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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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Ab Majid NL, Vanoh D, Zainuddin NZS, Md Hashim MN. Post bariatric surgery complications, nutritional and psychological status. Asia Pac J Clin Nutr 2024; 33:162-175. [PMID: 38794976 PMCID: PMC11170006 DOI: 10.6133/apjcn.202406_33(2).0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 02/19/2024] [Accepted: 07/29/2023] [Indexed: 05/27/2024]
Abstract
BACKGROUND AND OBJECTIVES Bariatric surgery becomes the final option for managing severe obesity. This study aims to identify the complications, changes in anthropometry, adherence to dietary recommendations, and psychological well-being of post-bariatric surgery patients. METHODS AND STUDY DESIGN An observational study was conducted on 63 post-bariatric surgery patients who had undergone bariatric surgery between two weeks and five years after surgery. The participants were assessed for the complications experienced, current comorbidities, anthropometric changes, dietary intake, and psychological well-being. A three-day, 24-hour diet recall was done to assess the dietary intake of the patients. The mean macronutrient and micronutrient intakes were compared to several available recommendations. The DASS-21 questionnaire was administered to determine the psychological well-being of the participants. RESULTS The most common complications experienced by patients after bariatric surgery were hair loss (50.8%), gastroesophageal reflux disease (GERD) (49.2%), and vomiting (41.3%). There were significant differences in mean weight before (129.5 (33.0) kg/m2) and after (85.0 (32.0) kg/m2) bariatric surgery (p<0.001). The prevalence of clinically severe obesity declined by 55%. Overall, patients had insufficient intake of some nutrients such as protein, fat, calcium, and iron. Majority of the patients experienced a normal level of stress, anxiety, and depression, but some had mild (3.2%), moderate (4.8%), and severe anxiety (1.6%). CONCLUSIONS There were drastic improvements in patients' weight following bariatric surgery. However, there were several complications including nutrient deficiencies. Due to the anatomical changes in the gastrointestinal tract, patients must comply with the dietary and lifestyle changes and follow up with the healthcare professional. A nutrition module will be helpful for patients to prepare for and adapt to the changes after bariatric surgery.
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Affiliation(s)
- Nor Latifah Ab Majid
- Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia
| | - Divya Vanoh
- Dietetics Programme, School of Health Sciences, Universiti Sains Malaysia, Kelantan, Malaysia.
| | | | - Mohd Nizam Md Hashim
- Surgery Department, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Menzies RE, Richmond B, Sharpe L, Skeggs A, Liu J, Coutts-Bain D. The 'revolving door' of mental illness: A meta-analysis and systematic review of current versus lifetime rates of psychological disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:178-196. [PMID: 38197576 DOI: 10.1111/bjc.12453] [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: 11/01/2023] [Revised: 12/13/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVES Therapists have long observed a phenomenon referred to as the 'revolving door' of mental health services, in which individuals often develop, seek treatment for, and recover from multiple mental illnesses across their life. However, this has not been systematically examined. If this phenomenon is widespread, one would expect that the number of lifetime disorders would exceed that of current disorders. The aim of this meta-analysis was to test this hypothesis. METHODS A search was conducted of the following databases: MEDLINE, PsycINFO and Web of Science. In total, 38 studies were included in the current review; 27 of these contained sufficient quantitative data to be included in the meta-analysis, addressing the primary research aim. The remaining 11 studies were included in the systematic review only. RESULTS Meta-analyses of the 27 studies indicated that the average number of lifetime disorders was 1.84 times that of current disorders. Previous treatment significantly moderated this relationship, while the clinical nature of the sample did not. Examination of the remaining studies revealed common temporal sequences, indicating disorders which typically develop first or consequently to other disorders. CONCLUSIONS These findings provide support for the revolving door of mental illness, suggesting a need for transdiagnostic treatments and broader conceptualisation of relapse prevention.
