjay Kinra
- Department of Genetics and Adolescent Paediatrics, London School of Hygiene & Tropical Medicine, London, UK
| | - Deborah Christie
- Department of Behavioural Science and Health, University College London Hospitals NHS Foundation Trust, London, UK
| | - Tim J Cole
- Department of Infection, Immunology and Inflamation, Institute of Child Health, University College London, London, UK
| | - Silvia Costa
- Population, Policy and Practice Programme, Institute of Child Health, University College London, London, UK
| | - Helen Croker
- The Obesity and Policy Research Unit, Institute of Child Health, University College London, London, UK
| | - Tam Fry
- Child Growth Foundation, Edgware, UK
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University of London, London, UK
| | - Lee Hudson
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Anthony S Kessel
- Director of Global Public Health, Public Health England, London, UK
| | - Steve Morris
- Centre of Applied Health Research, University College London, London, UK
| | - Irwin Nazareth
- Research Department of Primary Care and Population Science, University College London, London, UK
| | - Dasha Nicholls
- Feeding and Eating Disorders Team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Min Hae Park
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sonia Saxena
- Faculty of Medicine, Imperial College London, London, UK
| | - Barry Taylor
- Paediatrics and Child Health, The Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Billy White
- Department for Children’s and Young People’s Diabetes, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ian C Wong
- Research Department of Practice and Policy, University College London School of Pharmacy, University College London, London, UK
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Varns JA, Fish AF, Eagon JC. Testing a model of body image in the bariatric surgery patient. Appl Nurs Res 2020; 52:151228. [PMID: 31955943 DOI: 10.1016/j.apnr.2019.151228] [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: 06/23/2019] [Revised: 10/24/2019] [Accepted: 12/21/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose was to test a published model of body image in the bariatric surgery patient in the clinical office setting. BACKGROUND A model was created based on clinical observations during field work and the literature. It focuses on five concepts of body image: body attitude, body checking, appearance orientation, perceived body size, and perceived body space. Testing this model 3 months after surgery is important because morphology changes rapidly influencing early changes in body image, yet there is a paucity of research at this time point. METHODS For this study of 67 bariatric surgery patients, sequential sampling was used. Body image and anthropometric measures (body mass index and other weight loss indicators) were obtained at baseline and 3-months postoperatively. Established model testing criteria were used. RESULTS Over 3 months, mean body mass index was significantly reduced. Mean body image was significantly improved regarding all concepts in the model, except body checking. Body image improvement varied widely when individual responses were examined. CONCLUSIONS The model was successfully tested. Data on the five concepts in the model provided a body image profile at 3 months indicating individuals' degree of improvement. Areas of non-improvement in the early postoperative phase may signal the need for interventions, like support or psychological counseling, for patients who might be struggling with views of themselves after surgery. Preliminary recommendations are made regarding several of the instruments and their use clinically. Researchers should take into consideration the study's short 3-month time frame when designing future studies.
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Affiliation(s)
- Julie A Varns
- St. John's College of Nursing, 729 East Carpenter, Springfield, IL 62702, United States of America.
| | - Anne F Fish
- College of Nursing, University of Missouri, One University Blvd., St. Louis, MO. 63121, United States of America.
| | - J Christopher Eagon
- Washington University School of Medicine, 4921 Parkview Place, Suite C, Floor 8, St. Louis, MO 63110, United States of America.
