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Hoyt T, Walter FA, Michl TM. The role of obesity severity in Minnesota multiphasic personality inventory-2-restructured form prediction of 12-month bariatric surgery outcomes. Surg Obes Relat Dis 2024; 20:267-274. [PMID: 37880030 DOI: 10.1016/j.soard.2023.09.019] [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: 05/26/2023] [Revised: 08/04/2023] [Accepted: 09/04/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND The Minnesota Multiphasic Personality Inventory-2 Restructured Form (MMPI-2-RF) has been widely used in bariatric surgery samples. However, questions remain regarding its utility when predicting changes in body mass index over time following bariatric surgery. OBJECTIVES Examine whether MMPI-2-RF scales differentially predict 12-month changes in body mass index (BMI) following bariatric surgery when comparing patients with Class III or higher versus Class II or lower obesity. SETTING Military hospital in the Northwestern United States. METHODS This retrospective study evaluated data from 193 bariatric surgery patients who completed the MMPI-2-RF as part of presurgical evaluation requirements. Hierarchical linear modeling was used to predict body mass index over a 12-month postsurgical period based on MMPI-2-RF scales. Loss to follow-up rate was 30% during this period. RESULTS Among patients with Class II or lower obesity, the Symptom Validity, Adjustment Validity, Response Bias, Cynicism, Aggression, Stress/Worry, and Anger Proneness scales showed a significant relationship to BMI after bariatric surgery. Among patients with Class III or higher obesity, the Infrequent Psychopathology Responses, Emotional / Internalizing Dysfunction, Ideas of Persecution, Multiple Specific Fears, and Inefficacy scales showed a significant relationship to body mass index after bariatric surgery. CONCLUSIONS Certain MMPI-2-RF scales may have better utility in predicting bariatric surgery outcomes based on the patient's obesity severity. The interaction of metabolic and personality factors may play a significant role in weight change following bariatric surgery.
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Affiliation(s)
- Tim Hoyt
- Department of Behavioral Health, Madigan Army Medical Center, Tacoma, Washington.
| | - Fawn A Walter
- Department of Behavioral Health, Madigan Army Medical Center, Tacoma, Washington
| | - Tegan M Michl
- Department of Behavioral Health, Madigan Army Medical Center, Tacoma, Washington
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2
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Bartholomay EM, Cox S, Tabone L, Szoka N, Abunnaja S, Aylward L. The role of anxiety and depression in understanding the relationship between coping and weight loss 24 months after bariatric surgery. Surg Obes Relat Dis 2024; 20:304-314. [PMID: 38001014 DOI: 10.1016/j.soard.2023.10.004] [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: 06/07/2023] [Revised: 09/08/2023] [Accepted: 10/04/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND The relationship between coping (i.e., how a person deals with stress) and weight loss after bariatric surgery is relatively inconsistent. Anxiety and depression may contribute to the lack of consistent findings in this area. It is possible that coping, including interpersonal, intrapersonal, and maladaptive coping, predicts weight loss among individuals with higher levels of anxiety or depression but not among those with lower levels of anxiety and depression. OBJECTIVE The aim of this study was to examine the moderating role of anxiety and depression on the association between coping and weight loss in patients 24 months after bariatric surgery. SETTING University Hospital, West Virginia, U.S.A. METHODS Participants included 841 patients who underwent bariatric surgery, 396 of whom had 24-month weight loss data (mean age, 43.21 yr [SD, ±11.40 yr]). We ran 3 moderation models to test whether the relationship between various coping styles and postoperative weight loss was moderated by anxiety and depression symptoms. RESULTS There was a statistically significant interaction between anxiety and depression on the association between interpersonal coping and percent excess weight loss (%EWL). Anxiety and depression also moderated the relationship between maladaptive coping and %EWL. Anxiety and depression did not moderate the association between intrapersonal coping and %EWL, but intrapersonal coping positively predicted %EWL at 24 months after bariatric surgery. CONCLUSIONS Maladaptive coping predicted less weight loss for patients with high levels of anxiety and/or depression. Interpersonal coping predicted more weight loss for patients with low levels of anxiety and/or depression. Clinicians should take patient levels of anxiety and depression into account when making recommendations to promote weight loss among patients pursuing bariatric surgery.