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Affiliation(s)
| | | | - Louise Sharpe
- The University of Sydney, Sydney, New South Wales, Australia
| | - Amira Skeggs
- The University of Sydney, Sydney, New South Wales, Australia
| | - Janessa Liu
- The University of Sydney, Sydney, New South Wales, Australia
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Kikuchi JLD, Carvalhal MMDL, Inete MB, Souza YDDES, Moraes TM, Costa RLV, Gabbay RD, Paracampo CCP, Gomes DL. Emotional Eating and Uncontrolled Eating as Risk Predictors for Disordered Eating Attitudes in Candidates for Bariatric Surgery Treated at a Public Hospital in the Amazon. Nutrients 2024; 16:1600. [PMID: 38892533 PMCID: PMC11174724 DOI: 10.3390/nu16111600] [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: 04/19/2024] [Revised: 04/29/2024] [Accepted: 05/03/2024] [Indexed: 06/21/2024] Open
Abstract
This study analyzes the eating behavior and factors associated with the presence of disordered eating attitudes in patients undergoing bariatric surgery. It is a cross-sectional, descriptive, and analytical study conducted at a hospital in the Amazon region of Brazil. The Disordered Eating Attitude Scale reduced version (DEAS-s) was used to assess the risk of eating disorders and the Three-Factor Eating Questionnaire (TFEQ-R21) was used to characterize eating behavior. A total of 205 patients participated, with a mean age of 37.5 ± 8.6 years. The majority of participants were female (93.7%; p < 0.001), and the mean BMI was 45.3 ± 6.7 kg/m2. It was found that cognitive restraint had the highest mean (52.6 ± 19.9; p < 0.001). As for the DEAS-s, the question with the highest mean response was "spending one or more days without eating or consuming only liquids to lose weight" (2.80 ± 1.99). Female participants had a higher score for emotional eating (p = 0.016). Disordered eating attitudes showed a correlation with emotional eating and uncontrolled eating. These results suggest that candidates for bariatric surgery may have susceptibility to eating disorders. The importance of a multidisciplinary team conducting monitoring during the preoperative period is highlighted.
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Affiliation(s)
- Jeane Lorena Dias Kikuchi
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Millena Borges Inete
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | | | - Tainá Martins Moraes
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | - Rafaela Lorena Viana Costa
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | - Rafaelle Dias Gabbay
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | - Carla Cristina Paiva Paracampo
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
| | - Daniela Lopes Gomes
- Graduate Program in Neuroscience and Behavior, Behavior Theory and Research Center, Federal University of Pará, Belém 66075-110, Brazil
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Moro O, Albert U, De Caro EF, Palmisano S, Mastronardi M, Di Blas L. Pre-operative body shape concerns moderate excess weight loss trajectory in bariatric surgery patients: a 2-year longitudinal study. Eat Weight Disord 2024; 29:30. [PMID: 38653913 DOI: 10.1007/s40519-024-01660-w] [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: 01/03/2024] [Accepted: 04/13/2024] [Indexed: 04/25/2024] Open
Abstract
PURPOSE The main research aim was to inspect whether pre-operative body shape concerns and discomfort as Body Shape Questionnaire (BSQ) scores moderate post-operative weight loss trajectory in bariatric patients. METHODS Two studies were conducted. Study 1 analyzed cross-sectional data and verified the structural validity of the 34-item BSQ questionnaire on a sample of 327 candidates for bariatric surgery. Study 2 examined longitudinal data, with objective Body Mass Index (BMI) recorded every 6 months, from surgery intervention on, with 5 measurement occasions, from 111 patients who initially completed BSQ as bariatric surgery candidates and then underwent periodic medical post-operative follow-ups, over 2 years. RESULTS In Study 1, confirmatory factor analysis of a single-dimension model yielded acceptable fit indices and high internal consistency levels. Study 2 showed that post-operative excess BMI reduction trend was not linear and pre-operative BSQ scores moderated it, with a higher risk of weight regain in patients who initially were less concerned with their body shape. CONCLUSIONS The present findings support the structural validity of the BSQ questionnaire in bariatric candidates and call attention on the role of pre-operative body shape concerns on post-operative weight loss trajectories over 2 years, in accordance with a pathoplasty model. They suggest the need for systematic attention on perceived body image and psychological paths aimed to help bariatric patients regain positive attitudes towards their own body. Level of evidence III, well-designed cohort.
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Affiliation(s)
- Oriana Moro
- Department of Life Sciences, University of Trieste, Trieste, Italy
| | - Umberto Albert
- Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Mental Health, ASUGI, Trieste, Italy
| | | | - Silvia Palmisano
- Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Manuela Mastronardi
- Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Lisa Di Blas
- Department of Life Sciences, University of Trieste, Trieste, Italy.
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Johnston L, Jackson K, Hilton C, Graham Y. The forgotten patient: A psychological perspective on the implementation of bariatric surgery guidelines. Obes Sci Pract 2023; 9:538-547. [PMID: 37810523 PMCID: PMC10551119 DOI: 10.1002/osp4.670] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 02/04/2023] [Accepted: 03/17/2023] [Indexed: 10/10/2023] Open
Abstract
There is strong evidence demonstrating the impact of bariatric surgery on weight-loss and comorbidity improvement. In the UK, there is specific guidance to facilitate the assessment of a person's suitability for bariatric surgery. This paper highlights the clinical reality of routinely implementing this guidance, supported by literature and the perspectives of practicing psychologists. The consequences of the implementation of clinical guidelines within the context of the typical biopsychosocial profile of those referred for bariatric surgery are discussed. The ramifications of a screening approach rather than a clinical formulation-based approach to assessment, impact of a possible unconscious bias in commissioning and an overemphasis on a biomedical model approach to treatment are also presented. These contextual factors are argued to contribute to a population of "forgotten patients" that is, patients who have been assessed as not suitable for bariatric surgery, and thus "stuck" in their journey toward better health. For these individuals the only option left are energy balance only approaches, which are the very same approaches to weight-loss and comorbidity improvement that have been attempted, often for many years. Not only have these approaches not resulted in weight-loss and health improvement, they also fail to address the underlying psychological causes of obesity. Consequently, this lack of support means that patients continue to suffer from poor quality of life, with no clear pathway to improved health and wellbeing. This paper illuminates the clear gaps in weight management service provision, the implementation of guidelines in practice, and offers practical suggestions to reduce the unintended consequences of clinical guidelines for bariatric surgery.
