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Conceição E, Mitchell JE, Sarwer DB. Update on eating disorders and disordered eating behaviors in metabolic bariatric surgery patients. Curr Opin Psychiatry 2024:00001504-990000000-00138. [PMID: 39239873 DOI: 10.1097/yco.0000000000000962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
PURPOSE OF REVIEW Recent literature suggests a potential causal link between metabolic bariatric surgery (MBS) and an increased risk of eating disorders. However, the available literature offers unclear results regarding the definition of eating problems among MBS patients, their potential impact on weight outcomes, and the efficacy of adjunctive treatment. RECENT FINDINGS Although eating disorders may be rare phenomena after surgery, disordered eating behaviors are more common and tend to be more consistently associated with suboptimal weight loss. There also appear to be clear problems when using Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) criteria to assess eating disorders among MBS patients, particularly for restrictive eating, binge-eating episodes, and the core psychopathology of eating disorders. Finally, preoperative interventions appear to offer effects limited to the presurgery period, and the evidence for the efficacy of postoperative interventions remains limited. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer promising benefits for weight loss and the treatment of binge-eating problems, but their potential risks must be carefully managed. SUMMARY Recognizing the diverse presentations of these problems among individuals undergoing MBS is crucial. Clinical attention should focus on intensive specialized care during the postoperative period for those who develop eating-related problems.
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Affiliation(s)
- Eva Conceição
- Faculty of Psychology and Education Sciences, University of Porto, Center for Psychology at University of Porto, Rua Alfredo Allen, Porto, Portugal
| | - James E Mitchell
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota
| | - David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA
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Kerver GA, Heinberg LJ, Bond DS, Laam LA, Crosby RD, Engel SG, Steffen KJ. Disordered eating behavior and dietary intake prior to metabolic and bariatric surgery. Surg Obes Relat Dis 2024:S1550-7289(24)00687-7. [PMID: 39155184 DOI: 10.1016/j.soard.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/25/2024] [Accepted: 07/07/2024] [Indexed: 08/20/2024]
Abstract
BACKGROUND Disordered eating is a concern for patients seeking metabolic and bariatric surgery (MBS), but little is known about how these behaviors are reflected in typical dietary intake prior to surgery. OBJECTIVES This study examined the relationships between disordered eating behavior and the content and context of typical dietary intake among patients seeking MBS using an innovative combination of rigorous self-report and interview assessments. SETTING Participants were recruited from two academic medical centers in the United States. METHODS Adults were enrolled prior to MBS. Participants completed the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV) and then reported details of their dietary intake for three consecutive days using a validated 24-hour dietary recall system. RESULTS Among the sample (n = 140), objective overeating (OOE) was prevalent and related to greater daily energy and macronutrient intake. Individuals engaging in recurrent OOE were also more likely to consume meals past 8 pm Findings failed to identify significant associations between other disordered eating behaviors, such as objective binge eating (OBE), and contextual factors related to dietary intake. CONCLUSIONS The timing of eating may play a greater role in recurrent overeating than social and physical aspects of the environment. Individuals reporting frequent OOE before MBS may benefit from targeted education and intervention aimed at reducing OOE and subsequently promoting better adherence to dietary recommendations.
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Affiliation(s)
- Gail A Kerver
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota.