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Affiliation(s)
- Emily M Bartholomay
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia.
| | - Stephanie Cox
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Lawrence Tabone
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Nova Szoka
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Salim Abunnaja
- Department of Surgery, West Virginia University School of Medicine, Morgantown, West Virginia
| | - Laura Aylward
- Department of Behavioral Medicine and Psychiatry, West Virginia University School of Medicine, Morgantown, West Virginia
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Johnston L, Jackson K, Hilton C, N H Graham Y. Mind the gap! Factors that predict progression to bariatric surgery indicate that more psychological treatment may be required. Clin Obes 2024; 14:e12626. [PMID: 38058253 DOI: 10.1111/cob.12626] [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: 08/17/2022] [Revised: 09/06/2023] [Accepted: 10/01/2023] [Indexed: 12/08/2023]
Abstract
In the UK, the number of adults living with obesity is increasing. Bariatric surgery is an available treatment for those living with a BMI (kg/m2 ) ≥40 and above, or ≥35 with obesity-related comorbidities. Guidelines highlight the importance of providing psychological support pre- and post-surgery owing to the complex psychopathology present in those living with obesity. There are a lack of studies examining which patients proceed to surgery and the factors that predict progression. Routine patient data were collected within one NHS regional service in the UK, comprising 733 patients between 3 August 2018 and 26 July 2019, aged between 17 and 76 years (M = 43.20, SD = 12.32). The only exclusion criteria were patients still awaiting a final decision for surgical outcome at the point of analysis (N = 29), which resulted in 704 patients included in analysis. Binary Logistic Regression revealed those who were more likely to progress to surgery had a lower-level use of maladaptive external substances; lower level of self-harm and/or suicidality, were older in age; had a lower BMI; and had less comorbidities than those who did not progress. Findings support existing literature in that bariatric patients often present with physical and mental health complexity. Two thirds of patients in this study did not progress to surgery. Service commissioning decisions meant that these patients did not have access to psychology treatment. Consequently, in cases where bariatric surgery is considered, a final treatment option and otherwise clinically appropriate, lack of access to specialist services may result in unmet patient need owing particularly to a lack of psychological treatment provision.
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Affiliation(s)
- Lynne Johnston
- Clinical Health Psychology, Golden Jubilee University National Hospital, Clydebank, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Halley Johnston Associates Ltd, Whitley Bay, UK
- Department of Clinical Health Psychology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
- Faculty of Health Sciences and Wellbeing, Helen McArdle Nursing and Care Research Institute, University of Sunderland, Sunderland, UK
| | - Kacey Jackson
- Department of Clinical Health Psychology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
- Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Charlotte Hilton
- Hilton Health Consultancy, Derbyshire, UK
- Division of Clinical Research in the College of Medicine, University of Florida, Gainsville, Florida, USA
- College of Health Psychology and Social Care, University of Derby, Derby, UK
| | - Yitka N H Graham
- Department of Clinical Health Psychology, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, UK
- Faculty of Health Sciences and Wellbeing, Helen McArdle Nursing and Care Research Institute, University of Sunderland, Sunderland, UK
- Faculty of Psychology, University of Anahuac Mexico, Ciudad de Mexico, Mexico
- Facultad de Ciencias Biomedicas, Universidad Austral, Buenos Aires, Argentina
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Butt M, Eisler RA, Hu A, Rogers AM, Rigby A. Incidence of Substance Use Disorder Following Bariatric Surgery: A Retrospective Cohort Study. Obes Surg 2023; 33:890-896. [PMID: 36477697 DOI: 10.1007/s11695-022-06400-6] [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: 08/15/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND New-onset substance use disorder (SUD) following bariatric surgery is a significant concern that is likely multi-factorial, although the etiologies are unclear. Previous studies have identified variable rates of SUD along with utilizing different methods and measures. The objective of this study is to evaluate new-onset SUD diagnoses among adults following bariatric surgery and compare these rates to those in the general population as well as those diagnosed with overweight or obesity. METHODS Data was extracted from TriNetX Research Platform and used to build three cohorts of adults: those who had bariatric surgery (bariatric surgery cohort), those diagnosed with obesity or overweight, and a general population cohort. Rates of incident SUD were compared among these three groups. Initial encounters for all individuals were from January 1, 2018, to June 30, 2019. RESULTS The incidence rate of SUD in patients with a history of bariatric surgery was 6.55% (n = 2523). When compared to the general population, persons who had any type of bariatric procedure had a decreased risk of new-onset SUD with an overall odds ratio (OR) [95% confidence limits (CL)] of 0.89 [0.86, 0.93]. When compared to persons with overweight or obesity, bariatric patients were less likely to develop any form of SUD (OR: 0.65 [0.62, 0.67]). CONCLUSION While overall rates of new-onset SUD are lower among those who had bariatric surgery, they also vary by surgery and substance type. Efforts should still be made to address new-onset SUD in order to optimize the post-surgical care of patients.