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Affiliation(s)
- Lynne Johnston
- Halley Johnston Associated LtdWhitley BayUK
- Golden Jubilee University National HospitalScotlandUK
- Helen McArdle Nursing and Care Research InstituteFaculty of Health Sciences and WellbeingUniversity of SunderlandSunderlandUK
- South Tyneside and Sunderland NHS Foundation TrustSunderlandUK
| | | | - Charlotte Hilton
- South Tyneside and Sunderland NHS Foundation TrustSunderlandUK
- Hilton Health ConsultancyDerbyshireUK
- University of FloridaGainesvilleFloridaUSA
- University of DerbyDerbyUK
| | - Yitka Graham
- Helen McArdle Nursing and Care Research InstituteFaculty of Health Sciences and WellbeingUniversity of SunderlandSunderlandUK
- South Tyneside and Sunderland NHS Foundation TrustSunderlandUK
- Faculty of PsychologyUniversity of Anahuac MexicoMexico CityMexico
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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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8
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Allison KC, Wu J, Spitzer JC, McCuen-Wurst C, Ashare RL, Tewksbury C, LaGrotte CA, Wadden TA, Williams NN, Sarwer DB. Changes in Eating Behaviors and Their Relation to Weight Change 6 and 12 Months After Bariatric Surgery. Obes Surg 2023; 33:733-742. [PMID: 36690865 PMCID: PMC9870778 DOI: 10.1007/s11695-022-06442-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Identifying eating behaviors associated with suboptimal weight loss following bariatric surgery remains important. This study assessed the relationship between eating behaviors and weight loss following bariatric surgery in a racially diverse sample. METHODS Participants were assessed before surgery and 6 and 12 months postoperatively, with the Structured Clinical Interview for DSM-5, the Eating Disorder Examination-Bariatric Surgery Version, and validated measures assessing a range of eating behaviors. Linear mixed effect models were used to test the impact of eating behaviors on percent weight loss (%WL) at 6 and 12 months. RESULTS We enrolled 300 participants (mean age 40.1 years; BMI 45.9 kg/m2; 87% women; 62% Black and 30% White). The majority (82%) underwent sleeve gastrectomy (SG). Mean %WL was 23.0 ± 5.1% at 6 months and 26.2 ± 7.6% at 12 months. Subjective binge episodes prior to surgery predicted greater %WL over the first 12 postoperative months (p = 0.028). Postoperative disinhibition, hunger, night eating symptoms, objective binge episodes, global disordered eating attitudes and behaviors, and snacks per day were associated with smaller %WL over 12 months (all p's < 0.01). The presence of picking/nibbling and addictive-like eating behaviors was not associated with %WL at the end of the first postoperative year. CONCLUSION Among a diverse participant sample, problematic eating behaviors following surgery were associated with smaller %WL over 12 months. Postoperative assessment and treatment of eating behaviors are needed to address these issues as they arise and to prevent attenuation of early weight loss in some patients.
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Affiliation(s)
- Kelly C Allison
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA.