| | - Leslie J Heinberg
- Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Dale S Bond
- Departments of Surgery and Research, Hartford Hospital, Hartford, Connecticut
| | - Leslie A Laam
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota
| | - Ross D Crosby
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota
| | - Scott G Engel
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota; Department of Psychiatry and Behavioral Science, School of Medicine and Health Sciences, University of North Dakota, Fargo, North Dakota
| | - Kristine J Steffen
- Sanford Research, Center for Biobehavioral Research, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota
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Lydecker JA, Ivezaj V, Wiedemann AA, Kerrigan S, Grilo CM. Reliability of the original and brief versions of the Eating Disorder Examination in binge-eating disorder. Obesity (Silver Spring) 2024; 32:702-709. [PMID: 38311600 PMCID: PMC10965370 DOI: 10.1002/oby.23993] [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: 10/27/2023] [Accepted: 12/20/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE Psychometric studies evaluating the reliability of eating-disorder assessment among individuals with binge-eating disorder (BED) have been limited. The current study documents the interrater reliability and internal consistency of the Eating Disorder Examination (EDE) interview when administered to adults with Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5)-defined BED. METHODS Participants (N = 56) were adults seeking treatment for BED in the context of clinical trials testing pharmacological and psychological treatments. Doctoral-level, trained, and supervised clinical researchers evaluated eating-disorder psychopathology using the EDE interview and audio-recorded the interview. A second doctoral-level, trained, and supervised clinical researcher, who did not conduct the initial assessment, coded eating-disorder psychopathology using the audio recording. RESULTS Agreement among raters on the number of binge-eating episodes was near perfect. There was excellent interrater reliability for nearly all scales of the EDE interview. Agreement among raters for behavioral indicators of loss of control and marked distress regarding binge eating ranged from moderate to perfect. Internal consistency was variable for all scales, ranging from unacceptable to good. CONCLUSIONS Our study suggests that the EDE can be administered reliably by multiple interviewers to assess adults with BED. However, internal consistency was mostly subpar. Tests of reliability and other psychometric properties (e.g., validity) in other patient groups such as children with BED are warranted.
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Affiliation(s)
- Janet A. Lydecker
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Valentina Ivezaj
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Ashley A. Wiedemann
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Stephanie Kerrigan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Carlos M. Grilo
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
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Dunford A, Ivezaj V, Grilo CM. Shape discrepancy, weight bias internalization, and eating-disorder psychopathology in patients with loss-of-control eating after bariatric surgery. Surg Obes Relat Dis 2024; 20:291-296. [PMID: 37926627 PMCID: PMC10922050 DOI: 10.1016/j.soard.2023.09.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Postoperative loss-of-control (LOC) eating is associated with eating-disorder psychopathology, poorer weight loss, and mental health outcomes following bariatric surgery. The nature and significance of shape discrepancy has not been examined in patients with LOC eating following bariatric surgery. OBJECTIVES To examine shape discrepancy, WBI (weight bias internalization) and ED (eating-disorder) psychopathology in patients with LOC eating after bariatric surgery. SETTING Yale University School of Medicine, United States. METHODS Participants (N = 148, 84.5% female) seeking treatment for eating and weight concerns and with recurrent LOC eating approximately 6 months after bariatric surgery were assessed with the Eating Disorder Examination-Bariatric Surgery Version Interview and completed questionnaires measuring WBI and depression. Participants selected body shapes representing their current and ideal shapes, and a shape discrepancy score was calculated. RESULTS Most participants (N = 142/148) reported an ideal shape smaller than their current shape; shape discrepancy scores ranged from 0 to 5 (M = 1.89, SD = .82). Greater shape discrepancy was significantly correlated with greater current body mass index (BMI; r = .271, p=<.001) and percent weight loss (%WL) since surgery (r = -.19, p = .023). After adjusting for %WL, shape discrepancy was significantly correlated with greater WBI (r = .37, p < .001), depression (r = .27, p < .001), and ED psychopathology (r = .25, p = .002). CONCLUSIONS Nearly all participants preferred a significantly smaller shape than their current shape. Greater discrepancy between current and ideal shape was associated with higher levels of a range of behavioral (ED psychopathology), cognitive (WBI), and psychological/somatic (depression) concerns. These findings, which persisted after adjusting for %WL, highlight the importance of addressing body image in postoperative interventions.
