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Zhang H, Liu Z, Zheng H, Xu T, Liu L, Xu T, Yuan TF, Han X. Multiple mediation of the association between childhood emotional abuse and adult obesity by anxiety and bulimia - a sample from bariatric surgery candidates and healthy controls. BMC Public Health 2024; 24:653. [PMID: 38429770 PMCID: PMC10905949 DOI: 10.1186/s12889-024-18015-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 02/06/2024] [Indexed: 03/03/2024] Open
Abstract
Bulimia, which means a person has episodes of eating a very large amount of food (bingeing) during which the person feels a loss of control over their eating, is the most primitive reason for being overweight and obese. The extended literature has indicated that childhood emotional abuse has a close relationship with adverse mood states, bulimia, and obesity. To comprehensively understand the potential links among these factors, we evaluated a multiple mediation model in which anxiety/depression and bulimia were mediators between childhood emotional abuse and body mass index (BMI). A set of self-report questionnaires, including the Childhood Trauma Questionnaire (CTQ), Beck Anxiety Inventory, Beck Depression Inventory (BDI), and Eating Disorder Inventory (EDI), was sent out. Clinical data from 37 obese patients (age: 29.65 ± 5.35, body mass index (BMI): 37.59 ± 6.34) and 37 demographically well-matched healthy people with normal body weight (age: 31.35 ± 10.84, BMI: 22.16 ± 3.69) were included in the investigation. We first performed an independent t-test to compare all scales or subscale scores between the two groups. Then, we conducted Pearson correlation analysis to test every two variables' pairwise correlation. Finally, multiple mediation analysis was performed with BMI as the outcome variable, and childhood emotional abuse as the predictive variable. Pairs of anxiety, bulimia, and depression, bulimia were selected as the mediating variables in different multiple mediation models separately. The results show that the obese group reported higher childhood emotional abuse (t = 2.157, p = 0.034), worse mood state (anxiety: t = 5.466, p < 0.001; depression: t = 2.220, p = 0.030), and higher bulimia (t = 3.400, p = 0.001) than the healthy control group. Positive correlations were found in every pairwise combination of BMI, childhood emotional abuse, anxiety, and bulimia. Multiple mediation analyses indicate that childhood emotional abuse is positively linked to BMI (β = 1.312, 95% CI = 0.482-2.141). The model using anxiety and bulimia as the multiple mediating variables is attested to play roles in the relationship between childhood emotional abuse and obesity (indirect effect = 0.739, 95% CI = 0.261-1.608, 56.33% of the total effect). These findings confirm that childhood emotional abuse contributes to adulthood obesity through the multiple mediating effects of anxiety and bulimia. The present study adds another potential model to facilitate our understanding of the eating psychopathology of obesity.
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Affiliation(s)
- Hongwei Zhang
- Department of Bariatric & Metabolic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ziqi Liu
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychology, Anhui Provincial Children's Hospital, Children's Hospital of Fudan University Anhui Hospital, National Children's Regional Medical Center, Hefei, China
| | - Hui Zheng
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ting Xu
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Liu
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tao Xu
- Department of Anesthesiology, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Brain Health Institute, National Center for Mental Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Co-innovation Center of Neuroregeneration, Nantong University, Nantong, Jiangsu, China.
| | - Xiaodong Han
- Department of Bariatric & Metabolic Surgery, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- Department of Endocrinology and Metabolism, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Büyükkasap Ç. Assessing how bariatric surgery, emotional eating, and depression could affect each other: A cross-sectional study. Medicine (Baltimore) 2023; 102:e36409. [PMID: 38050210 PMCID: PMC10695543 DOI: 10.1097/md.0000000000036409] [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: 08/29/2023] [Accepted: 11/10/2023] [Indexed: 12/06/2023] Open
Abstract
Emotional eating (EE) has been found to be associated with depression, anxiety, excessive weight, obesity, and unhealthy eating habits. EE could also be associated with recurrent weight gain. To date, the factors predicting success following bariatric surgery remain uncertain. In addition, there is a paucity of data regarding the associations between EE, percent of total weight loss (TWL), and depression after bariatric surgery. The aims of this study were to evaluate the relationship between EE behavior, depression, and TWL, and to identify other factors, such as the type of bariatric surgery, that may have an impact on EE, depression and TWL after bariatric surgery. A self-report questionnaire was administered to 253 patients who underwent bariatric surgery between 2014 and 2021 at the Department of General Surgery, Faculty of Medicine, Gazi University. In total, 115 patients agreed to participate and completed the questionnaire. The administered scales consisted of the Sociodemographic Data Form, Emotional Eating Scale (EES), and Beck Depression Inventory (BDI). The participants were divided into the Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) groups. The RYGB and SG groups included 79 (68.8%) and 36 (31.3%) patients, respectively. A significant difference was found in terms of age (P = .002) and gender (P = .033). The BDI scores (P = .499) and TWL (P = .068) did not differ significantly. The EES score was higher in the SG group (P = .020). Between the groups with and without EE, age (P = .004) and BDI scores (P = .004) were significantly different. In correlation analyses, EES score was related to BDI score(ρ = 0.402, P < .001) and age(ρ = -0.348, P = .002) in the RYGB group. In regression analyses, TWL was associated with age (β = -0.366, P < .001) and surgery type (β = -6.740, P < .001), EES score was associated with BDI score (β = 0.149, P = .009) and age (β = -0.154, P = .006), and BDI score was associated with EES score (β = 0.419, P = .009) and age (β = -195, P = .041). In patients with moderate-to-severe depression, TWL was higher than in those without depression (P = .025). The effect of emotional eating and depression on TWL was not detected. Emotional eating and depression trigger each other in the individuals who underwent bariatric surgery. Young individuals who undergo bariatric surgery are more vulnerable to emotional eating and depression than older patients.
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Affiliation(s)
- Çağri Büyükkasap
- Gazi University Faculty of Medicine, Department of General Surgery, Ankara, Turkey
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Rodriguez-Murguia N, Malacara JM, Kusnir D, Siniego A, Melendez-Rios D, Raubenheimer D, Simpson S, Martinez-Cordero C. Testing for Protein Leverage in Patients with Gastric Bypass: A Pilot Study. ANNALS OF NUTRITION & METABOLISM 2023; 79:355-360. [PMID: 37536296 PMCID: PMC10614273 DOI: 10.1159/000532125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/01/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Protein leverage (PL) is the phenomenon whereby a dominant appetite for protein drives overconsumption of energy with a decline in the ratio of protein to fat and carbohydrate in the diet. PL has been independently verified in several randomized control trials, and its predictions are supported by diet surveillance data. Our aim in the present study was to test whether surgical intervention through gastric bypass will ameliorate the PL effect. METHODS Ten patients with gastric bypass (2-5 years postsurgical time) were given ad libitum access to study food comprising 10%, 15%, or 25% protein and no access to other foods for 3 days while controlling food palatability and variety. Food intake was measured, and energy and nutrient intakes were calculated. Body weight, blood chemistry, lipid profile, hormones (insulin, leptin, and ghrelin), and creatinine were determined before and after each experimental period. RESULTS The gastric bypass patients in our study did not show evidence for protein intake regulation as predicted under PL but ate to constant total energy intake on the 10%, 15%, and 25% protein diets with protein intake varying significantly. Patients lost weight in the three study periods, but significant weight loss was observed only on the 15% protein diet. CONCLUSION Our results suggest that gastric bypass might disengage the PL mechanism, thus ameliorating an appetite-specific mechanism that drives energy overconsumption in modern food environments.
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Affiliation(s)
| | | | | | | | | | - David Raubenheimer
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Camperdown, NSW, Australia
| | - Stephen Simpson
- Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Camperdown, NSW, Australia
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Ahmadkaraji S, Farahani H, Orfi K, Fathali Lavasani F. Food addiction and binge eating disorder are linked to shared and unique deficits in emotion regulation among female seeking bariatric surgery. J Eat Disord 2023; 11:97. [PMID: 37312144 PMCID: PMC10265849 DOI: 10.1186/s40337-023-00815-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/29/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Problematic eating behaviors can indicate obesity-related problems. Food addiction (FA) is not classified as an official diagnosis. However, given the many commonalities between FA and binge-eating disorder (BED) within the context of obesity, it is imperative to conduct a comparative investigation. The current study aimed to identify overlapping and distinctive features in emotion dysregulation as an underlying mechanism and emotional eating as a clinical feature among four groups of females with obesity seeking bariatric surgery. METHODS Data on emotion dysregulation and emotional eating were derived from the total 128 Females with obesity seeking bariatric surgery (Mage = 38.91 ± 10.59, MBMI = 42.10 kg/m2 ± 4.43) divided into four groups: those with FA (n = 35), BED (n = 35), BED + FA (n = 31) and a control group of individuals with obesity only (OB; n = 27), using well-established measures. RESULTS Regarding descriptive statistics, the BED + FA group showed the highest levels of emotional dysregulation (M = 111.09) and emotional eating (M = 46.80), while the OB group acquired the lowest scores (M = 70.44 and M = 27.29, respectively). Univariate analyses of variance revealed significant differences between the four groups in terms of emotion dysregulation F(3, 124) = 24.63, p < .01 and emotional eating F(3, 124) = 26.26, p < .01. All of the emotion dysregulation domains revealed significant differences too. Pairwise comparisons using Bonferroni post hoc tests did not reveal any significant differences between BED + FA and BED groups, while all of our other hypotheses regarding this matter were confirmed. CONCLUSIONS The study found that individuals with obesity and comorbid BED exhibit greater emotional dysregulation compared to those with OB or FA, indicating a need to assess BED in individuals with obesity. Emotion dysregulation may be linked to increased BED and FA, but those with BED seem more affected by limited access to emotion regulation strategies. These findings support the notion that PEBs are associated with emotion dysregulation and underscore the need for tailored interventions that target emotion regulation skills before and after bariatric surgery.