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Ritter Annex Building, 9th Floor, 1301 Cecil B Moore Avenue, Philadelphia, PA, 19122, USA
| | - Jacqueline C Spitzer
- Center for Obesity Research and Education, College of Public Health, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA, 19140, USA
| | - Courtney McCuen-Wurst
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Rebecca L Ashare
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
- Department of Psychology, University at Buffalo, 334 Diefendorf Hall, South Campus, Buffalo, NY, 14214, USA
| | - Colleen Tewksbury
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 4th Floor Maloney Building, Philadelphia, PA, 19104, USA
- School of Nursing, University of Pennsylvania, Clair M. Fagin Hall, 418 Curie Boulevard, Philadelphia, PA, 19104, USA
| | - Caitlin A LaGrotte
- Behavioral Medicine, Cooper University Health Care and Cooper Medical School of Rowan University, Camden, NJ, 1 Cooper Plaza, Camden, NJ, 08103, USA
| | - Thomas A Wadden
- Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, 3rd floor, Philadelphia, PA, 19104, USA
| | - Noel N Williams
- Department of Surgery, Perelman School of Medicine at the University of Pennsylvania, 4th Floor Maloney Building, Philadelphia, PA, 19104, USA
| | - David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, 3223 North Broad Street, Suite 175, Philadelphia, PA, 19140, USA
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Bell Building, 3Rd Floor, 1101 W. Montgomery Avenue, Philadelphia, PA, 19122, USA
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Er E, Durieux N, Vander Haegen M, Flahault C, Etienne AM. Patients' perceptions of the mechanisms underlying alcohol use problems after bariatric surgery: A qualitative systematic review. Clin Obes 2023; 13:e12551. [PMID: 36096544 DOI: 10.1111/cob.12551] [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: 05/26/2022] [Revised: 08/07/2022] [Accepted: 08/08/2022] [Indexed: 01/19/2023]
Abstract
Alcohol-related problems increase after bariatric surgery. The objective of this review was to synthesize findings of qualitative studies on patients' perceptions of the mechanisms leading to problematic alcohol consumption after bariatric surgery. This review followed the Joanna Briggs Institute methodology for systematic review of qualitative evidence. A comprehensive search strategy was performed in MEDLINE, PsycInfo, Scopus and Google Scholar. Study selection, data extraction and critical appraisal of included studies were undertaken by two independent reviewers. Confidence in review findings was assessed using the ConQual approach. Four studies were included in this review and led to the development of four synthesized results: (1) persistence or reappearance of psychological problems after bariatric surgery; (2) using alcohol as a coping strategy, sometimes as a replacement for food; (3) changes in the physiological response to alcohol; and (4) importance of increased information about alcohol-related risks and long-term counselling. Confidence in the synthesized results ranged from moderate to low. The results indicated postoperative problematic alcohol consumption is a complex issue, involving psychological and physiological mechanisms. Several recommendations are formulated based on the results obtained. More qualitative and quantitative studies are needed to better understand this phenomenon given the few existing qualitative studies on this topic and some divergent results found between qualitative and previous quantitative research.
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Affiliation(s)
- Esin Er
- Research Unit for a Life-Course Perspective on Health & Education-RUCHE, Faculty of Psychology, Speech and Language Therapy and Educational Sciences, University of Liège, Liège, Belgium
| | - Nancy Durieux
- Research Unit for a Life-Course Perspective on Health & Education-RUCHE, Faculty of Psychology, Speech and Language Therapy and Educational Sciences, University of Liège, Liège, Belgium
- Belgian Interuniversity Collaboration for Evidence-based Practice (BICEP): A JBI Affiliated Group, Leuven, Belgium
| | - Marie Vander Haegen
- Research Unit for a Life-Course Perspective on Health & Education-RUCHE, Faculty of Psychology, Speech and Language Therapy and Educational Sciences, University of Liège, Liège, Belgium
| | - Cécile Flahault
- Laboratoire de Psychopathologie et Processus de la santé, Université de Paris, Paris, France
| | - Anne-Marie Etienne
- Research Unit for a Life-Course Perspective on Health & Education-RUCHE, Faculty of Psychology, Speech and Language Therapy and Educational Sciences, University of Liège, Liège, Belgium
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Ardiles LG. Obesity and renal disease: Benefits of bariatric surgery. Front Med (Lausanne) 2023; 10:1134644. [PMID: 36926320 PMCID: PMC10011092 DOI: 10.3389/fmed.2023.1134644] [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: 12/30/2022] [Accepted: 01/25/2023] [Indexed: 03/04/2023] Open
Abstract
The prevalence of obesity, a preventable and reversible condition with a high impact on health, continues to rise, especially after the COVID-19 pandemic. Severe overweight is well recognized as a risk factor for diabetes and hypertension, among other conditions, that may increase cardiovascular risk. Obesity has grown simultaneously with a rise in the prevalence of chronic kidney disease, and a pathophysiological link has been established, which explains its role in generating the conditions to facilitate the emergence and maximize the impact of the risk factors of chronic kidney disease and its progression to more advanced stages. Knowing the mechanisms involved and having different tools to reverse the overweight and its consequences, bariatric surgery has arisen as a useful and efficient method, complementary or alternative to others, such as lifestyle changes and/or pharmacotherapy. In a detailed review, the mechanisms involved in the renal consequences of obesity, the impact on risk factors, and the potential benefit of bariatric surgery at different stages of the disease and its progression are exposed and analyzed. Although the observational evidence supports the value of bariatric surgery as a renoprotective measure in individuals with obesity, diabetic or not, randomized studies are expected to establish evidence-based recommendations that demonstrate its positive risk-benefit balance as a complementary or alternative therapeutic tool.