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Affiliation(s)
- Ashley Dunford
- Department of Psychiatry, Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, New Haven, Connecticut.
| | - Valentina Ivezaj
- Department of Psychiatry, Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale University School of Medicine, Program for Obesity, Weight, and Eating Research, New Haven, Connecticut
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Smith CE, Dilip A, Ivezaj V, Duffy AJ, Grilo CM. Predictors of early weight loss in post-bariatric surgery patients receiving adjunctive behavioural treatments for loss-of-control eating. Clin Obes 2023; 13:e12603. [PMID: 37257889 PMCID: PMC10524670 DOI: 10.1111/cob.12603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
This study examined baseline patient characteristics as predictors of early weight loss, defined as any weight loss within the first month of treatment, among patients receiving adjunctive behavioural treatments for loss-of-control (LOC) eating about 6 months after bariatric surgery. Participants were 126 patients in a treatment trial for LOC-eating (roughly 6 months postoperatively) categorized by early weight change following 1 month of treatment. Early weight-loss, defined as any weight loss following 1 month of treatment, and weight-gain, defined as any weight gain, groups were compared on sociodemographic and clinical variables assessed using a battery of reliably administered diagnostic and clinical interviews and established self-report measures, and on surgery-related variables (time since surgery, percent total [%TWL], and percent excess weight loss). Most patients (n = 99; 78.6%) lost weight after the first month of adjunctive treatments. Black patients (n = 24; 61.5%) were significantly less likely to achieve early weight loss compared to patients identifying as White (n = 60; 83%) or 'other' (n = 15; 100%) which was not predicted by any other sociodemographic variable. Severity of eating-disorder psychopathology, psychiatric comorbidity, and a broad range of psychosocial measures were not significantly predictive of early weight changes. Duration since surgery and percent weight loss from time of surgery to study enrolment 6-months post-surgery differed by early weight-loss and weight-gain groups. Findings suggest that among post-bariatric surgery patients receiving adjunctive behavioural treatments for LOC-eating, baseline patient characteristics, aside from race and surgery-related variables, do not predict early weight loss.
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Affiliation(s)
- Caitlin E. Smith
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Abhaya Dilip
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Andrew J. Duffy
- Yale School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Carlos M. Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
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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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Yu Y, Yeh KL, Kalarchian MA, Groth S. Experiences of loss of control eating in women after bariatric surgery: A qualitative study. Int J Eat Disord 2023. [PMID: 36786350 DOI: 10.1002/eat.23912] [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: 11/10/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/15/2023]
Abstract
OBJECTIVE Loss of control (LOC) eating following bariatric surgery remains insufficiently understood, reflected in a lack of clear conceptualization, valid measurements, and effective treatments. This study explored patients' perspectives on LOC eating post-bariatric surgery, focusing on the relevance of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5) indicators of impaired control, and patients' experiences before (precipitating factors), during (eating patterns, perpetuating factors), and after the episodes (strategies used to stop eating). METHODS This was a qualitative study using descriptive phenomenology. Participants were adults who have undergone gastric bypass or sleeve gastrectomy and self-reported recent LOC eating. Data were collected by semi-structured interviews and analyzed using a combined inductive and deductive approach. RESULTS Participants were all women (N = 15; age: 34.5 ± 9.2 years). Results suggested that (1) except for feeling disgusted, guilty, or depressed after eating, other DSM-5 indicators did not seem to be highly relevant to this bariatric cohort; (2) LOC eating could occur across contexts, with food access, boredom, and food craving being consistent triggers; (3) the food amount consumed during a LOC episode was not necessarily considered excessive; (4) "mindlessness" and "satisfying hedonic, physiological, and mental needs" were the main perpetuating factors of LOC eating; and (5) self-talk and distracting attention were the most adopted strategies to stop eating. DISCUSSION Study findings have implications concerning the conceptualization, measurement, and intervention of LOC eating among bariatric patients. For example, results suggested the need for more data to determine the appropriate indicators of LOC eating and the inclusion of boredom as an intervention target in bariatric patients. PUBLIC SIGNIFICANCE Loss of control (LOC) eating is characterized by a sense of being unable to stop while eating. LOC eating is prevalent in patients who have undergone weight loss surgery and is associated with worse surgical outcomes. This qualitative study that explored post-bariatric surgery patients' experiences of LOC eating will inform efforts to better assess and intervene in this disordered eating behavior, thus ultimately optimizing patients' health following weight loss surgery.