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Affiliation(s)
- Shahrzad Ahmadkaraji
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran
- Minimally Invasive Surgery Research Center, Rasool-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | | | - Koosha Orfi
- Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Fahimeh Fathali Lavasani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, Iran.
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Ramzi NH, Auvinen J, Veijola J, Miettunen J, Ala-Mursula L, Sebert S, Keinänen-Kiukaanniemi S, Svento R, Jokelainen J, Drenos F, Dovey TM, Järvelin MR, Blakemore AIF. Depression mediates the relationship between alexithymia and obesity in the Northern Finland Birth Cohort 1966 (NFBC1966). J Affect Disord 2023; 331:1-7. [PMID: 36933669 DOI: 10.1016/j.jad.2023.03.026] [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: 11/04/2022] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 03/20/2023]
Abstract
BACKGROUND The fact that a complex relationship exists between alexithymia and body mass index (BMI) is well established, but the underlying mechanisms remain poorly understood. Here, we explore the relationship between alexithymia and depressive symptoms in relation to adiposity measures, including the direct and indirect effect of alexithymia and depressive symptoms on obesity over a 15-year time-period, in the Northern Finland Birth Cohort 1966 (NFBC1966). METHODS The study included individuals from the Northern Finland Birth Cohort 1966 (NFBC1966) who had available data for adiposity measures (body mass index and waist-to-hip ratio), alexithymia (measured by the 20-Item Toronto Alexithymia Scale: TAS-20), depressive symptoms (measured by the 13-item depression subscale of Hopkins Symptom Checklist: HSCL-13) at age of 31 years (n = 4773) and 46 years (n = 4431). Pearson's (r) correlation, and multiple linear regression were used to investigate the relationships between alexithymia, depressive symptoms, and adiposity measures. The potential mediating role of depressive symptoms was examined via Hayes' procedure (PROCESS). RESULTS Positive correlations were confirmed between adiposity measures (BMI and WHR) and the TAS-20 score (and its subscale), but not between obesity and HSCL-13 score. The strongest correlation was between the DIF (difficulty identifying feelings) subscale of the TAS-20 and HSCL-13 at both time points (31 y: r(3013) = 0.41, p < 0.01, 46 y: r(3013) = 0.43, p < 0.01). Depressive symptoms completely (z = 2.55 (±0.00003), p = 0.01) and partly (z = 2.16 (±0.0001), p = 0.03) mediated the alexithymia-obesity relationship over the 15-year time-period. LIMITATIONS Other psychological and environmental factors such as interoception, dietary intake and physical activities may also play a role as a potential mediating factor in alexithymia-obesity relationship. CONCLUSIONS Our findings provide additional insights of theoretical framework of depressive symptoms mediation effect in the relationship between alexithymia and obesity. Alexithymia and depression should, therefore, be considered in the design of future clinical obesity research.
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Affiliation(s)
- Nurul Hanis Ramzi
- Institute for Research, Development and Innovation (IRDI), International Medical University, Kuala Lumpur, Malaysia; Department of Metabolism, Digestion and Reproduction, Division of Diabetes, Endocrinology, and Metabolism, Faculty of Medicine, Imperial College London, United Kingdom; Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom.
| | - Juha Auvinen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Unit of Primary Health Care and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Juha Veijola
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland; Department of Psychiatry, University Hospital of Oulu, Oulu, Finland; Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Jouko Miettunen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Leena Ala-Mursula
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Sylvain Sebert
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Sirkka Keinänen-Kiukaanniemi
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Unit of Primary Health Care and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Rauli Svento
- Department of Economics, Oulu Business School, University of Oulu, Oulu, Finland
| | - Jari Jokelainen
- Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Unit of Primary Health Care and Medical Research Center, Oulu University Hospital, Oulu, Finland
| | - Fotios Drenos
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
| | - Terence M Dovey
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
| | - Marjo-Riitta Järvelin
- Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom; Research Unit of Population Health, Faculty of Medicine, University of Oulu, Oulu, Finland; Biocenter Oulu, University of Oulu, Finland; Unit of Primary Health Care and Medical Research Center, Oulu University Hospital, Oulu, Finland; Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment & Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Alexandra I F Blakemore
- Department of Metabolism, Digestion and Reproduction, Division of Diabetes, Endocrinology, and Metabolism, Faculty of Medicine, Imperial College London, United Kingdom; Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, United Kingdom
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6
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McAtamney K, Mantzios M, Egan H, Wallis DJ. A systematic review of the relationship between alexithymia and emotional eating in adults. Appetite 2023; 180:106279. [PMID: 36087827 DOI: 10.1016/j.appet.2022.106279] [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: 01/10/2022] [Revised: 07/07/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022]
Abstract
Elucidating psychological characteristics associated with emotional eating may further inform interventions for this behaviour related to eating psychopathology. The present systematic review aimed to examine the relationship between alexithymia and self-reported emotional eating in adults, and provide a narrative synthesis of the existing literature. Using the PRISMA method for systematic reviews, six databases (MEDLINE, PsycInfo, PsycArticles, PubMed, SCOPUS, and Web of Science) were searched for peer-reviewed, quantitative research published between January 1994 and 20th July 2021, when the searches were conducted. Eligible articles investigated the association between alexithymia, as measured by the Toronto Alexithymia Scale (Bagby, Parker, & Taylor, 1994), and emotional eating, as measured by any validated self-report instrument. Nine cross-sectional articles were reviewed, and risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies (Downes, Brennan, Williams, & Dean, 2016). A narrative synthesis of articles suggests positive associations between alexithymia and self-reported emotional eating. Five measures of emotional eating were used across articles, with limited but consistent evidence for the relationship between alexithymia and emotional eating as measured by the Dutch Eating Behaviour Questionnaire (Van strien et al., 1986). Further research is required to add evidence to the nature of the relationship between alexithymia and emotional eating, and to explore mechanisms that might underpin any relationships. Understanding the association between alexithymia and emotional eating may support strategies and interventions for those seeking help for emotional eating and related eating behaviours.
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Affiliation(s)
- Katherine McAtamney
- Department of Psychology, School of Social Sciences, Birmingham City University, Cardigan Street, Birmingham, B4 7DB, United Kingdom.
| | - Michail Mantzios
- Department of Psychology, School of Social Sciences, Birmingham City University, Cardigan Street, Birmingham, B4 7DB, United Kingdom.
| | - Helen Egan
- Department of Psychology, School of Social Sciences, Birmingham City University, Cardigan Street, Birmingham, B4 7DB, United Kingdom.
| | - Deborah J Wallis
- Department of Psychology, School of Social Sciences, Birmingham City University, Cardigan Street, Birmingham, B4 7DB, United Kingdom.
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Monteleone AM, Globus I, Cascino G, Klomek AB, Latzer Y. Psychopathology predicts mental but not physical bariatric surgery outcome at 3-year follow-up: a network analysis study. Eat Weight Disord 2022; 27:3331-3340. [PMID: 36029369 PMCID: PMC9803758 DOI: 10.1007/s40519-022-01463-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/29/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE This study aimed to explore the psychopathological variables that may predict bariatric surgery outcomes after 3 years. METHODS One hundred ninety-six candidates for bariatric surgery completed self-report questionnaires to assess eating attitudes, eating disorder (ED)-related psychopathology, affective symptoms, interpersonal and psycho-social functioning. One-hundred patients repeated this assessment 3 years after bariatric surgery. A network analysis was run including the pre-surgical measurements in the network. A composite score derived from the combination of the most central network nodes, as well as clinical and socio-demographical variables, was included in a multivariate regression analysis with weight loss, ED psychopathology and psycho-social functioning as outcomes. RESULTS Depression, stress, and shape concerns were the most central network nodes. The composite network score predicted higher ED psychopathology and worse psycho-social functioning at 3-year follow-up, but not weight loss. Higher age, restricting type of bariatric surgery and higher pre-operative BMI were further predictors of reduced weight loss and greater ED psychopathology. CONCLUSIONS Affective symptoms and shape concern play a central role in the psychopathology of candidates to bariatric surgery and predict post-surgery ED psychopathology and psycho-social functioning. These variables may allow to identify patients with higher pre-operative risk and in need of further psycho-social interventions. LEVEL OF EVIDENCE III, evidence obtained from well-designed cohort study.