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Affiliation(s)
- Leopoldo G Ardiles
- Department of Nephrology, Faculty of Medicine, Universidad Austral de Chile, Valdivia, Chile
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11
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Kiser HM, Pratt KJ, Focht BC, Wallace L, Slesnick N, Noria S, Needleman B, Pona AA. Preoperative Psychological Evaluation Outcomes, Reasoning, and Demographic and Diagnostic Correlates. Obes Surg 2023; 33:539-547. [PMID: 36538213 PMCID: PMC9765350 DOI: 10.1007/s11695-022-06414-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Revised: 12/02/2022] [Accepted: 12/09/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE Little is known about associations between preoperative psychiatric, disordered eating, and substance use diagnoses with the clinical decision to require follow-up after the preoperative psychological evaluation. To determine the proportion of patients who require follow-up (no required follow-up (NFU), required follow-up (RFU), placed on hold (POH)) from the preoperative psychological evaluation, associations with diagnoses, and noted reasons for follow-up. MATERIALS AND METHODS The sample included 508 patients (77.6% female; 64.4% White) pursuing bariatric metabolic surgery with completed psychological evaluations between August 2019 and December 2020 at a Midwest medical center. Patient demographics, psychological evaluation outcome and corresponding reasoning, and psychiatric, disordered eating, and substance use diagnoses were extracted from the health record. Descriptive and bivariate analyses determined associations between demographics and diagnoses with psychological evaluation outcomes and corresponding reasoning. RESULTS The breakdown of psychological evaluation outcomes was 60.6% (n = 308) NFU, 38.4% (n = 195) RFU, and 1.0% (n = 5) POH. Demographic correlates of RFU included higher BMI, being single, lower educational attainment, unemployment, public/no insurance, and receiving multiple or any psychiatric diagnosis (all p-values < 0.05). Diagnostic correlates of RFU included anxiety, depression, not having a current trauma or stressor-related disorder, disordered eating, and substance use diagnoses (all p-values < 0.001). RFU/POH was primarily due to psychiatric (61%) reasons. CONCLUSION Higher rates of RFU were observed for patients with higher economic need and with psychiatric, disordered eating, or substance use diagnoses. Future work should establish preoperative programming to assist patients with addressing ongoing psychiatric concerns prior to bariatric metabolic surgery.
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Affiliation(s)
- Haley M. Kiser
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA
| | - Keeley J. Pratt
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA ,Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH 43210 USA
| | - Brian C. Focht
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA
| | - Lorraine Wallace
- Biomedical Education and Anatomy, College of Medicine, The Ohio State University, Columbus, OH 43210 USA
| | - Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Avenue, Columbus, OH 43210 USA
| | - Sabrena Noria
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH 43210 USA
| | - Bradley Needleman
- Department of Surgery, The Ohio State University Medical Wexner Center, Columbus, OH 43210 USA
| | - Ashleigh A. Pona
- Psychiatry and Behavioral Health, College of Medicine, The Ohio State University, Columbus, OH 43210 USA
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12
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Marchese SH, Pandit AU. Psychosocial Aspects of Metabolic and Bariatric Surgeries and Endoscopic Therapies. Gastroenterol Clin North Am 2022; 51:785-798. [PMID: 36375996 DOI: 10.1016/j.gtc.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Obesity is a prevalent progressive and relapsing disease for which there are several levels of intervention, including metabolic and bariatric surgery (MBS) and now endoscopic bariatric and metabolic therapies (EBMTs). Preoperative psychological assessment focused on cognitive status, psychiatric symptoms, eating disorders, social support, and substance use is useful in optimizing patient outcomes and minimizing risks in MBS. Very little is known about the psychosocial needs of patients seeking EBMTs, though these investigations will be forthcoming if these therapies become more widespread. As MBS and EBMT inherently alter the gastrointestinal (GI) tract, considerations for the longer-term GI functioning of the patient are relevant and should be considered and monitored.
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Affiliation(s)
- Sara H Marchese
- Department of Psychiatry & Behavioral Sciences, Section of Bariatric & Outpatient Psychotherapy, Rush University Medical Center, 1645 W. Jackson Boulevard, Suite 400, Chicago, IL 60618, USA
| | - Anjali U Pandit
- Division of Gastroenterology and Hepatology & Psychiatry, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, 14th Floor, Chicago, IL 60611, USA.