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Affiliation(s)
- Melissa Butt
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, USA.
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.
| | - Riley A Eisler
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA
| | - Antoinette Hu
- Department of Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Ann M Rogers
- Department of Surgery - Division of Minimally Invasive Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
| | - Andrea Rigby
- Department of Surgery - Division of Minimally Invasive Surgery, Penn State Milton S. Hershey Medical Center, Hershey, PA, USA
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Talledo O, Carroll R, Worden E, Greenwood AM, Alexander H, Karlsdottir B, Lehmann R, Peoples R, Smith J, Thompson D, Zhang KA, Nau P. The impact of COVID-19 on medium term weight loss and comorbidities in patients undergoing bariatric surgery and its association with psychological wellbeing. Surg Endosc 2023; 37:1537-1542. [PMID: 35731301 PMCID: PMC9215154 DOI: 10.1007/s00464-022-09377-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/03/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND The COVID-19 epidemic imposed significant stressors on individuals and changed how medical care is delivered. The affect that this stress has placed on the field of bariatric surgery and the associated outcomes is not well established. METHODS A retrospective review of a prospectively collected database from a single academic institution was conducted. Weight loss and comorbidity outcomes were compared between a cohort of patients operated on during the pandemic and a matched group operated on prior to COVID-19. GAD-7 and PHQ-9 questionnaires were used to assess for anxiety and depression, respectively. RESULTS A total of 329 and 155 patients were enrolled in the pre-pandemic and COVID-19 groups respectively. There were no significant differences in pre-operative BMI (p = 0.437) or comorbidities: Type II DM (p = 0.810), hypertension (p = 0.879), sleep apnea (p = 0.502), and hyperlipidemia (p = 0.227). Post-operatively, weight loss was comparable at all time points out to 1 year. Type II DM resolution rates were higher in the control cohort at 6 months (p = 0.007), but not at 12 months (p = 1.000). There was no statistically significant difference in resolution rates between the control group and the COVID-19 group for the other measured comorbidities. There was no difference in objective measures of anxiety and depression when comparing the two groups (both p > 0.05). CONCLUSIONS The COVID-19 pandemic has fundamentally changed how society and medical systems function. Focusing on pre-operative dietary training and screening for inadequately managed psychological comorbidities yielded similar weight loss outcomes notwithstanding the significant societal and individual stressors with which patients were faced.
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Affiliation(s)
- Oscar Talledo
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Rory Carroll
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Erin Worden
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Anna Marie Greenwood
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Hart Alexander
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Bergljot Karlsdottir
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Ryan Lehmann
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Rebecca Peoples
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Jessica Smith
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Dakota Thompson
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Ke Anne Zhang
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA
| | - Peter Nau
- Roy J. and Lucille A. Carver College of Medicine, MIS, Bariatric and GI Surgery, 200 Hawkins Drive 4634 JCP, Iowa City, IA, 52242-1086, USA.