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Reiter-Purtill J, Ley S, Kidwell KM, Mikhail C, Austin H, Chaves E, Rofey DL, Jenkins TM, Inge TH, Zeller MH. Change, predictors and correlates of weight- and health-related quality of life in adolescents 2-years following bariatric surgery. Int J Obes (Lond) 2019; 44:1467-1478. [PMID: 31209270 PMCID: PMC6918011 DOI: 10.1038/s41366-019-0394-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/03/2019] [Accepted: 04/19/2019] [Indexed: 01/27/2023]
Abstract
Background/Objectives: Weight-related quality of life (WRQOL) and generic health-related quality of life (HRQOL) have been identified as important patient reported outcomes for obesity treatment and outcome research. This study evaluated patterns of WRQOL and HRQOL outcomes for adolescents at 24-months post-bariatric surgery relative to a non-surgical comparator sample of youth with severe obesity, and examined potential weight-based (e.g., BMI, weight dissatisfaction) and psychosocial predictors and correlates of these outcomes. Subjects/Methods: Multi-site data from 139 adolescents undergoing bariatric surgery (Mage=16.9; 79.9% female, 66.2% White; MBody Mass Index [BMI]= 51.5kg/m2) and 83 comparators (Mage=16.1; 81.9 % female, 54.2% White; MBMI= 46.9kg/m2) were collected at pre-surgery/baseline, 6-, 12-, and 24-months post-surgery/baseline with high participation rates across time points (>85%). Self-reports with standardized measures of WRQOL/HRQOL as well as predictors/covariates (e.g., weight dissatisfaction, social support, peer victimization, family dysfunction, loss of control eating, self-worth, and internalizing symptoms) were obtained. Growth curve models using structural equation modeling examined WRQOL/HRQOL over time and linear regressions examined predictors and correlates of WRQOL/HRQOL outcomes. Results: Significant improvement in WRQOL and Physical HRQOL, particularly in the first post-operative year with a leveling off subsequently, was found for the surgical group relative to comparators, but with no significant Mental HRQOL change. At 24 months, the surgical group had signficantly greater WRQOL/HRQOL across most subscales. Within the surgical group at 24 months, weight-based variables were signficantly associated with WRQOL and Physical HRQOL, but not Mental HRQOL. Mental HRQOL was associated with greater internalizing symptoms and loss of control eating. Conclusions: For adolescents undergoing bariatric surgery, most clinically meaningful changes in WRQOL and Physical HRQOL occurred early post-operatively, with weight-based variables as the primary drivers of 24-month levels. In contrast, expectations for Mental HRQOL improvement following surgery should be tempered, with 24-month levels significantly associated with psychosocial rather than weight-based correlates.
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Affiliation(s)
| | - Sanita Ley
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | | | - Heather Austin
- University of Alabama at Birmingham, Birmingham, AL, USA
| | - Eileen Chaves
- Nationwide Children's Hospital Medical Center, Columbus, OH, USA
| | - Dana L Rofey
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Todd M Jenkins
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Meg H Zeller
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Ivezaj V, Grilo CM. The complexity of body image following bariatric surgery: a systematic review of the literature. Obes Rev 2018; 19:1116-1140. [PMID: 29900655 PMCID: PMC6296375 DOI: 10.1111/obr.12685] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 01/30/2018] [Accepted: 02/03/2018] [Indexed: 12/16/2022]
Abstract
Poor body image is common among individuals seeking bariatric surgery and is associated with adverse psychosocial sequelae. Following massive weight loss secondary to bariatric surgery, many individuals experience excess skin and associated concerns, leading to subsequent body contouring procedures. Little is known, however, about body image changes and associated features from pre-to post-bariatric surgery and subsequent body contouring. The objective of the present study was to conduct a comprehensive literature review of body image following bariatric surgery to help inform future clinical research and care. The articles for the current review were identified by searching PubMed and SCOPUS and references from relevant articles. A total of 60 articles examining body image post-bariatric surgery were identified, and 45 did not include body contouring surgery. Overall, there was great variation in standards of reporting sample characteristics and body image terms. When examining broad levels of body image dissatisfaction, the literature suggests general improvements in certain aspects of body image following bariatric surgery; however, few studies have systematically examined various body image domains from pre-to post-bariatric surgery and subsequent body contouring surgery. In conclusion, there is a paucity of research that examines the multidimensional elements of body image following bariatric surgery.