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13
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Erden Aki ŞÖ, Yıldız Mİ, Kamış GZ, Aytulun A, Karakaya J, Işıklı S. Relationship of depression, impulsivity, distress intolerance and coping styles with maladaptive eating patterns in bariatric candidates. Eat Weight Disord 2022; 27:3351-3366. [PMID: 35999437 DOI: 10.1007/s40519-022-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/27/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The study aimed to investigate the problematic eating patterns and understand their relationship to psychological constructs, including stress intolerance, coping mechanisms and impulsivity, and psychiatric symptoms among bariatric surgery candidates. METHODS The bariatric candidates were evaluated by psychiatric interview and standard scales assessing maladaptive eating behaviors (Eating Attitudes Test (EAT), Bulimia Investigatory Test-Edinburgh (BITE), Dutch Eating Behavior Questionnaire (DEBQ)), depression (Beck Depression Inventory (BDI)), psychiatric symptoms (Brief Symptom Inventory (BSI)), and psychological constructs (Distress Intolerance Index (DSI), Coping Styles Scale (CSS), UPPS Impulsive Behavior Scale(UPPS)). RESULTS More than half (57.8%) had maladaptive eating behaviors, and 23.6% had binge-eating behavior. Depression and anxiety predicted EAT, BITE, and DEBQ emotional and external eating sub-scale scores; distress intolerance, helpless coping style, and impulsivity predicted maladaptive eating behaviors in bariatric candidates. CONCLUSION Maladaptive eating patterns play an essential role in the failure to lose weight and regain weight and are predicted by depression, anxiety, and psychological constructs in this study. Evaluation of pathological trait characteristics besides discrete psychiatric syndromes should be recommended in the pre-operation process to plan relevant interventions in the long-term management of weight. LEVEL OF EVIDENCE Level III, evidence obtained from well-designed cohort analytic studies.
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Affiliation(s)
| | - M İrem Yıldız
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - G Zuhal Kamış
- Health Ministry of Turkish Republic Ankara City Hospital, Ankara, Turkey
| | - Aslı Aytulun
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sedat Işıklı
- Department of Psychology, Hacettepe University Faculty of Letters, Ankara, Turkey
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14
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Braun TD, Puhl RM, Quinn DM, Gorin A, Tishler D, Papasavas P. Weight stigma and posttraumatic stress disorder symptoms in individuals seeking bariatric surgery. Surg Obes Relat Dis 2022; 18:1066-1073. [PMID: 35811291 PMCID: PMC9797255 DOI: 10.1016/j.soard.2022.05.011] [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: 12/13/2021] [Revised: 04/13/2022] [Accepted: 05/10/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S. OBJECTIVE Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S. SETTING Teaching hospital and surgical weight loss center in the United States. METHODS A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189). RESULTS After accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR2 = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR2 = .12 and .13, respectively; overall model R2 =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms. CONCLUSIONS Over and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.
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Affiliation(s)
- Tosca D. Braun
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Centers of Preventive Medicine, The Miriam Hospital, Providence, Rhode Island,Butler Hospital, Providence, Rhode Island,Correspondence: Tosca D. Braun, Ph.D., Alpert Brown Medical School, Butler Hospital, 345 Blackstone Boulevard, Providence, RI 02906. (T.D. Braun)
| | - Rebecca M. Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, Connecticut
| | - Diane M. Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut
| | - Amy Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Healthcare, Hartford, Connecticut
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Healthcare, Hartford, Connecticut
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15
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Prevalence and psychiatric comorbidities of night-eating behavior in obese bariatric patients: preliminary evidence for a connection between night-eating and bipolar spectrum disorders. Eat Weight Disord 2022; 27:1695-1704. [PMID: 34617263 PMCID: PMC9122845 DOI: 10.1007/s40519-021-01306-1] [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: 08/03/2021] [Accepted: 09/15/2021] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The co-occurrence of obesity, eating and mood disorders has been frequently reported in clinical and epidemiological settings. This study aimed to explore the prevalence of night-eating obese patients referred for bariatric surgery and to identify associated psychopathology and psychiatric comorbidity. METHODS The sample was composed of 121 obese patients consecutively enrolled between November 2010 and May 2012 during psychiatric evaluations for bariatric intervention. Clinical features and psychiatric diagnoses were collected. Night-eating was investigated through the administration of the Night-eating Questionnaires (NEQ) and was defined as the presence of self-reported evening hyperphagia and/or nocturnal ingestions. Binge-eating and purging behaviors and general psychopathology were respectively assessed using the Bulimic Investigatory Test, Edinburgh and the Symptom Checklist-90-Revised. RESULTS Night-eating was reported by twenty subjects (16.5%). Patients with night-eating behavior were significantly more frequently diagnosed with bipolar spectrum disorders and with comorbid eating and mood disorders in comparison with other patients. Night-eating patients showed significantly more binging/purging behaviors and greater severity of somatization, obsessive-compulsive symptoms, phobic anxiety, psychoticism and sleep disorders. Patients with bipolar disorder type 1 or 2 scored significantly higher than those without mood disorders at NEQ total score, mood/sleep and nocturnal ingestions subscales, but also scored significantly higher than other patients with mood disorders at the latter subscale. CONCLUSION Patients with evening hyperphagia and/or nocturnal ingestions should be carefully evaluated to detect possible bipolar spectrum disorders and other eating disorders. Prompt management of these conditions should be provided before bariatric interventions. LEVEL OF EVIDENCE V, cross-sectional descriptive study.