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Marek RJ, Ivezaj V, Parikh MS, Jayade M, Davila-Shiau E, Grilo CM. Factor structure and measurement invariance of the English- versus Spanish-language Eating Disorder Examination Questionnaire: Brief Form (S-EDE-Q-BF) in Hispanic/Latino/a/x persons seeking bariatric surgery. Surg Obes Relat Dis 2022; 19:576-584. [PMID: 36639321 DOI: 10.1016/j.soard.2022.12.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 11/14/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Assessment of eating disorder psychopathology during preoperative psychological evaluations could be facilitated with psychometrically valid measures. One of the most commonly used measures, the Eating Disorder Examination Questionnaire (EDE-Q), is lengthy and has been found to have psychometric limitations. Research has identified a shorter version that has received reliable support across diverse samples but requires further validation for use with patients being evaluated for bariatric surgery. OBJECTIVES To cross-validate the factor structure of the EDE-Q: Brief Form (EDE-Q-BF, standalone, nonnested version) with patients being evaluated for bariatric surgery across English- and Spanish-language versions and establish measurement invariance for gender and language. SETTING Northeastern hospital in the United States. METHODS Participants (n = 618) undergoing evaluations prior to bariatric surgery who identified as Hispanic/Latino/a/x and consented to participate in this research study (which did not influence eligibility for bariatric surgery) completed self-reports. Of the 618 participants, 92 were male and 526 were female, 318 preferred English and were administered English versions of the measures, and 300 preferred Spanish and were administered Spanish versions of the measures. RESULTS The 3-factor structure ("Restraint," "Weight/Shape Concerns," and "Body Dissatisfaction") of the EDE-Q-BF fit the data well (χ2 [11] = 18.47; P = .071; root mean square error of approximation [RMSEA] = .033; comparative fit index [CFI] > .99; standardized root mean squared residual [SRMR] = .02). Scaler invariance was met for both gender and language. Correlations with external criteria further supported its validity. CONCLUSION The EDE-Q-BF can easily be administered as part of a preoperative psychological assessment battery to screen for eating disorder psychopathology and is valid for Hispanic/Latino/a/x men and women who speak either English or Spanish.
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Affiliation(s)
- Ryan J Marek
- Sam Houston State University College of Osteopathic Medicine, Conroe, Texas.
| | - Valentina Ivezaj
- Department of Psychiatry, Program for Obesity, Weight, and Eating Research, Yale University School of Medicine, New Haven, Connecticut
| | - Manish S Parikh
- Department of General Surgery, Bellevue Hospital/NYU Langone Health, New York, New York
| | - Maansi Jayade
- Department of General Surgery, Bellevue Hospital/NYU Langone Health, New York, New York
| | - Elissa Davila-Shiau
- Department of General Surgery, Bellevue Hospital/NYU Langone Health, New York, New York
| | - Carlos M Grilo
- Department of Psychiatry, Program for Obesity, Weight, and Eating Research, Yale University School of Medicine, New Haven, Connecticut
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Long-term changes in dietary intake and its association with eating-related problems after gastric bypass in adolescents. Surg Obes Relat Dis 2022; 18:1399-1406. [PMID: 36195523 DOI: 10.1016/j.soard.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/02/2022] [Accepted: 08/11/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND Roux-en-Y gastric bypass (RYGB) surgery is an established, effective treatment for severe adolescent obesity. Long-term dietary intake and the relationship to eating-related problems are scarcely evaluated in this population. OBJECTIVES Assess changes in dietary intake in adolescents after RYGB and explore associations between dietary intake and eating-related problems. SETTING Multicenter study in Swedish university hospitals. METHOD Diet history, binge eating scale (BES), and Three-Factor Eating Questionnaire were assessed preoperatively and 1, 2, and 5 years after RYGB in 85 adolescents (67% female) aged 16.5 ± 1.2 years with a body mass index (BMI) of 45.5 ± 6.0 kg/m2 and compared with control individuals at 5 years. RESULTS Five-year BMI change was -28.6% ± 12.7% versus +9.9% ± 18.9% in RYGB patients versus control individuals (P < .001). Through 5 years, RYGB adolescents reported reduced energy intake, portion size of cooked meals at dinner, and milk/yoghurt consumption (P < .01). The BES scores were 9.3 ± 8.3 versus 13.4 ± 10.5 in RYGB patients versus control individuals (P = .04). Association between BES score and energy intake was stronger in control individuals (r = .27 versus r = .62 in RYGB patients versus control individuals, P < .001). At 5 years, lower energy intake was associated with greater BMI loss in all adolescents (r = .33, P < .001). Higher scores in BES and uncontrolled and emotional eating were associated with higher energy intake, cooked meals, candies/chocolates, cakes/cookies, desserts, and sugary drinks (r > .23, P < .04) and lower intake of fruits/berries (r = -.32, P = .044). A higher score in cognitive restraint was associated with a higher intake of cereals and fruits/berries (r > .22, P < .05) and a lower intake of sugary drinks (r = -.24, P < .03). CONCLUSION To support optimization of long-term outcomes in adolescent RYGB patients, it is important to provide management strategies to reduce energy intake. Monitoring eating-related problems could identify potential individuals at risk of poor weight loss and to initiate treatment interventions.