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Affiliation(s)
- V Ivezaj
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - C M Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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Pedroso FE, Angriman F, Endo A, Dasenbrock H, Storino A, Castillo R, Watkins AA, Castillo-Angeles M, Goodman JE, Zitsman JL. Weight loss after bariatric surgery in obese adolescents: a systematic review and meta-analysis. Surg Obes Relat Dis 2017; 14:413-422. [PMID: 29248351 DOI: 10.1016/j.soard.2017.10.003] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 09/18/2017] [Accepted: 10/03/2017] [Indexed: 01/06/2023]
Abstract
Of adolescents in the United States, 20% have obesity and current treatment options prioritize intensive lifestyle interventions that are largely ineffective. Bariatric surgery is increasingly being offered to obese adolescent patients; however, large-scale effectiveness data is lacking. We used MEDLINE, Embase, and Cochrane databases, and a manual search of references to conduct a systematic review and meta-analysis on overall weight loss after gastric band, gastric sleeve, and gastric bypass in obese adolescent patients (age ≤19) and young adults (age ≤21) in separate analyses. We provided estimates of absolute change in body mass index (BMI, kg/m2) and percent excess weight loss across 4 postoperative time points (6, 12, 24, and 36 mo) for each surgical subgroup. Study quality was assessed using a 10 category scoring system. Data were extracted from 24 studies with 4 having multiple surgical subgroups (1 with 3, and 3 with 2 subgroups), totaling 29 surgical subgroup populations (gastric band: 16, gastric sleeve: 5, gastric bypass: 8), and 1928 patients (gastric band: 1010, gastric sleeve: 139, gastric bypass: 779). Mean preoperative BMI (kg/m2) was 45.5 (95% confidence interval [CI]: 44.7, 46.3) in gastric band, 48.8 (95%CI: 44.9, 52.8) in gastric sleeve, and 53.3 (95%CI: 50.2, 56.4) in gastric bypass patients. The short-term weight loss, measured as mean (95%CI) absolute change in BMI (kg/m2) at 6 months, was -5.4 (-3.0, -7.8) after gastric band, -11.5 (-8.8, -14.2) after gastric sleeve, and -18.8 (-10.9, -26.6) after gastric bypass. Weight loss at 36 months, measured as mean (95%CI) absolute change in BMI (kg/m2) was -10.3 (-7.0, -13.7) after gastric band, -13.0 (-11.0, -15.0) after gastric sleeve, and -15.0 (-13.5, -16.5) after gastric bypass. Bariatric surgery in obese adolescent patients is effective in achieving short-term and sustained weight loss at 36 months; however, long-term data remains necessary to better understand its long-term efficacy.
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Affiliation(s)
- Felipe E Pedroso
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York.
| | | | - Atsushi Endo
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Hormuzdiyar Dasenbrock
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Neurological Surgery, Brigham and Women's Hospital. Harvard Medical School, Boston, Massachusetts
| | | | - Ricardo Castillo
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Ammara A Watkins
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | - Julie E Goodman
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jeffrey L Zitsman
- Department of Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Department of Surgery, Division of Pediatric Surgery, Center for Adolescent Bariatric Surgery, New York Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York
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A 5-Year Follow-Up Study of Laparoscopic Sleeve Gastrectomy Among Morbidly Obese Adolescents: Does It Improve Body Image and Prevent and Treat Diabetes? Obes Surg 2017; 28:513-519. [DOI: 10.1007/s11695-017-2884-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Mölbert SC, Sauer H, Dammann D, Zipfel S, Teufel M, Junne F, Enck P, Giel KE, Mack I. Multimodal Body Representation of Obese Children and Adolescents before and after Weight-Loss Treatment in Comparison to Normal-Weight Children. PLoS One 2016; 11:e0166826. [PMID: 27875563 PMCID: PMC5119783 DOI: 10.1371/journal.pone.0166826] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 11/05/2016] [Indexed: 12/29/2022] Open
Abstract
Objective The aim of the study was to investigate whether obese children and adolescents have a disturbed body representation as compared to normal-weight participants matched for age and gender and whether their body representation changes in the course of an inpatient weight-reduction program. Methods Sixty obese (OBE) and 27 normal-weight (NW) children and adolescents (age: 9–17) were assessed for body representation using a multi-method approach. Therefore, we assessed body size estimation, tactile size estimation, heartbeat detection accuracy, and attitudes towards one’s own body. OBE were examined upon admission and before discharge of an inpatient weight-reduction program. NW served as cross-sectional control group. Results Body size estimation and heartbeat detection accuracy were similar in OBE and NW. OBE overestimated sizes in tactile size estimation and were more dissatisfied with their body as compared to NW. In OBE but not in NW, several measures of body size estimation correlated with negative body evaluation. After weight-loss treatment, OBE had improved in heartbeat detection accuracy and were less dissatisfied with their body. None of the assessed variables predicted weight-loss success. Conclusions Although OBE children and adolescents generally perceived their body size and internal status of the body accurately, weight reduction improved their heartbeat detection accuracy and body dissatisfaction.