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16
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Changes in Antihypertensive Medication Following Bariatric Surgery. Obes Surg 2022; 32:1312-1324. [PMID: 35083703 DOI: 10.1007/s11695-022-05893-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/05/2022] [Accepted: 01/11/2022] [Indexed: 10/19/2022]
Abstract
Obesity is a leading cause of hypertension (i.e., high blood pressure [BP]). While hypertension can be managed with antihypertensive medication, substantial weight loss can also lower BP, reducing the need for antihypertensive medication. Articles in this review (n = 60) presented data on antihypertensive medication use among adults pre- and postoperatively. Roux-en-Y gastric bypass was the most studied surgical approach followed by Laparoscopic Sleeve Gastrectomy. Antihypertensive medication was discontinued in a large proportion of patients after surgery, and the mean number of antihypertensive medications decreased by approximately one. In almost a third of the studies, over 75% of participants experienced hypertension remission. All articles aside from two reported a decrease in systolic BP, with about 40% reporting a decrease of ≥ 10 mm Hg.
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17
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Benzerouk F, Guénin M, Gierski F, Raucher-Chéné D, Barrière S, Bertin E, Kaladjian A. Contributing roles of depression, anxiety, and impulsivity dimensions in eating behaviors styles in surgery candidates. J Eat Disord 2021; 9:148. [PMID: 34749827 PMCID: PMC8573893 DOI: 10.1186/s40337-021-00503-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 10/21/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Even if bariatric surgery is considered the most effective therapeutic approach, it is not equally successful among individuals suffering from severe obesity and candidates for this weight loss surgery. Among the factors that influence postsurgical outcomes, eating behaviors styles are known to play a key role in relapses. The aim of our study was to assess eating behaviors styles and several modulating psychopathological factors in patients suffering from severe obesity. METHODS Patients seeking bariatric surgery (N = 127) completed a set of standardized tools assessing eating behaviors (Dutch Eating Behavior Questionnaire), comorbid psychiatric conditions (Mini International Neuropsychiatric Interview), depression, and anxiety scores (Beck Depression Inventory, State-Trait Anxiety Inventory), and impulsivity scores (UPPS-P Impulsive Behavior Scale). RESULTS We detected significant correlations between DEBQ Emotional Eating (EmoE) and depression, state and trait anxiety, and all dimensions of impulsivity. Significant correlations were also present between DEBQ External Eating (ExtE) and depression, state and trait anxiety and UPPS-P positive urgency, lack of perseverance and sensation seeking. Regression analyses identified sex (female), trait anxiety, and lack of perseverance as explanatory factors for EmoE, and depression severity score and positive urgency for ExtE. CONCLUSIONS EmoE might be a means of dealing with negative emotions and/or intrusive thoughts, while ExtE might result from a mechanism associated with depression. These results should help to improve patients' outcomes by defining specific therapeutic targets in psychological interventions. After bariatric surgery, some patients regain weight. This is likely due to various factors, including a return of maladaptive eating styles, such as emotional eating (which occurs as a response to negative emotions, like depression, anxiety, anger, sadness, and discouragement), external eating (which refers to the tendency to eat in response to positive external cues, regardless of internal signals of hunger and satiety), and restraint eating (implying to make efforts to develop and maintain strategies to control calories intake, associated with weight loss after lifestyle intervention). Our goal in this research project was to explore associated factors (particularly depression, anxiety, and impulsivity) to these eating styles in patients suffering from obesity prior to bariatric surgery. Individuals seeking bariatric surgery were asked questions about their eating styles and their levels of depression, anxiety, and impulsivity using standardized questionnaires. We found that emotional eating might be a means of dealing with negative emotions and/or intrusive thoughts (e.g. about food or body dissatisfaction), while external eating might result from a mechanism associated with depression. We detected no association between restraint eating and any of the dimensions of impulsivity, nor depression and anxiety. Therapies aimed at improving patients' abilities to regulate negative affects seem promising among subjects suffering from obesity and those seeking bariatric surgery. If well learned, these therapies might also help them to maintain weight loss after surgery by limiting maladaptive eating styles.
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Affiliation(s)
- Farid Benzerouk
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100, Reims, France. .,Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 51100, Reims, France. .,Champagne Ardenne Specialized Center in Obesity, University Hospital Center, 51100, Reims, France.