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Affiliation(s)
| | - Inbal Globus
- School of Public Health, University of Haifa, Haifa, Israel
- Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | | | - Yael Latzer
- Eating Disorders Institution, Psychiatric Division, Rambam Medical Center, Haifa, Israel
- Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
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Meneguzzo P, Tenconi E, Collantoni E, Longobardi G, Zappalà A, Vindigni V, Favaro A, Pavan C. The Cyberball task in people after obesity surgery: preliminary evaluation of cognitive effects of social inclusion and exclusion with a laboratory task. Eat Weight Disord 2022; 27:1523-1533. [PMID: 34510394 PMCID: PMC8435164 DOI: 10.1007/s40519-021-01297-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 08/31/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Social cognition and temperamental and interpretative styles could play a role in the outcome of bariatric surgery. This study aims to assess preliminary evidence about how obesity surgery patients evaluate social inclusion and exclusion through a ball-tossing game called Cyberball, looking at the influence of early maladaptive schemas. METHODS Thirty-four patients with a history of obesity surgery interventions and 44 controls were recruited for this study. A psychological evaluation was performed before and after the Cyberball task with self-report questionnaires. RESULTS In the ostracism condition, significant differences were seen across all the patients' fundamental psychological needs with less perceived ostracization (p = 0.001) even if they recognized less interaction via fewer ball tosses than controls. Moreover, the ostracism paradigm resulted in patients experiencing a higher urge to binge (p = 0.010) and a higher urge to restrain (p = 0.012) than controls. Looking at differences due to the Cyberball paradigm applied, clear differences emerged only between controls subgroups at the specific self-report scales applied, corroborating the reduced perception of the exclusion. As evidenced by the schema domains, the study found a connection between the impaired limits-schema domain and the drive to binge. CONCLUSION The results show that obesity surgery patients reported different effects of the Cyberball task than controls. Different possible interpretations are discussed, and future directions for studies are exposed, both for the evaluation of social interactions effects and in the assessment of the role of specific cognitive schemas. LEVEL OF EVIDENCE Level III: evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Paolo Meneguzzo
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Elena Tenconi
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Enrico Collantoni
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | | | - Adele Zappalà
- Department of Medicine, University of Padova, Padova, Italy
| | - Vincenzo Vindigni
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.,Padova Neuroscience Center, University of Padova, Padova, Italy
| | - Chiara Pavan
- Department of Medicine, University of Padova, Padova, Italy
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9
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El Archi S, Brunault P, De Luca A, Cortese S, Hankard R, Bourbao-Tournois C, Ballon N, Réveillère C, Barrault S. Do Emotion Dysregulation, Alexithymia and Personality Dimensions Explain the Association Between Attention-Deficit/Hyperactivity Disorder and Binge Eating Among Bariatric Surgery Candidates? Front Psychol 2021; 12:745857. [PMID: 34867628 PMCID: PMC8641657 DOI: 10.3389/fpsyg.2021.745857] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 10/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Addictive-like eating and attention-deficit/hyperactivity disorder (ADHD) are both common among persons seeking treatment for severe obesity. Given that ADHD and addictive-like eating, especially binge eating (BE) and food addiction (FA), are both strongly associated with personality dimensions and emotion dysregulation, it is possible emotional and personality characteristics contribute to the link between addictive-like eating behaviors and ADHD in people with severe obesity. This study aimed to investigate the psychological factors associated with BE and FA in bariatric surgery candidates, and to explore the mediational role of emotional factors (emotion dysregulation and alexithymia) and personality dimensions in the association between ADHD and BE. Method: Two hundred and eighty-two (n = 282) bariatric surgery candidates were recruited during the systematic preoperative psychiatric assessment (University Hospital of Tours, France). We assessed significant BE (Binge Eating Scale), probable adult ADHD (Wender Utah Render Scale and Adult ADHD Self-Report Scale), FA (Yale Food Addiction Scale 2.0, YFAS 2.0), emotion dysregulation (Difficulties in Emotion Regulation Scale-16), alexithymia (Toronto Alexithymia Scale-20) and personality dimensions (Big Five Inventory). Mediation analyses were performed using the PROCESS macro for IBM SPSS Statistics 22. Results: Prevalence of probable adult ADHD, significant BE and FA were 8.2, 19.1, and 26.6%, respectively. Participants who screened positive for addictive-like eating showed higher prevalence of probable adult ADHD, as well as higher scores on adult and childhood ADHD symptoms. They also reported lower conscientiousness, but higher emotion dysregulation, higher alexithymia, and higher neuroticism. Only BE (as opposed to FA) was also associated with lower scores on agreeableness and openness. Analysis of the association between adult ADHD and BE suggests that emotion dysregulation, conscientiousness, agreeableness, and neuroticism are total mediators and alexithymia a partial mediator. Conclusion: Our findings suggest a significant association between ADHD and addictive-like eating among bariatric surgery candidates, and also suggest a significant role of emotion dysregulation and personality dimensions in this association. For individuals with ADHD and obesity, eating may be a way to cope with negative emotions, potentially increasing the risk for addictive-like eating behavior.
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Affiliation(s)
| | - Paul Brunault
- Qualipsy, EE 1901, Université de Tours, Tours, France.,CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France.,INSERM U1253 Imagerie et Cerveau (iBrain), Tours, France
| | - Arnaud De Luca
- CHRU de Tours, Centre Spécialisé de l'Obésité, Tours, France.,Inserm U1069 Université de Tours, Tours, France
| | - Samuele Cortese
- Academic Unit of Psychology, Center for Innovation in Mental Health, University of Southampton, Southampton, United Kingdom.,Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, United Kingdom.,Solent NHS Trust, Southampton, United Kingdom.,Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, United States.,Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Régis Hankard
- CHRU de Tours, Centre Spécialisé de l'Obésité, Tours, France.,Inserm U1069 Université de Tours, Tours, France
| | | | - Nicolas Ballon
- CHRU de Tours, Service d'Addictologie Universitaire, Équipe de Liaison et de Soins en Addictologie, Tours, France.,INSERM U1253 Imagerie et Cerveau (iBrain), Tours, France
| | | | - Servane Barrault
- Qualipsy, EE 1901, Université de Tours, Tours, France.,CHRU de Tours, Service d'Addictologie Universitaire, Centre de Soins d'Accompagnement et de Prévention en Addictologie d'Indre-et-Loire (CSAPA-37), Tours, France.,Laboratoire de Psychopathologie et Processus de Santé, Université Paris Descartes, Paris, France
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10
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Herb Neff KM, Schuh LM, Saules KK, Creel DB, Stote JJ, Schuh KM, Inman M. Psychological Functioning and Health Behaviors Associated with Weight Loss Patterns up to 13.7 Years After Weight Loss Surgery. J Clin Psychol Med Settings 2021; 28:833-843. [PMID: 34324141 DOI: 10.1007/s10880-021-09807-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 01/22/2023]
Abstract
Weight loss surgery produces dramatic health improvements immediately after surgery, including rapid declines in diabetes. However, less is known about its long-term effects. 124 St. Vincent Bariatric Center patients completed questionnaires on weight and psychological functioning a mean of 7.7 and 13.7 years post-surgery (T1 and T2, respectively). Because mean weight data may mask differing weight trajectories, participants were categorized based on weight over time. Most participants underwent Roux-En-Y gastric bypass (90.3%) and were Caucasian (96%), female (81.5%), and married (69.1%). Mean age at T2 was 64; mean %EWL was 64.9%. Most patients fit into one of three weight change patterns, reaching weight nadir, and regaining by T1 and then, by T2, experiencing (1) Weight Loss (n = 36), (2) Weight Maintenance (n = 37), or (3) Continued Weight Gain (n = 39). Groups differed significantly on body satisfaction, weighing frequency, and conscientiousness, with Weight Gainers significantly lower than other groups on conscientiousness and body satisfaction, and Weight Losers reporting higher frequency of weighing than Maintainers. Bariatric patients can maintain substantial weight loss and positive psychological functioning for many years post-surgery, although weight regain is associated with less body satisfaction. Conscientiousness may signify medical adherence, whereas frequent weighing may be a behavior that promotes ongoing weight loss.
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Affiliation(s)
| | - Leslie M Schuh
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA
| | - Karen K Saules
- Department of Psychology, Eastern Michigan University, Ypsilanti, MI, USA. .,Community Behavioral Health Clinic, Eastern Michigan University, 1075 North Huron River Drive, Ypsilanti, MI, 48197, USA.
| | - David B Creel
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA.,Cleveland Clinic, Cleveland, OH, USA
| | - Joseph J Stote
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA
| | - Kristen M Schuh
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA.,Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Margaret Inman
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, USA
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11
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Favieri F, Marini A, Casagrande M. Emotional Regulation and Overeating Behaviors in Children and Adolescents: A Systematic Review. Behav Sci (Basel) 2021; 11:11. [PMID: 33477932 PMCID: PMC7833366 DOI: 10.3390/bs11010011] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/15/2021] [Accepted: 01/15/2021] [Indexed: 12/19/2022] Open
Abstract
The worldwide prevalence of obesity has dramatically increased, mostly in children and adolescents. The Emotional Eating theoretical model has proposed that the failure in emotional regulation could represent a risk factor for establishing maladaptive overeating behavior that represents an inadequate response to negative emotions and allows increasing body-weight. This systematic review investigates the relationship between overeating and both emotional regulation and emotional intelligence in childhood and adolescence, considering both cross-sectional and longitudinal studies. Moreover, another goal of the review is evaluating whether emotional regulation and emotional intelligence can cause overeating behaviors. The systematic search was conducted according to the PRISMA-statement in the databases Medline, PsychArtcles, PsychInfo, PubMed, Scopus, and Web of Sciences, and allows 484 records to be extracted. Twenty-six studies were selected according to inclusion (e.g., studies focused on children and adolescents without clinical conditions; groups of participants overweight or with obesity) and exclusion (e.g., studies that adopted qualitative assessment or cognitive-affective tasks to measure emotional variables; reviews, commentary, or brief reports) criteria detailed in the methods. Cross-sectional studies showed a negative association between emotional regulation and overeating behavior that was confirmed by longitudinal studies. These findings highlighted the role of maladaptive emotion regulation on overeating and being overweight. The relationship between these constructs in children and adolescents was consistent. The results indicated the complexity of this association, which would be influenced by many physiological, psychological, and social factors. These findings underline the need for further studies focused on emotion regulation in the development of overeating. They should analyze the mediation role of other variables (e.g., attachment style, peer pressure) and identify interventions to prevent and reduce worldwide overweight prevalence.