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Erden Aki ŞÖ, Yıldız Mİ, Kamış GZ, Aytulun A, Karakaya J, Işıklı S. Relationship of depression, impulsivity, distress intolerance and coping styles with maladaptive eating patterns in bariatric candidates. Eat Weight Disord 2022; 27:3351-3366. [PMID: 35999437 DOI: 10.1007/s40519-022-01465-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/27/2022] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The study aimed to investigate the problematic eating patterns and understand their relationship to psychological constructs, including stress intolerance, coping mechanisms and impulsivity, and psychiatric symptoms among bariatric surgery candidates. METHODS The bariatric candidates were evaluated by psychiatric interview and standard scales assessing maladaptive eating behaviors (Eating Attitudes Test (EAT), Bulimia Investigatory Test-Edinburgh (BITE), Dutch Eating Behavior Questionnaire (DEBQ)), depression (Beck Depression Inventory (BDI)), psychiatric symptoms (Brief Symptom Inventory (BSI)), and psychological constructs (Distress Intolerance Index (DSI), Coping Styles Scale (CSS), UPPS Impulsive Behavior Scale(UPPS)). RESULTS More than half (57.8%) had maladaptive eating behaviors, and 23.6% had binge-eating behavior. Depression and anxiety predicted EAT, BITE, and DEBQ emotional and external eating sub-scale scores; distress intolerance, helpless coping style, and impulsivity predicted maladaptive eating behaviors in bariatric candidates. CONCLUSION Maladaptive eating patterns play an essential role in the failure to lose weight and regain weight and are predicted by depression, anxiety, and psychological constructs in this study. Evaluation of pathological trait characteristics besides discrete psychiatric syndromes should be recommended in the pre-operation process to plan relevant interventions in the long-term management of weight. LEVEL OF EVIDENCE Level III, evidence obtained from well-designed cohort analytic studies.
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Affiliation(s)
| | - M İrem Yıldız
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - G Zuhal Kamış
- Health Ministry of Turkish Republic Ankara City Hospital, Ankara, Turkey
| | - Aslı Aytulun
- Department of Psychiatry, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Jale Karakaya
- Department of Biostatistics, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sedat Işıklı
- Department of Psychology, Hacettepe University Faculty of Letters, Ankara, Turkey
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Aylward L, Konsor M, Cox S. Binge Eating Before and After Bariatric Surgery. Curr Obes Rep 2022; 11:386-394. [PMID: 36287376 DOI: 10.1007/s13679-022-00486-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW The purpose is to review the state of the literature of binge eating in the context of bariatric surgery including prevalence, conceptualization, assessment, course, and related sequela throughout the perioperative continuum, particularly highlighting new advancements and future directions. RECENT FINDINGS Accurate assessment of binge eating in bariatric samples is essential for optimization of patient outcomes. Binge eating is less prevalent after bariatric surgery; however, prevalence rates increase over time. Most studies do not find a relationship between pre-operative binge eating and suboptimal weight outcomes after surgery. Refinement in understanding and conceptualization of post-operative binge eating is needed; new conceptualizations have proposed such a definition. Emerging constructs relevant to binge eating for bariatric patients include food addiction and food insecurity. Despite the introduction of formal diagnostic criteria for binge eating disorder, many uncertainties regarding the prevalence, course, and effects of binge eating currently exist; varied assessment methods continue to be a barrier to research on binge eating in bariatric surgery samples. Consensus on operational definitions for post-operative binge eating and best practices for assessment are areas for future consideration.
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Affiliation(s)
- Laura Aylward
- West Virginia University School of Medicine, Department of Behavioral Medicine and Psychiatry, Morgantown, USA
| | - Madeline Konsor
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Stephanie Cox
- West Virginia University School of Medicine, Department of Behavioral Medicine and Psychiatry, Morgantown, USA.