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Affiliation(s)
- Yang Yu
- School of Nursing, University of Rochester, Rochester, New York, USA
| | - Kuan-Lin Yeh
- School of Nursing, University of Rochester, Rochester, New York, USA
| | | | - Susan Groth
- School of Nursing, University of Rochester, Rochester, New York, USA
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Marek RJ, Ivezaj V, Parikh MS, Jayade M, Davila-Shiau E, Grilo CM. Factor structure and measurement invariance of the English- versus Spanish-language Eating Disorder Examination Questionnaire: Brief Form (S-EDE-Q-BF) in Hispanic/Latino/a/x persons seeking bariatric surgery. Surg Obes Relat Dis 2022; 19:576-584. [PMID: 36639321 DOI: 10.1016/j.soard.2022.12.015] [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: 07/06/2022] [Revised: 11/14/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Assessment of eating disorder psychopathology during preoperative psychological evaluations could be facilitated with psychometrically valid measures. One of the most commonly used measures, the Eating Disorder Examination Questionnaire (EDE-Q), is lengthy and has been found to have psychometric limitations. Research has identified a shorter version that has received reliable support across diverse samples but requires further validation for use with patients being evaluated for bariatric surgery. OBJECTIVES To cross-validate the factor structure of the EDE-Q: Brief Form (EDE-Q-BF, standalone, nonnested version) with patients being evaluated for bariatric surgery across English- and Spanish-language versions and establish measurement invariance for gender and language. SETTING Northeastern hospital in the United States. METHODS Participants (n = 618) undergoing evaluations prior to bariatric surgery who identified as Hispanic/Latino/a/x and consented to participate in this research study (which did not influence eligibility for bariatric surgery) completed self-reports. Of the 618 participants, 92 were male and 526 were female, 318 preferred English and were administered English versions of the measures, and 300 preferred Spanish and were administered Spanish versions of the measures. RESULTS The 3-factor structure ("Restraint," "Weight/Shape Concerns," and "Body Dissatisfaction") of the EDE-Q-BF fit the data well (χ2 [11] = 18.47; P = .071; root mean square error of approximation [RMSEA] = .033; comparative fit index [CFI] > .99; standardized root mean squared residual [SRMR] = .02). Scaler invariance was met for both gender and language. Correlations with external criteria further supported its validity. CONCLUSION The EDE-Q-BF can easily be administered as part of a preoperative psychological assessment battery to screen for eating disorder psychopathology and is valid for Hispanic/Latino/a/x men and women who speak either English or Spanish.
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Affiliation(s)
- Ryan J Marek
- Sam Houston State University College of Osteopathic Medicine, Conroe, Texas.
| | - Valentina Ivezaj
- Department of Psychiatry, Program for Obesity, Weight, and Eating Research, Yale University School of Medicine, New Haven, Connecticut
| | - Manish S Parikh
- Department of General Surgery, Bellevue Hospital/NYU Langone Health, New York, New York
| | - Maansi Jayade
- Department of General Surgery, Bellevue Hospital/NYU Langone Health, New York, New York
| | - Elissa Davila-Shiau
- Department of General Surgery, Bellevue Hospital/NYU Langone Health, New York, New York
| | - Carlos M Grilo
- Department of Psychiatry, Program for Obesity, Weight, and Eating Research, Yale University School of Medicine, New Haven, Connecticut
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Schreyer CC. Comment on: Inter-Rater Reliability and Internal Consistency of the Eating Disorder Examination in the Longitudinal Assessment of Bariatric Surgery. Surg Obes Relat Dis 2022; 18:1022-1024. [DOI: 10.1016/j.soard.2022.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 05/14/2022] [Indexed: 10/18/2022]
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