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Affiliation(s)
- Francesca Favieri
- Department of Psychology, “Sapienza” University of Rome, 00185 Rome, Italy
| | - Andrea Marini
- Department of Dynamic, Clinical and Health Psychology, “Sapienza” University of Rome, 00185 Rome, Italy;
| | - Maria Casagrande
- Department of Dynamic, Clinical and Health Psychology, “Sapienza” University of Rome, 00185 Rome, Italy;
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12
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Benzerouk F, Djerada Z, Bertin E, Barrière S, Gierski F, Kaladjian A. Contributions of Emotional Overload, Emotion Dysregulation, and Impulsivity to Eating Patterns in Obese Patients with Binge Eating Disorder and Seeking Bariatric Surgery. Nutrients 2020; 12:nu12103099. [PMID: 33053641 PMCID: PMC7650699 DOI: 10.3390/nu12103099] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Binge eating disorder (BED) is very frequently observed in patients considered for weight loss surgery and seems to influence their outcome critically. Literature highlights a global emotional overload in individuals with BED, but little is known on the mechanisms involved. The present study aimed to focus on emotion regulation, impulsivity, depression, and anxiety in people with and without BED and fulfilling inclusion criteria for bariatric surgery. Doing so, we sought to individualize factors related to BED. Then, we examined the contribution of depression, anxiety, emotion regulation difficulties, and impulsivity to inappropriate eating behaviors observed in patients with BED. Methods: A sample of 121 individuals (79.3% female, mean age: 40.82 ± 9.26, mean current body mass index (BMI): 44.92 kg/m2 ± 7.55) seeking bariatric surgery were recruited at the Champagne Ardenne Specialized Center in Obesity in Reims, France from November 2017 to October 2018. They were stratified as with or without BED according to the binge eating scale. Characteristics identified in univariate analyses as differentiating the two groups were then included in multivariable analyses. Results: Multivariable analyses showed that limited access to emotional regulation strategies was significantly associated with BED. Furthermore, inappropriate eating behaviors were independently associated with age, depression severity, anxiety, emotional dysregulation, and impulsivity in BED group. Conclusions: The present findings are indicative of an association between emotion deficit and BED in obese patients seeking bariatric surgery. Patients with BED could benefit from the addition of an emotion regulation intervention.
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Affiliation(s)
- Farid Benzerouk
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100 Reims, France; (S.B.); (F.G.); (A.K.)
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 51100 Reims, France
- Correspondence:
| | - Zoubir Djerada
- Department of Pharmacology E.A.3801, SFR CAP-santé, Reims University Hospital, 51100 Reims, France;
| | - Eric Bertin
- Champagne Ardenne Specialized Center in Obesity, University Hospital Center, 51100 Reims, France;
| | - Sarah Barrière
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100 Reims, France; (S.B.); (F.G.); (A.K.)
| | - Fabien Gierski
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100 Reims, France; (S.B.); (F.G.); (A.K.)
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 51100 Reims, France
- INSERM U1247 GRAP, Research Group on Alcohol and Pharmacodependences, Université de Picardie Jules Verne, 80000 Amiens, France
| | - Arthur Kaladjian
- Psychiatry Department, Reims University Hospital, EPSM Marne, 51100 Reims, France; (S.B.); (F.G.); (A.K.)
- Cognition Health and Society Laboratory (EA 6291), Université de Reims Champagne-Ardenne, 51100 Reims, France
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13
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Casagrande M, Boncompagni I, Forte G, Guarino A, Favieri F. Emotion and overeating behavior: effects of alexithymia and emotional regulation on overweight and obesity. Eat Weight Disord 2020; 25:1333-1345. [PMID: 31473988 DOI: 10.1007/s40519-019-00767-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE Obesity and overweight are significant risk factors for many serious diseases. Several studies have investigated the relationship between emotional regulation and overweight or obesity in people with eating disorders. Although a few studies have explored alexithymia in individuals with severe obesity without eating disorders, no attention has been paid to individuals with overweight and preclinical form of obesity. This study aims to assess whether overweight and obesity are related to emotional dysregulation and alexithymia. METHODS The study involved 111 undergraduate students who had not been diagnosed with an eating disorder. The sample was divided into two groups according to their body mass index (BMI): normal weight (N = 55) and overweight (N = 56). All of them completed the Toronto Alexithymia Scale (TAS-20), the Emotional Regulation Questionnaire (ERQ), and the Eating Disorder Inventory-2 (EDI-2). RESULTS Results showed higher levels of alexithymia, and specifically higher difficulty in identifying feelings and an externally oriented thought, in participants with overweight. Multiple correlation analysis highlighted the positive relations between some EDI-2 subscales and both alexithymia and emotional regulation scores. Linear regressions revealed a significant relationship between body BMI and both alexithymia and emotional regulation strategies. CONCLUSIONS The condition of overweight/obesity seems to be associated with higher emotional dysregulation compared to normal weight condition. It is essential to study this relationship because it could represent a risk factor for the worsening of problems related to overeating and excessive body weight. These findings suggest that an integrated approach aimed at considering the promotion of emotional regulation could contribute to the effectiveness of a program designed to reduce overweight and obesity. LEVEL OF EVIDENCE Level III: case-control analytic study.
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Affiliation(s)
- Maria Casagrande
- Dipartimento di Psicologia Dinamica e Clinica, Università di Roma "Sapienza", Via degli Apuli, 1, 00185, Rome, Italy.
| | - Ilaria Boncompagni
- Dipartimento di Psicologia, Università di Roma "Sapienza", Via dei Marsi, 78, 00185, Rome, Italy
| | - Giuseppe Forte
- Dipartimento di Psicologia, Università di Roma "Sapienza", Via dei Marsi, 78, 00185, Rome, Italy
| | - Angela Guarino
- Dipartimento di Psicologia, Università di Roma "Sapienza", Via dei Marsi, 78, 00185, Rome, Italy
| | - Francesca Favieri
- Dipartimento di Psicologia, Università di Roma "Sapienza", Via dei Marsi, 78, 00185, Rome, Italy
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14
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Willem C, Nandrino JL, Doba K, Roussel M, Triquet C, Verkindt H, Pattou F, Gandolphe MC. Interoceptive reliance as a major determinant of emotional eating in adult obesity. J Health Psychol 2020; 26:2118-2130. [DOI: 10.1177/1359105320903093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study examined the association between emotional eating, emotion dysregulations, and interoceptive sensibility in 116 patients with obesity by distinguishing an “awareness” and a “reliance” component of interoceptive sensibility. Deficits in interoceptive awareness were only associated with more emotional eating in obesity through less interoceptive reliance and more emotion dysregulations. The results suggest that good interoceptive awareness can increase the risk of emotional eating if not supported by good interoceptive reliance. Interoceptive reliance, like the ability to trust, positively consider, and positively use inner sensations, should be a privileged target of psychotherapeutic interventions in obesity.
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Affiliation(s)
- Clémence Willem
- University of Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Jean-Louis Nandrino
- University of Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Karyn Doba
- University of Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
| | - Méline Roussel
- CETRADIMN Diabetology Center, Roubaix Hospital, Roubaix, France
| | - Claire Triquet
- Departmental Hospital of Felleries-Liessies, Sorle le chateau, France
| | - Hélène Verkindt
- General and Endocrine Surgery, Faculty of Medicine, University of Lille, CHU Lille, Inserm, Lille, France
| | - François Pattou
- General and Endocrine Surgery, Faculty of Medicine, University of Lille, CHU Lille, Inserm, Lille, France
| | - Marie-Charlotte Gandolphe
- University of Lille, CNRS, CHU Lille, UMR 9193 - SCALab - Sciences Cognitives et Sciences Affectives, Lille, France
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15
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Lavender JM, King WC, Kalarchian MA, Devlin MJ, Hinerman A, Gunstad J, Marcus MD, Mitchell JE. Examining emotion-, personality-, and reward-related dispositional tendencies in relation to eating pathology and weight change over seven years in the Longitudinal Assessment of Bariatric Surgery (LABS) study. J Psychiatr Res 2020; 120:124-130. [PMID: 31670260 PMCID: PMC6901114 DOI: 10.1016/j.jpsychires.2019.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 12/28/2022]
Abstract
This study examined dispositional emotion-, personality/temperament-, and reward-related variables in relation to post-surgery eating pathology and weight-change among 107 adults who underwent Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB). As part of a prospective cohort study, annual post-surgical assessments were conducted to evaluate eating pathology, using the Eating Disorder Examination-Bariatric Surgery Version, and percent weight change from pre-surgery. Dispositional measures were administered at the 6- or 7-year assessment and included the Affect Intensity Measure, Difficulties in Emotion Regulation Scale, UPPS-P Impulsive Behavior Scale, Adult Temperament Questionnaire-Effortful Control Scale, and Sensitivity to Punishment/Sensitivity to Reward Questionnaire. Results from a series of linear mixed models revealed significant associations of emotion dysregulation, affect intensity, positive and negative urgency, effortful control, and reward sensitivity with eating pathology severity across 7 years; additionally, all but two of the subscales comprising the total scores were also significantly associated. Fewer statistically significant results were found in relation to weight change; emotion dysregulation and affect intensity (along with several subscales) were significantly associated with lower percent weight change (i.e., less weight loss), but of the reward-related and personality/temperament variables, only total effortful control emerged as significant. However, the associations of the other variables with both outcomes were consistently in the expected direction. Associations also appeared consistent across surgical procedures. Taken together, findings suggest that certain dispositional tendencies may relate to less optimal long-term outcomes following bariatric surgery and thus may be useful to assess in pre-surgical or early post-surgical evaluations to inform targeted recommendations.