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Aylward L, Lilly C, Tabone L, Szoka N, Abunnaja S, Cox S. Anxiety Predicts Reduced Weight Loss 30 Months after Bariatric Surgery. Surg Obes Relat Dis 2022; 18:919-927. [DOI: 10.1016/j.soard.2022.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 10/18/2022]
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Riegel KD, Konecna J, Matoulek M, Rosova L. Implementation of the DSM-5 and ICD-11 Dimensional Models of Maladaptive Personality Traits Into Pre-bariatric Assessment. Front Psychol 2022; 12:814421. [PMID: 35082734 PMCID: PMC8785802 DOI: 10.3389/fpsyg.2021.814421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Personality pathology does not have to be a contraindication to a bariatric surgery if a proper pre-surgical assessment is done. Indicating subgroups of patients with their specific needs could help tailor interventions and improve surgical treatment outcomes. Objectives: Using the Alternative DSM-5 model for personality disorders (AMPD) and the ICD-11 model for PDs to detect subgroups of patients with obesity based on a specific constellation of maladaptive personality traits and the level of overall personality impairment. Methods: 272 consecutively consented patients who underwent a standard pre-surgical psychological assessment. The majority were women (58.0%), age range was 22-79 years (M = 48.06, SD = 10.70). Patients' average body mass index (BMI) was 43.95 kg/m2. All participants were administered the Personality Inventory for DSM-5 (PID-5) from which Level of Personality Functioning Scale-Self Report (LPFS-SR) and Standardized Assessment of Severity of Personality Disorder (SASPD) scores were gained using the "crosswalk" for common metric for self-reported severity of personality disorder. The k-means clustering method was used to define specific subgroups of patients with obesity and replicated for equality testing to the samples of non-clinical respondents and psychiatric patients. Results: The cluster analysis detected specific groups in the sample of patients with obesity, which differed quantitatively from the samples of non-clinical respondents and psychiatric patients. A vast majority of patients with obesity showed above-average values in most of the PID-5 facets compared to the United States representative general community sample. In two out of the three clusters defined, patients demonstrated moderate (> M + 1.5 × SD) to severe (> M + 2.0 × SD) personality psychopathology within the Detachment and Negative Affectivity domains according to PID-5, which in one of the clusters corresponded to the mild overall impairment in both, LPFS-SR (M = 2.18, SD = 0.27) and SASPD (M = 8.44, SD = 2.38). Moreover, higher levels of psychopathology prove to be associated with higher age and use of psychiatric medication. Conclusions: The dimensional DSM-5 and ICD-11 trait models are suitable procedures for defining specific "characters" of patients in a pre-bariatric setting. As such, they help to identify subgroups of patients with obesity who are different from general population and psychiatric patients. Implications for clinical practice and further research are discussed.
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Affiliation(s)
- Karel D Riegel
- Department of Addictology, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Judita Konecna
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia.,Department of Psychiatry, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Martin Matoulek
- 3rd Department of Medicine-Department of Endocrinology and Metabolism, 1st Faculty of Medicine, Charles University and General University Hospital, Prague, Czechia
| | - Livia Rosova
- Department of Applied Mathematics and Statistics, Faculty of Mathematics, Physics and Informatics, Comenius University, Bratislava, Slovakia
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Marek RJ, Ivezaj V, Schuh L, Creel D, Grilo CM. Factor Structure and Measurement Invariance of the Attitudes Toward Persons with Obesity (ATOP) Scale in a Preoperative and Postoperative Bariatric Surgery Sample. Obes Surg 2021; 31:5207-5212. [PMID: 34363552 DOI: 10.1007/s11695-021-05645-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The Attitudes Toward Persons with Obesity (ATOP) scale is widely used to assess stigmatization toward persons with obesity. The measure has previously been suggested to assess three facets-self-esteem, personality, and social difficulties-however, psychometric support for this has been inconsistent and warrants further study if the measure intends to be scored this way. OBJECTIVES Explore and confirm the factor structure of the ATOP in people assessed prior to bariatric surgery and reassessed 1 year postoperatively SETTING: Midwestern hospital in the USA. MATERIALS AND METHODS Three-hundred sixteen people who were seeking bariatric surgery were assessed preoperatively, and 161 of those people were reassessed 1 year after surgery with a battery of measures including the ATOP. Exploratory factor analysis (EFA) was performed on ATOP data from a random split-half of people before surgery, and confirmatory factor analysis (CFA) was performed on the second randomly selected half. With the postoperative sample, a CFA was performed, testing the best-fitting model from the preoperative CFA findings. RESULTS The EFA suggested a two-factor structure interpreted as self-esteem and personality/social difficulties. This structure was supported by CFA performed on the second randomly selected half of people at preoperative assessment and by CFA performed on people 1 year following surgery. Tests of measurement invariance suggested that the two-factor structure was similar at both time points. CONCLUSIONS Only two factors for the ATOP were empirically supported in the current sample (self-esteem and personality/social difficulties), which is slightly different from the three factors that were originally proposed when the measure was developed. This factor structure is supported both prior to bariatric surgery and 1 year after bariatric surgery.