| | - Monique Guénin
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100, Reims, France
| | - Fabien Gierski
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100, Reims, France.,Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 51100, Reims, France.,Reims Champagne-Ardenne University, Reims, France
| | - Delphine Raucher-Chéné
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100, Reims, France.,Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 51100, Reims, France
| | - Sarah Barrière
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100, Reims, France
| | - Eric Bertin
- Reims Champagne-Ardenne University, Reims, France.,Champagne Ardenne Specialized Center in Obesity, University Hospital Center, 51100, Reims, France
| | - Arthur Kaladjian
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100, Reims, France.,Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 51100, Reims, France.,Reims Champagne-Ardenne University, Reims, France
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18
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Youssef A, Mylopoulos M, Maunder R, Wiljer D, Cassin SE, Wnuk S, Leung S, Sockalingam S. Understanding bariatric patients' experiences of self-management post-surgery: A qualitative study. Clin Obes 2021; 11:e12473. [PMID: 34128336 DOI: 10.1111/cob.12473] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/03/2021] [Accepted: 05/24/2021] [Indexed: 12/15/2022]
Abstract
Although most bariatric patients achieve significant weight loss and improvements in both physical and mental health-related quality of life (HRQoL) in the short-term, there is wide variability in weight and long-term HRQoL outcomes. The role of bariatric patients' self-management style in explaining variability in long-term outcomes is unclear. This qualitative study examined bariatric patients' self-management experiences after bariatric surgery in relation to long-term outcomes. A qualitative study was conducted using semi-structured individual interviews with post-surgery patients (n = 23) at a Canadian bariatric surgery program. A constant comparative approach was used to systematically analyse the data and identify overarching themes. Variation in patients' experiences and follow-up time were the two primary units of analysis. Patients were predominantly female (n = 19; 82.6%) and had a mean age of 50 ± 8.49 years. The median time post-surgery was 2 years (range: 6 months-7 years). Three distinct phases described the process of self-management post-bariatric surgery: (1) rediscovering self-esteem and confidence in one's ability to self-manage (1-month to 1.5-years post-surgery), (2) achieving weight maintenance and addressing emotion dysregulation (1.5-3-years post-surgery) and (3) embracing a flexible balanced lifestyle (beyond 3-years). Bariatric surgery patients experience distinct challenges relative to their post-surgery time course. Facilitating access to interprofessional bariatric care after surgery allowed patients to acquire the self-management knowledge and skills necessary to address challenges to following the bariatric guidelines in the long-term.
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Affiliation(s)
- Alaa Youssef
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bariatric Surgery Program, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada
- The Wilson Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- The Wilson Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
| | - Robert Maunder
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry - Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - David Wiljer
- The Wilson Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Education, Technology & Innovation, UHN Digital, University Health Network, Toronto, Ontario, Canada
| | - Stephanie E Cassin
- Bariatric Surgery Program, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada
| | - Susan Wnuk
- Bariatric Surgery Program, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada
| | - Samantha Leung
- Bariatric Surgery Program, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Bariatric Surgery Program, Toronto Western Hospital - University Health Network, Toronto, Ontario, Canada
- The Wilson Centre, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada
- Education, Centre for Addiction and Mental Health (CAMH), Toronto, Ontario, Canada
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19
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Dickhut C, Hase C, Gruner-Labitzke K, Mall JW, Köhler H, de Zwaan M, Müller A. No addiction transfer from preoperative food addiction to other addictive behaviors during the first year after bariatric surgery. EUROPEAN EATING DISORDERS REVIEW 2021; 29:924-936. [PMID: 34460134 DOI: 10.1002/erv.2857] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/03/2021] [Accepted: 08/12/2021] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The aim of the present study was to investigate whether the remission of preoperative food addiction is associated with increases or new onset of other addictions within the first year following bariatric surgery. METHODS One hundred and twenty-five bariatric surgery patients were assessed before surgery (t1) and at 6 months (t2) and 1 year (t3) follow-ups. The assessments included the Yale Food Addiction Scale 2.0 (YFAS 2.0) and standardized questionnaires to measure symptoms of problematic alcohol use, gambling disorder, internet-use disorder, buying-shopping disorder, hypersexual disorder and exercise dependence. RESULTS Forty-nine (39.2%) patients were assigned to the food addiction (FA+ ) and 76 patients (60.8%) to the non-food addiction group (FA- ) based on their preoperative YFAS scores. Overall, BMI and symptoms of food addiction decreased significantly from baseline to follow-ups. Preoperative food addiction status was not associated with postoperative increases or new onset of other addictions. Elevated symptoms of buying-shopping disorder, internet-use and hypersexual behaviour at baseline in the FA+ -group decreased over time and were comparable to the FA- -group at follow-ups. CONCLUSION The 'addiction transfer' or 'cross addiction' hypothesis was not supportive for alcohol addiction, gambling addiction or other behaviours that may be addictive. Further studies are needed that investigate larger samples and longer observation periods, as well as other substance-use disorders.
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Affiliation(s)
- Clemens Dickhut
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Department of Psychiatry, Social Psychiatry and Psychotherapy, Division of Clinical Psychology & Sexual Medicine, Hannover Medical School, Hannover, Germany
| | - Carolin Hase
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | | | - Julian W Mall
- Department of General, Vascular and Bariatric Surgery, KRH Klinikum Nordstadt, Hannover, Germany
| | - Hinrich Köhler
- Department of Surgery, Herzogin Elisabeth Hospital, Braunschweig, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Astrid Müller
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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