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Affiliation(s)
- Jason M Lavender
- Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Military Cardiovascular Outcomes Research Program (MiCOR), Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Metis Foundation, San Antonio, TX, USA.
| | - Wendy C King
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | | | - Michael J Devlin
- Columbia University Vagelos College of Physicians and Surgeons / New York State Psychiatric Institute, New York, NY, USA
| | - Amanda Hinerman
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, USA
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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16
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Willem C, Gandolphe MC, Roussel M, Verkindt H, Pattou F, Nandrino JL. Difficulties in emotion regulation and deficits in interoceptive awareness in moderate and severe obesity. Eat Weight Disord 2019; 24:633-644. [PMID: 31243741 DOI: 10.1007/s40519-019-00738-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 06/15/2019] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Difficulties in emotion regulation and deficits in interoceptive awareness may be responsible for overeating and weight gain in obesity by increasing the risks of problematic eating behaviors. This study aimed to: (1) examine emotion regulation difficulties and interoceptive deficits in obesity; (2) compare the emotion regulation and interoceptive abilities of moderately and severely obese patients. METHODS Participants were recruited through the university, diabetology centers and bariatric surgery departments. A total of 165 participants were categorized in three groups, matched by age and gender, according to their Body Mass Index (BMI). The severely obese (SO), moderately obese (MO) and normal weight (NW) groups were constituted of 55 participants each. Self-report questionnaires were used to assess emotion regulation difficulties (CERQ-DERS) and interoceptive awareness (MAIA-FFMQ). RESULTS Overall, obese participants reported more emotion regulation difficulties and less interoceptive awareness than NW participants did. They also reported a lack of planning strategies and emotional awareness, as well as less ability to observe, notice and trust body sensations. No differences in emotion regulation and interoceptive abilities were found between MO and SO participants. CONCLUSIONS Emotion regulation and interoceptive awareness should be targeted in the psychotherapeutic care of obese people, regardless of their BMI. LEVEL OF EVIDENCE Level III, case-control analytic study.
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Affiliation(s)
- Clémence Willem
- SCALab Laboratory, Department of Psychology, UMR 9193, CNRS, University of Lille, Villeneuve d'ascq, France.
| | - Marie-Charlotte Gandolphe
- SCALab Laboratory, Department of Psychology, UMR 9193, CNRS, University of Lille, Villeneuve d'ascq, France
| | - Méline Roussel
- Diabetology Center, CETRADIMN, Hospital of Roubaix, Roubaix, France
| | - Hélène Verkindt
- General and Endocrine Surgery, University Hospital of Lille, INSERM U1190, University of Lille, Lille, France
| | - François Pattou
- General and Endocrine Surgery, University Hospital of Lille, INSERM U1190, University of Lille, Lille, France
| | - Jean-Louis Nandrino
- SCALab Laboratory, Department of Psychology, UMR 9193, CNRS, University of Lille, Villeneuve d'ascq, France
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17
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Alexithymia and weight loss in obese patients underwent laparoscopic sleeve gastrectomy. Eat Weight Disord 2019; 24:129-134. [PMID: 28353096 DOI: 10.1007/s40519-017-0381-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/14/2017] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Obesity is a multifactorial disease characterized by genetic, social, cultural and psychological factors. Currently, bariatric surgery represents the gold-standard intervention to treat morbid obesity in order to counteract associated disabling comorbidities. Several studies showed correlation between post-surgery weight loss and psychological factors. Also, the alexithymia may have a role in affecting post-surgery outcomes in bariatric patients, even if there are no studies investigating its role at 12-month follow-up. The purpose of the present study was to investigate the association between alexithymia and the postoperative weight loss 12 months after laparoscopic sleeve gastrectomy. METHODS Seventy-five patients undergoing laparoscopic sleeve gastrectomy were enrolled. The Toronto Alexithymia Scale (TAS-20) was administered to patients. A postoperative weight loss check was performed at 3 and then 12 months after surgery. RESULTS The TAS-20 total score was negatively correlated with the percent of excess weight loss (%EWL) at the 12-month follow-up (r = -0.24; p = 0.040). The analysis showed that non-alexithymic patients had a greater weight loss at 12 months after surgery compared to both probably alexithymics (71.88 ± 18.21 vs. 60.7 ± 12.5; p = 0.047) and probably alexithymic patients (71.88 ± 18.21 vs. 56 ± 22.8; p = 0.007). The preoperative BMI was a significant covariate [F(1,70) = 6.13 (p = 0.016)]. CONCLUSION In the present study, the patients with higher preoperative BMI and identified as alexithymic showed lower %EWL at 12 months after laparoscopic sleeve gastrectomy. Findings point out the importance to take into consideration possible psychological treatments focused on improving emotional regulations of patients who are seeking bariatric surgery.
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18
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Multi-unit relations among neural, self-report, and behavioral correlates of emotion regulation in comorbid depression and obesity. Sci Rep 2018; 8:14032. [PMID: 30232351 PMCID: PMC6145883 DOI: 10.1038/s41598-018-32394-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 08/28/2018] [Indexed: 11/21/2022] Open
Abstract
Depression is a leading cause of disability and is commonly comorbid with obesity. Emotion regulation is impaired in both depression and obesity. In this study, we aimed to explicate multi-unit relations among brain connectivity, behavior, and self-reported trait measures related to emotion regulation in a comorbid depressed and obese sample (N = 77). Brain connectivity was quantified as fractional anisotropy (FA) of the uncinate fasciculi, a white matter tract implicated in emotion regulation and in depression. Use of emotion regulation strategies was assessed using the Emotion Regulation Questionnaire (ERQ). We additionally measured reaction times to identifying negative emotions, a behavioral index of depression-related emotion processing biases. We found that greater right uncinate fasciculus FA was related to greater usage of suppression (r = 0.27, p = 0.022), and to faster reaction times to identifying negative emotions, particularly sadness (r = −0.30, p = 0.010) and fear (r = −0.35, p = 0.003). These findings suggest that FA of the right uncinate fasciculus corresponds to maladaptive emotion regulation strategies and emotion processing biases that are relevant to co-occurring depression and obesity. Interventions that consider these multi-unit associations may prove to be useful for subtyping and improving clinical outcomes for comorbid depression and obesity.
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19
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Cognitive reappraisal of low-calorie food predicts real-world craving and consumption of high- and low-calorie foods in daily life. Appetite 2018; 131:44-52. [PMID: 30176299 DOI: 10.1016/j.appet.2018.08.036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 07/15/2018] [Accepted: 08/28/2018] [Indexed: 11/23/2022]
Abstract
In an increasingly obesogenic environment, an individual's regulatory capacity to pursue nutrient-rich, low-calorie foods over palatable, energy-dense items is essential to maintaining a healthy weight and preventing the detrimental health risks of obesity. Cognitive reappraisal, the process by which one changes the meaning of a stimulus by altering its emotional impact (or in this case, its appetitive value) demonstrates promise as a regulatory strategy to decrease obesogenic food consumption, but little research has directly addressed the relationship between cognitive reappraisal of food cravings and real-world eating behaviors. Additionally, research examining self-regulation of eating has typically focused exclusively on diminishing cravings and consumption of unhealthy, high-calorie foods, rather than examining, in tandem, ways to strengthen (or, up-regulate) cravings for healthier, low-calorie alternatives. In the present study, fifty-seven college aged participants first completed a cognitive reappraisal task in the laboratory in which they practiced regulating their craving responses to high- and low-calorie food items by focusing on the long-term health consequences of repeatedly consuming the pictured foods. Next, for a week following the laboratory session, participants reported daily eating behaviors via ecological momentary assessment. Participants who reported greater up-regulatory success during the reappraisal task also reported increased craving strength for low-calorie foods as well as decreased consumption of high-calorie foods in their daily lives. Greater overall regulation success also predicted more frequent consumption of craved low-calorie foods. These findings substantiate the association between cognitive reappraisal ability and real-world appetitive behaviors, and suggest that future interventions may benefit from specifically targeting individuals' evaluations of low-calorie foods.
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20
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Wierenga KL. Emotion Regulation and Perceptions of Illness Coherence and Controllability on Regimen Adherence and Negative Cardiac Health Events in African American Women With Heart Failure. J Cardiovasc Nurs 2018; 32:594-602. [PMID: 28398917 PMCID: PMC5633482 DOI: 10.1097/jcn.0000000000000403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND African American women with heart failure (HF) have stressors that negatively impact HF self-management adherence and heighten the occurrence of negative cardiac health events. Perceptions of illness coherence and controllability and emotion regulation are known to facilitate self-management in the face of stressors. OBJECTIVE The aim of this study was to determine whether difficulties with emotion regulation and negative perceptions of illness coherence and controllability are detrimental to adherence and increase negative cardiac health events in this patient population. METHODS African American women (n = 54) with HF, aged 49 to 84 years, participated in this longitudinal descriptive correlational study. Using convenience sampling, we recruited patients from hospitals and HF clinics. They completed interviews at intake and 30 days, and their medical records were reviewed at 90 days. Linear and logistic regression models were used to assess predictors of general adherence and negative cardiac health events. RESULTS Of 54 patients who participated in the study, 28 experienced a negative health event during 90 days, and 57% of these events were cardiac related. The only clear predictor of these events was greater New York Heart Association functional classification (β = 1.47, P = .027). No associations were found between predictors (emotion regulation, controllability, coherence, age, education) and general adherence. CONCLUSIONS Emotion regulation showed a possible greater impact on negative cardiac health events than on general adherence. Perceived illness coherence showed less impact on negative cardiac health events than on general adherence.