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Affiliation(s)
- Simone Claire Mölbert
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- Max Planck Institute for Biological Cybernetics, Tübingen, Germany
- Graduate Training Centre of Neuroscience, International Max Planck Research School, University Tübingen, Tübingen, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Dirk Dammann
- Fachkliniken Wangen i.A., Children Rehabilitation Hospital for Respiratory Diseases, Allergies and Psychosomatics, Wangen i.A., Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Hospital, Tübingen, Germany
- * E-mail:
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White B, Doyle J, Colville S, Nicholls D, Viner RM, Christie D. Systematic review of psychological and social outcomes of adolescents undergoing bariatric surgery, and predictors of success. Clin Obes 2015; 5:312-24. [PMID: 26541244 DOI: 10.1111/cob.12119] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 09/16/2015] [Indexed: 01/20/2023]
Abstract
The psychological and social outcomes of bariatric surgery in adolescents, together with psychological and social predictors of success, were systematically reviewed. PubMed, EMBASE, ISI Web of Science and PsychInfo were searched on July 2014. Existing data were sparse; 15 were suitable for qualitative review and six for meta-analysis (four quality of life [QOL], two depression). One study was a randomized controlled trial. A total of 139 subjects underwent Roux-en-Y gastric bypass, 202 underwent adjustable gastric band and 64 underwent sleeve gastrectomy. Overall QOL improved after bariatric surgery, regardless of surgical type with peak improvement at 6-12 months. Meta-analysis of four studies showed changed in overall QOL at latest follow-up of 2.80 standard deviation (SD) (95% confidence interval [CI] 1.23-4.37). Depression improved across all studies, regardless of procedure (effect size -0.47 SD [95% CI -0.76, -0.18] at 4-6 months). Two cohorts reported changes in both overall QOL and depression following a quadratic trajectory, with overall improvement over 2 years and deterioration in the second post-operative year. There were limited data on other psychological and social outcomes. There were insufficient data on psychosocial predictors of outcome to form evidence-based recommendations for patient selection for bariatric surgery at this time.
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Affiliation(s)
- B White
- Department of Population Health Sciences, UCL Institute of Child Health, London, UK
- Department of Paediatric and Adolescent Medicine, University College London Hospital, London, UK
| | - J Doyle
- Department of Child and Adolescent Psychological Services, University College London Hospital, London, UK
| | - S Colville
- Department of Child and Adolescent Psychological Services, University College London Hospital, London, UK
| | - D Nicholls
- Feeding and Eating Disorders Service, Department of Child and Adolescent Mental Health, Great Ormond Street Hospital, London, UK
| | - R M Viner
- Department of Population Health Sciences, UCL Institute of Child Health, London, UK
- Department of Paediatric and Adolescent Medicine, University College London Hospital, London, UK
| | - D Christie
- Department of Population Health Sciences, UCL Institute of Child Health, London, UK
- Department of Child and Adolescent Psychological Services, University College London Hospital, London, UK
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Schneider NM, Tully CB, Washington GA, Price KL. Information needs among adolescent bariatric surgery patients and their caregivers. Surg Obes Relat Dis 2015; 12:876-881. [PMID: 26922165 DOI: 10.1016/j.soard.2015.10.071] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Bariatric surgery is an invasive medical treatment for morbid obesity that requires behavioral maintenance for physical success. Patient knowledge, motivation, and adherence are important factors in optimizing results. OBJECTIVES The purpose of the present study was to identify perceived informational gaps of adolescent and young adult bariatric surgery patients with morbid obesity (body mass index≥40 kg/m(2)). SETTING This study took place in a pediatric tertiary care academic medical center. METHODS Thirty-one adolescents/young adults who had undergone Roux-en-Y gastric bypass surgery at the authors' institution were recruited to complete questionnaires at their postsurgical visits (≥3 months postsurgery). Seventeen caregivers also participated in this study. The questionnaire used in the present study prompted patients and caregivers to reflect on information they wish they had known before surgery; questionnaire items included multiple choice and open-ended questions. RESULTS Participants indicated that their informational needs were generally well met before surgery, although there were more needs noted by patients than by caregivers. Adolescent/young adult participants expressed a desire to have had more information about the necessity of taking vitamins daily and about having more gas. An association between informational needs and satisfaction was also found. Qualitative data revealed the importance of conveying cognitive-behavioral aspects of surgery to families (e.g., adherence, motivation). CONCLUSION Despite most patients and caregivers being satisfied with the adolescent bariatric surgery program at the authors' institution, informational gaps exist. Teen-friendly ways to disseminate information would be helpful in influencing patients' satisfaction.