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Affiliation(s)
- Kelly L Wierenga
- Kelly L. Wierenga, PhD, RN Postdoctoral Fellow, Case Western Reserve University, Cleveland, Ohio
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21
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Wierenga KL, Lehto RH, Given B. Emotion Regulation in Chronic Disease Populations: An Integrative Review. Res Theory Nurs Pract 2018; 31:247-271. [PMID: 28793948 DOI: 10.1891/1541-6577.31.3.247] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND PURPOSE Emotion regulation, the experiencing, processing, and modulating of emotional response, is necessary to manage the emotional stressors common in patients with chronic illness. Overwhelming emotional demands deplete the resources needed for everyday self-care management of chronic disease, contributing to poor health outcomes. Emotion regulation is shown to impact behaviors in healthy individuals; yet, a review of literature examining evidence of associations in chronically ill populations is lacking. The purpose of this article is to examine the state of the science relative to the impact of emotion regulation on health outcomes in chronic illness populations. METHODS Articles were reviewed (N = 14) that focused on emotion regulation and outcomes of patients with chronic illness. RESULTS Indicate that most of the studies focused on these concepts are cross-sectional and measure emotion regulation using various surveys. Potential relationships exist with increased age, male gender, higher education, decreased stress, depressive, and anxiety symptoms being associated with more adaptive emotion regulation. Of primary importance to patients with chronic illnesses is the potential link between greater difficulties with emotion regulation and the presence of chronic disease as well as poorer physical function. IMPLICATIONS FOR PRACTICE Care should include attention to affective regulation as well as physiologic responses of chronic illness.
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Neural predictors of 12-month weight loss outcomes following bariatric surgery. Int J Obes (Lond) 2017; 42:785-793. [PMID: 28894291 PMCID: PMC6319374 DOI: 10.1038/ijo.2017.190] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/13/2017] [Accepted: 07/22/2017] [Indexed: 12/13/2022]
Abstract
Background/Objectives: Despite the effectiveness of bariatric surgery, there is still substantial variability in long-term weight outcomes and few factors with predictive power to explain this variability. Neuroimaging may provide a novel biomarker with utility beyond other commonly used variables in bariatric surgery trials to improve prediction of long-term weight loss outcomes. The purpose of this study was to evaluate the effects of sleeve gastrectomy (SG) on reward and cognitive control circuitry post-surgery and determine the extent to which baseline brain activity predicts weight loss at 12-months post-surgery. Subjects/Methods: Using a longitudinal design, behavioral, hormone, and neuroimaging data (during a desire for palatable food regulation paradigm) were collected from 18 patients undergoing SG at baseline (<1 month prior) and 12-months post-SG. Results: SG patients lost an average of 29.0% of their weight (% total weight loss, %TWL) at 12-months post-SG, with significant variability (range: 16.0–43.5%). Maladaptive eating behaviors (uncontrolled, emotional, and externally-cued eating) improved (p<0.01), in parallel with reductions in fasting hormones (acyl ghrelin, leptin, glucose, insulin; p<0.05). Brain activity in the nucleus accumbens (NAcc), caudate, pallidum, and amygdala during desire for palatable food enhancement vs. regulation decreased from baseline to 12-months [p(FWE)<0.05]. Dorsolateral and dorsomedial prefrontal cortex activity during desire for palatable food regulation (vs. enhancement) increased from baseline to 12-months [p(FWE)<0.05]. Baseline activity in the NAcc and hypothalamus during desire for palatable food enhancement was significantly predictive of %TWL at 12-months [p(FWE)<0.05], superior to behavioral and hormone predictors, which did not significantly predict %TWL (p>0.10). Using stepwise linear regression, left NAcc activity accounted for 54% of the explained variance in %TWL at 12-months. Conclusions: Consistent with previous obesity studies, reward-related neural circuit activity may serve as an objective, relatively robust predictor of post-surgery weight loss. Replication in larger studies is necessary to determine true effect sizes for outcome prediction.
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Shields GS, Moons WG, Slavich GM. Inflammation, Self-Regulation, and Health: An Immunologic Model of Self-Regulatory Failure. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2017; 12:588-612. [PMID: 28679069 DOI: 10.1177/1745691616689091] [Citation(s) in RCA: 75] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Self-regulation is a fundamental human process that refers to multiple complex methods by which individuals pursue goals in the face of distractions. Whereas superior self-regulation predicts better academic achievement, relationship quality, financial and career success, and lifespan health, poor self-regulation increases a person's risk for negative outcomes in each of these domains and can ultimately presage early mortality. Given its centrality to understanding the human condition, a large body of research has examined cognitive, emotional, and behavioral aspects of self-regulation. In contrast, relatively little attention has been paid to specific biologic processes that may underlie self-regulation. We address this latter issue in the present review by examining the growing body of research showing that components of the immune system involved in inflammation can alter neural, cognitive, and motivational processes that lead to impaired self-regulation and poor health. Based on these findings, we propose an integrated, multilevel model that describes how inflammation may cause widespread biobehavioral alterations that promote self-regulatory failure. This immunologic model of self-regulatory failure has implications for understanding how biological and behavioral factors interact to influence self-regulation. The model also suggests new ways of reducing disease risk and enhancing human potential by targeting inflammatory processes that affect self-regulation.
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Affiliation(s)
| | | | - George M Slavich
- 3 Cousins Center for Psychoneuroimmunology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
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24
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Melin EO, Svensson R, Thunander M, Hillman M, Thulesius HO, Landin-Olsson M. Gender, alexithymia and physical inactivity associated with abdominal obesity in type 1 diabetes mellitus: a cross sectional study at a secondary care hospital diabetes clinic. BMC OBESITY 2017; 4:21. [PMID: 28588898 PMCID: PMC5455074 DOI: 10.1186/s40608-017-0157-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 05/19/2017] [Indexed: 01/16/2023]
Abstract
Background Obesity is linked to cardiovascular diseases and increasingly common in type 1 diabetes mellitus (T1DM) since the introduction of intensified insulin therapy. Our main aim was to explore associations between obesity and depression, anxiety, alexithymia and self-image measures and to control for lifestyle variables in a sample of persons with T1DM. Secondary aims were to explore associations between abdominal and general obesity and cardiovascular complications in T1DM. Methods Cross sectional study of 284 persons with T1DM (age 18–59 years, men 56%), consecutively recruited from one secondary care hospital diabetes clinic in Sweden. Assessments were performed with self-report instruments (Hospital Anxiety and Depression Scale, Toronto Alexithymia Scale-20 items and Structural Analysis of Social Behavior). Anthropometrics and blood samples were collected for this study and supplemented with data from the patients’ medical records. Abdominal obesity was defined as waist circumference men/women (meters): ≥1.02/≥0.88, and general obesity as BMI ≥30 kg/m2 for both genders. Abdominal obesity was chosen in the analyses due to the high association with cardiovascular complications. Different explanatory logistic regression models were elaborated for the associations and calibrated and validated for goodness of fit with the data variables. Results The prevalence of abdominal obesity was 49/284 (17%), men/women: 8%/29% (P < 0.001). Abdominal obesity was associated with women (AOR 4.9), physical inactivity (AOR 3.1), alexithymia (AOR 2.6) and age (per year) (AOR 1.04). One of the three alexithymia sub factors, “difficulty identifying feelings” (AOR 3.1), was associated with abdominal obesity. Gender analyses showed that abdominal obesity in men was associated with “difficulty identifying feelings” (AOR 7.7), and in women with use of antidepressants (AOR 4.3) and physical inactivity (AOR 3.6). Cardiovascular complications were associated with abdominal obesity (AOR 5.2). Conclusions Alexithymia, particularly the alexithymia subfactor “difficulty identifying feelings”, physical inactivity, and women, as well as cardiovascular complications were associated with abdominal obesity. As abdominal obesity is detrimental in diabetes due to its association with cardiovascular complications, our results suggest two risk factor treatment targets: increased emotional awareness and increased physical activity.
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Affiliation(s)
- Eva O Melin
- Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Sweden.,Department of Research and Development, Region Kronoberg, Box 1223, SE-351 12 Växjö, Sweden.,Primary Care, Region Kronoberg, Växjö, Sweden
| | - Ralph Svensson
- Department of Psychology, Linnaeus University, Växjö, Sweden
| | - Maria Thunander
- Lund University, Faculty of Medicine, Department of Clinical Sciences, Lund, Sweden.,Department of Research and Development, Region Kronoberg, Box 1223, SE-351 12 Växjö, Sweden.,Department of Internal Medicine, Central Hospital, Växjö, Sweden
| | - Magnus Hillman
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Faculty of Medicine, Lund, Sweden
| | - Hans O Thulesius
- Department of Research and Development, Region Kronoberg, Box 1223, SE-351 12 Växjö, Sweden.,Primary Care, Region Kronoberg, Växjö, Sweden.,Department of Clinical Sciences, Division of Family Medicine, Lund University, Malmö, Sweden
| | - Mona Landin-Olsson
- Department of Clinical Sciences, Diabetes Research Laboratory, Lund University, Faculty of Medicine, Lund, Sweden.,Department of Endocrinology, Lund University, Skane University Hospital, Lund, Sweden
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25
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Sevinçer GM, Konuk N, İpekçioğlu D, Crosby RD, Cao L, Coskun H, Mitchell JE. Association between depression and eating behaviors among bariatric surgery candidates in a Turkish sample. Eat Weight Disord 2017; 22:117-123. [PMID: 27342413 DOI: 10.1007/s40519-016-0296-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 06/13/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The purpose of this study was to explore further whether depression is associated with problematic eating behaviors in a sample of Turkish bariatric surgery candidates. METHODS This descriptive study included 168 consecutively seen bariatric surgery candidates in a university bariatric surgery outpatient. Participants were asked to complete the Dutch Eating Behavior Questionnaire (DEBQ), the Beck Depression Inventory (BDI) and surveys assessing sociodemographic and clinical variables. Correlations and linear regression analyses were performed to evaluate the relationship between clinical and demographic variables. RESULTS Participants had a mean age 37.7 ± 11.3 years and BMI of 46.4 ± 6.7 kg/m2 (SD = 6.7). According to BDI scores, 75.5 % of the patients had mild, moderate, or severe depressive symptomatology. Lower levels of depressive symptoms were associated with higher levels of restrictive eating (r = -0.17; p = 0.04), whereas higher levels of depressive symptoms were associated with more frequent eating in response to both internal (r = 0.3; p = 0.002) and external (r = 0.2; p = 0.04) cues. The BDI scores were significantly associated with increased external eating (ß = 0.03, p < 0.02) and emotional eating (ß = 0.03, p < 0.002) scores. BMI (β = -0.02, p = 0.02 > 0.1) was not associated with DEBQ total scores. CONCLUSIONS This research suggests that mild, moderate or severe depressive symptoms are observed in most of the bariatric surgical candidate patients. There is a positive correlation between severity of depression and emotional/external eating behaviors, and a negative correlation between severity of depression and restrictive eating behavior. Additional research is needed to determine whether treating depression preoperatively can assist with alleviating problematic eating behaviors.
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Affiliation(s)
- Güzin M Sevinçer
- Department of Psychology, Istanbul Gelisim University, Istanbul, Turkey.
| | - Numan Konuk
- Department of Psychiatry Istanbul, Istanbul University Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Derya İpekçioğlu
- Bakırköy Research and Training Hospital for Psychiatry, Neurology and Neurosurgery, Istanbul, Turkey
| | - Ross D Crosby
- Department of Clinical Research, Neuropsychiatric Research Institute, Fargo, ND, USA
| | - Li Cao
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine, Fargo, ND, USA
| | - Halil Coskun
- Department of Bariatric and Metabolic Surgery, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - James E Mitchell
- Department of Clinical Neuroscience, University of North Dakota School of Medicine, Fargo, ND, USA
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26
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Kass AE, Wildes JE, Coccaro EF. Identification and regulation of emotions in adults of varying weight statuses. J Health Psychol 2017; 24:941-952. [PMID: 28810399 DOI: 10.1177/1359105316689604] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Comparing individuals of varying weight statuses on their identification and regulation of emotions may increase our understanding of mechanisms that drive excess weight gain and highlight more precise weight regulation targets. In Study I ( N = 1333), adults with obesity had reduced self-reported attention to and repair of emotions compared to adults with overweight or normal weight. In Study II ( N = 85), adults with obesity had deficits in assessor-administrated tasks of strategic emotional intelligence (i.e. understanding and using emotional information for self-management). Problems identifying and regulating emotions could impact emotion regulation processes that lead to problematic behaviors associated with eating and weight gain.
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Affiliation(s)
- Andrea E Kass
- 1 Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, USA
| | - Jennifer E Wildes
- 1 Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, USA
| | - Emil F Coccaro
- 2 Clinical Neuroscience Research Unit, Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, USA
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27
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Fink-Miller E, Rigby A. The Utility of the Weight and Lifestyle Inventory (WALI) in Predicting 2-Year Weight Loss After Bariatric Surgery. Obes Surg 2016; 27:933-939. [DOI: 10.1007/s11695-016-2385-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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28
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Melin EO, Svensson R, Gustavsson SÅ, Winberg A, Denward-Olah E, Landin-Olsson M, Thulesius HO. Affect school and script analysis versus basic body awareness therapy in the treatment of psychological symptoms in patients with diabetes and high HbA1c concentrations: two study protocols for two randomized controlled trials. Trials 2016; 17:221. [PMID: 27121185 PMCID: PMC4848779 DOI: 10.1186/s13063-016-1347-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 04/18/2016] [Indexed: 11/25/2022] Open
Abstract
Background Depression is linked with alexithymia, anxiety, high HbA1c concentrations, disturbances of cortisol secretion, increased prevalence of diabetes complications and all-cause mortality. The psycho-educational method ‘affect school with script analysis’ and the mind-body therapy ‘basic body awareness treatment’ will be trialled in patients with diabetes, high HbA1c concentrations and psychological symptoms. The primary outcome measure is change in symptoms of depression. Secondary outcome measures are changes in HbA1c concentrations, midnight salivary cortisol concentration, symptoms of alexithymia, anxiety, self-image measures, use of antidepressants, incidence of diabetes complications and mortality. Methods Two studies will be performed. Study I is an open-labeled parallel-group study with a two-arm randomized controlled trial design. Patients are randomized to either affect school with script analysis or to basic body awareness treatment. According to power calculations, 64 persons are required in each intervention arm at the last follow-up session. Patients with type 1 or type 2 diabetes were recruited from one hospital diabetes outpatient clinic in 2009. The trial will be completed in 2016. Study II is a multicentre open-labeled parallel-group three-arm randomized controlled trial. Patients will be randomized to affect school with script analysis, to basic body awareness treatment, or to treatment as usual. Power calculations show that 70 persons are required in each arm at the last follow-up session. Patients with type 2 diabetes will be recruited from primary care. This study will start in 2016 and finish in 2023. For both studies, the inclusion criteria are: HbA1c concentration ≥62.5 mmol/mol; depression, alexithymia, anxiety or a negative self-image; age 18–59 years; and diabetes duration ≥1 year. The exclusion criteria are pregnancy, severe comorbidities, cognitive deficiencies or inadequate Swedish. Depression, anxiety, alexithymia and self-image are assessed using self-report instruments. HbA1c concentration, midnight salivary cortisol concentration, blood pressure, serum lipid concentrations and anthropometrics are measured. Data are collected from computerized medical records and the Swedish national diabetes and causes of death registers. Discussion Whether the “affect school with script analysis” will reduce psychological symptoms, increase emotional awareness and improve diabetes related factors will be tried, and compared to “basic body awareness treatment” and treatment as usual. Trial registration ClinicalTrials.gov: NCT01714986
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Affiliation(s)
- Eva O Melin
- Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden. .,Department of Research and Development, Region Kronoberg, Box 1223, SE-351 12, Växjö, Sweden. .,Primary Care, Region Kronoberg, Växjö, Sweden.
| | - Ralph Svensson
- Department of Psychology, Linnaeus University, Växjö, Sweden
| | | | | | | | - Mona Landin-Olsson
- Department of Clinical Sciences, Endocrinology and Diabetes, Lund University, Lund, Sweden.,Department of Endocrinology, Lund University Hospital, Lund, Sweden
| | - Hans O Thulesius
- Department of Research and Development, Region Kronoberg, Box 1223, SE-351 12, Växjö, Sweden.,Primary Care, Region Kronoberg, Växjö, Sweden.,Department of Clinical Sciences, Family Medicine, Lund University, Malmoe, Sweden
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29
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Giel KE, Hartmann A, Zeeck A, Jux A, Vuck A, Gierthmuehlen PCG, Wetzler-Burmeister E, Sandholz A, Marjanovic G, Joos A. Decreased Emotional Perception in Obesity. EUROPEAN EATING DISORDERS REVIEW 2016; 24:341-6. [DOI: 10.1002/erv.2444] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 02/17/2016] [Accepted: 02/22/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy; University Hospital Tübingen; Tübingen Germany
| | - Armin Hartmann
- Department of Psychosomatic and Psychotherapy; University Medical Center Freiburg; Freiburg Germany
| | - Almut Zeeck
- Department of Psychosomatic and Psychotherapy; University Medical Center Freiburg; Freiburg Germany
| | - Anna Jux
- Department of Psychosomatic and Psychotherapy; University Medical Center Freiburg; Freiburg Germany
| | - Alexander Vuck
- Department of Prosthetic Dentistry; University Medical Center Freiburg; Freiburg Germany
| | | | - Edda Wetzler-Burmeister
- Department of Psychosomatic and Psychotherapy; University Medical Center Freiburg; Freiburg Germany
| | - Angelika Sandholz
- Department of Psychosomatic and Psychotherapy; University Medical Center Freiburg; Freiburg Germany
| | - Goran Marjanovic
- Center for Metabolic and Bariatric Surgery, Department of Visceral Surgery; University Medical Center Freiburg; Freiburg Germany
| | - Andreas Joos
- Department of Psychosomatic and Psychotherapy; University Medical Center Freiburg; Freiburg Germany
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30
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Baldofski S, Rudolph A, Tigges W, Herbig B, Jurowich C, Kaiser S, Dietrich A, Hilbert A. Weight bias internalization, emotion dysregulation, and non-normative eating behaviors in prebariatric patients. Int J Eat Disord 2016; 49:180-5. [PMID: 26593154 DOI: 10.1002/eat.22484] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/15/2015] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Weight bias internalization (WBI) is associated with eating disorder psychopathology and non-normative eating behaviors among individuals with overweight and obesity, but has rarely been investigated in prebariatric patients. Based on findings demonstrating a relationship between emotion dysregulation and eating behavior, this study sought to investigate the association between WBI and eating disorder psychopathology as well as non-normative eating behaviors (i.e., food addiction, emotional eating, and eating in the absence of hunger), mediated by emotion dysregulation. METHOD Within a consecutive multicenter study, 240 prebariatric patients were assessed using self-report questionnaires. The mediating role of emotion dysregulation was examined using structural equation modeling. RESULTS The analyses yielded no mediational effect of emotion dysregulation on the association between WBI and eating disorder psychopathology. However, emotion dysregulation fully mediated the associations between WBI and emotional eating as well as eating in the absence of hunger. Further, emotion dysregulation partially mediated the relationship between WBI and food addiction symptoms. DISCUSSION Prebariatric patients with high levels of WBI are at risk for non-normative eating behaviors, especially if they experience emotion regulation difficulties. These findings highlight the importance of interventions targeting WBI and improving emotion regulation skills for the normalization of eating behavior in prebariatric patients.