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Affiliation(s)
| | - Carrie B Tully
- Center for Translational Science, Children's National Medical Center, Washington, DC
| | - Gia A Washington
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Karin L Price
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
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Park J, Cozza M. Research Trends in Measurement of Quality of Life Following Bariatric Surgery: Emerging Interest in Appearance. Bariatr Surg Pract Patient Care 2014. [DOI: 10.1089/bari.2014.0035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Juyeon Park
- Department of Design and Merchandising, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado State University
| | - Melissa Cozza
- Department of Design and Merchandising, College of Health and Human Sciences, Colorado State University, Fort Collins, Colorado State University
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Henriques A, Alves E, Barros H, Azevedo A. Women's satisfaction with body image before pregnancy and body mass index 4 years after delivery in the mothers of generation XXI. PLoS One 2013; 8:e70230. [PMID: 23936169 PMCID: PMC3729558 DOI: 10.1371/journal.pone.0070230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 06/17/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Body image satisfaction (BIS) influences body weight regulation and may contribute to long-term healthier lifestyle after pregnancy. Thus, we aimed to assess the association between BIS before pregnancy and body mass index (BMI) 4 years after the index pregnancy. METHODS As part of the follow-up of a birth cohort, 3612 women with prepregnancy BMI >18.5 kg/m(2) were reevaluated 4 years after the birth of a child. BIS was defined as the difference between perceived and ideal body size before pregnancy, assessed by Stunkard Silhouettes after birth. The associations of BIS with BMI change (continuous) and BMI classes at 4 years, based on measured weight and height, were estimated using linear and multinomial regression, respectively. RESULTS Among women with normal prepregnancy BMI, those who felt too small, regarding their ideal, had a 0.25 kg/m(2) smaller increase in BMI within 4 years and a lower likelihood of becoming overweight or obese [multivariate-adjusted odds ratio (OR) = 0.63; 95% confidence interval (95%CI): 0.44-0.91 and OR = 0.21; 95%CI: 0.05-0.91, respectively) than those satisfied with body image. Feeling too large was associated with a 0.41 kg/m(2) larger increase in BMI and a higher risk of becoming overweight or obese (OR = 2.12; 95%CI:1.73-2.59 and OR = 3.42; 95%CI:2.02-5.79, respectively). A similar, non-significant, trend was observed for overweight women. Obese women who felt too large had a non-significant decrease in BMI. CONCLUSIONS BIS plays a role in maternal body weight after delivery. Realistic body size goals may promote the motivation to lose weight and contribute to higher success in attaining them.
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Affiliation(s)
- Ana Henriques
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School, Porto, Portugal.
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Neff KJ, Olbers T, le Roux CW. Bariatric surgery: the challenges with candidate selection, individualizing treatment and clinical outcomes. BMC Med 2013; 11:8. [PMID: 23302153 PMCID: PMC3570360 DOI: 10.1186/1741-7015-11-8] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Accepted: 01/10/2013] [Indexed: 12/13/2022] Open
Abstract
Obesity is recognized as a global health crisis. Bariatric surgery offers a treatment that can reduce weight, induce remission of obesity-related diseases, and improve the quality of life. In this article, we outline the different options in bariatric surgery and summarize the recommendations for selecting and assessing potential candidates before proceeding to surgery. We present current data on post-surgical outcomes and evaluate the psychosocial and economic effects of bariatric surgery. Finally, we evaluate the complication rates and present recommendations for post-operative care.
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Affiliation(s)
- K J Neff
- Experimental Pathology, UCD Conway Institute, School of Medicine and Medical Sciences, University College Dublin, Belfield, Dublin 4, Dublin, Ireland
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