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Affiliation(s)
- Sabrina Baldofski
- Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Almut Rudolph
- Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Wolfgang Tigges
- Department of General Surgery, Asklepios Clinic, Hamburg, Germany
| | - Beate Herbig
- Schön Klinik Hamburg Eilbek Bariatric Clinic, Hamburg, Germany
| | - Christian Jurowich
- Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital, University of Würzburg, Würzburg, Germany
| | - Stefan Kaiser
- Department of Visceral, Pediatric and Vascular Surgery, Hospital Konstanz, Konstanz, Germany
| | - Arne Dietrich
- Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
| | - Anja Hilbert
- Medical Psychology and Medical Sociology, Integrated Research and Treatment Center AdiposityDiseases, Leipzig University Medical Center, Leipzig, Germany
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31
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Silva I. Importance of emotional regulation in obesity and weight loss treatment. FRACTAL: REVISTA DE PSICOLOGIA 2015. [DOI: 10.1590/1984-0292/1503] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Abstract This theoretical study discusses the importance of emotional regulation process in obesity and in the success/failure of weight loss treatment, systematizing results of empirical studies and theoretical developments that have occurred in this field. Although there has been a substantial interest about this theme, it is difficult to achieve a consensual formulation to explain the relation between emotional regulation and weight because of the huge variability in the methodologies adopted and of the complexity of this phenomenon. In spite of all efforts, more than definite answers, studies have been revealing new research paths to be followed in this complex field.
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32
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Aarts F, Geenen R, Gerdes VEA, van de Laar A, Brandjes DPM, Hinnen C. Attachment anxiety predicts poor adherence to dietary recommendations: an indirect effect on weight change 1 year after gastric bypass surgery. Obes Surg 2015; 25:666-72. [PMID: 25204408 DOI: 10.1007/s11695-014-1423-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Weight loss after gastric bypass surgery depends on the adoption of healthy dietary recommendations, which may be influenced by psychological issues and patients' attachment representations (habitual states of mind with respect to interpersonal relations). The present study tests (1) whether attachment representations are associated with dietary adherence, (2) whether dietary adherence and weight loss are correlated and (3) whether dietary adherence mediates the relation of attachment representations with weight reduction after gastric bypass surgery. Besides attachment representations, psychological problems are examined. METHODS This longitudinal study included 105 patients who had a laparoscopic Roux-en-Y gastric bypass operation. Current and past psychological problems and attachment representations were assessed before surgery. Dietary adherence was assessed 6 and 12 months postsurgery. Patients' weight and height were collected from medical records. Multiple linear and logistic regression analyses and mediation analyses using bootstrapping resampling procedures were conducted. RESULTS Of all examined predictor variables, attachment anxiety, i.e., fear of social rejection and abandonment, was most strongly associated with low dietary adherence at both 6 months (p = 0.009) and 12 months (p = 0.006) postsurgery. Dietary adherence 6 months postsurgery was associated with weight loss 1 year after the operation (p = 0.003). Dietary adherence at 6 months (β = 0.51; 95% confidence interval (CI) = 0.19-1.04) mediated the association between preoperative attachment anxiety and postoperative weight loss. CONCLUSIONS The results suggest that more anxiously attached patients are less adherent to dietary recommendations 6 months after gastric bypass surgery, influencing weight loss in a negative way during the first year after surgery.
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Affiliation(s)
- Floor Aarts
- Department of Internal Medicine, Slotervaart Hospital, Louwesweg 6, 1066 EC, Amsterdam, The Netherlands,
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33
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Kittel R, Brauhardt A, Hilbert A. Cognitive and emotional functioning in binge-eating disorder: A systematic review. Int J Eat Disord 2015; 48:535-54. [PMID: 26010817 DOI: 10.1002/eat.22419] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 03/30/2015] [Accepted: 03/31/2015] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Binge-eating disorder (BED) is characterized by recurrent episodes of binge eating and is associated with eating disorder and general psychopathology and overweight/obesity. Deficits in cognitive and emotional functioning for eating disorders or obesity have been reported. However, a systematic review on cognitive and emotional functioning for individuals with BED is lacking. METHOD A systematic literature search was conducted across three databases (Medline, PubMed, and PsycINFO). Overall, n = 57 studies were included in the present review. RESULTS Regarding cognitive functioning (CoF), individuals with BED consistently demonstrated higher information processing biases compared to obese and normal-weight controls in the context of disorder-related stimuli (i.e., food and body cues), whereas CoF in the context of neutral stimuli appeared to be less affected. Thus, results suggest disorder-related rather than general difficulties in CoF in BED. With respect to emotional functioning (EmF), individuals with BED reported difficulties similar to individuals with other eating disorders, with a tendency to show less severe difficulties in some domains. In addition, individuals with BED reported greater emotional deficits when compared to obese and normal-weight controls. Findings suggest general difficulties in EmF in BED. Thus far, however, investigations of EmF in disorder-relevant situations are lacking. DISCUSSION Overall, the cross-sectional findings indicate BED to be associated with difficulties in CoF and EmF. Future research should determine the nature of these difficulties, in regards to general and disorder-related stimuli, and consider interactions of both domains to foster the development and improvement of appropriate interventions in BED.
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Affiliation(s)
- Rebekka Kittel
- Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Anne Brauhardt
- Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Anja Hilbert
- Leipzig University Medical Center, Integrated Research and Treatment Center Adiposity Diseases, Medical Psychology and Medical Sociology, Leipzig, Germany
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34
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Opolski M, Chur-Hansen A, Wittert G. The eating-related behaviours, disorders and expectations of candidates for bariatric surgery. Clin Obes 2015; 5:165-97. [PMID: 26173752 DOI: 10.1111/cob.12104] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 05/13/2015] [Accepted: 05/21/2015] [Indexed: 12/17/2022]
Abstract
It is important that clinicians and researchers understand the possible eating-related difficulties experienced by pre-bariatric surgery candidates, as well as their expectations of how their eating and hunger will change after surgery. This review examines English-language publications related to the eating-related behaviours, disorders and expectations of bariatric candidates. Seventy-five articles related to binge eating disorder, grazing, night eating syndrome, emotional eating, food cravings and addiction, and pre-surgical expectations of post-surgical eating in this population were critically reviewed. A variety of often problematic eating behaviours appear more common in bariatric candidates than in non-obese populations. The literature suggests that 4-45% of candidates may have binge eating disorder, 20-60% may graze, 2-42% may have night eating syndrome, 38-59% may engage in emotional eating and 17-54% may fit criteria for food addiction. Binge eating may also be more prevalent in bariatric candidates than in similarly obese non-surgical individuals. Expectations of surgery are high, with pre-surgical candidates believing their bariatric procedure will virtually guarantee significantly improved eating behaviours. Study replications are needed, and further investigation into prevalence, impacts and candidate characteristics related to disordered eating behaviours, as well as candidates' expectations of eating after surgery, will be important. Further comparisons of bariatric candidates to similarly obese non-bariatric populations will be important to understand eating-related characteristics of candidates beyond those related to their weight. Future research may be improved by the use of validated measures, replicable methodologies, minimization of data collected in circumstances where respondents may been motivated to 'fake good', use of prospective data and consistent definitions of key terminology.
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Affiliation(s)
- M Opolski
- School of Psychology, University of Adelaide, Adelaide, Australia
- Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
| | - A Chur-Hansen
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - G Wittert
- Discipline of Medicine, School of Medicine, University of Adelaide, Adelaide, Australia
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Ouwens M, Schiffer A, Visser L, Raeijmaekers N, Nyklíček I. Mindfulness and eating behaviour styles in morbidly obese males and females. Appetite 2015; 87:62-7. [DOI: 10.1016/j.appet.2014.11.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 11/26/2014] [Accepted: 11/30/2014] [Indexed: 10/24/2022]
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Chesler BE. Emotional eating: a virtually untreated risk factor for outcome following bariatric surgery. ScientificWorldJournal 2012; 2012:365961. [PMID: 22566765 PMCID: PMC3330752 DOI: 10.1100/2012/365961] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 12/08/2011] [Indexed: 02/07/2023] Open
Abstract
Empirical investigations implicate emotional eating (EE) in dysfunctional eating behavior such as uncontrolled overeating and insufficient weight loss following bariatric surgery. They demonstrate that EE may be a conscious or reflexive behavior motivated by multiple negative emotions and/or feelings of distress about loss-of-control eating. EE, however, has not been targeted in pre- or postoperative interventions or examined as an explanatory construct for failed treatment of dysfunctional eating. Three cases suggest that cognitive behavioral treatment (CBT) might alleviate EE. One describes treatment for distress provoked by loss-of-control eating. The first of two others, associated with negative emotions/life situations, link treatment of a super-super-preoperative obese individual's reflexive EE with 52% excess BMI (body mass index) loss maintained for the past year, 64 months after surgery. The second relates treatment of conscious/reflexive EE with 84.52% excess BMI loss 53 months after surgery. Implications for research and treatment are discussed.
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