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Affiliation(s)
- Ryan J Marek
- Department of Primary Care and Clinical Medicine, Sam Houston State University College of Osteopathic Medicine, 925 City Central Avenue, Conroe, TX, 77304, USA.
| | - Valentina Ivezaj
- Program for Obesity, Weight, and Eating Research, Department of Psychiatry, School of Medicine, Yale University, 300 George Street, New Haven, CT, 06511, USA
| | - Leslie Schuh
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, 46032, USA
| | - David Creel
- St. Vincent Bariatrics, Ascension St. Vincent Carmel Hospital, Carmel, IN, 46032, USA
- Bariatric & Metabolic Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Carlos M Grilo
- Program for Obesity, Weight, and Eating Research, Department of Psychiatry, School of Medicine, Yale University, 300 George Street, New Haven, CT, 06511, USA
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13
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Schreyer CC, Salwen-Deremer JK, Montanari A, Coughlin JW. Restriction of range effects in post-metabolic and bariatric surgery outcomes research: considerations for clinical decision making. Surg Obes Relat Dis 2021; 18:425-432. [PMID: 34973926 DOI: 10.1016/j.soard.2021.11.022] [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: 08/26/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Preoperative psychopathology does not consistently predict postoperative outcomes in patients who undergo metabolic and bariatric surgery (MBS). Individuals with elevated pre-MBS psychopathology may be less likely to undergo surgery, which may create a floor effect given the limited range of scores on measures of psychopathology included in postoperative analyses, thereby decreasing the power to detect clinically significant differences between groups. OBJECTIVES Our objective was to compare rates of clinically significant pre-MBS psychopathology across domains of functioning in patients who did and did not undergo MBS: surgical completers (SCs, n = 286) and nonsurgical completers (NSCs, n = 125). SETTING Academic medical center, United States. METHODS Participants (n = 411) were a racially diverse sample of MBS candidates who completed a preoperative psychosocial evaluation including measures of disordered eating, alcohol and tobacco use, pain catastrophizing, anxiety, and depressive symptomatology. RESULTS Compared with SCs, NSCs had larger scale score variance on measures of psychopathology and were more likely to be Black; to report clinically significant scores on measures of binge eating, depression, anxiety, and pain catastrophizing; and to use tobacco. CONCLUSION Results support the presence of a restriction-of-range effect but do not demonstrate a floor effect. These data suggest that current outcome data for MBS patients may not generalize to those who report clinically significant psychopathology at the pre-MBS psychosocial evaluation and may warrant caution when using the current literature to inform clinical decision making for this group. Findings also suggest a need for interventions that will better engage Black patients.
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Affiliation(s)
- Colleen C Schreyer
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
| | - Jessica K Salwen-Deremer
- Departments of Psychiatry and Medicine, Dartmouth-Hitchcock Medical Center, Hanover, Lebanon, New Hampshire
| | - Amanda Montanari
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Janelle W Coughlin
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
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14
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Assessing Negative Response Bias: a Review of the Noncredible Overreporting Scales of the MMPI-2-RF and MMPI-3. PSYCHOLOGICAL INJURY & LAW 2021. [DOI: 10.1007/s12207-021-09435-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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15
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Psychosocial and behavioral correlates of weight loss 12 to 15 years after bariatric surgery. J Behav Med 2021; 45:252-259. [PMID: 34773537 DOI: 10.1007/s10865-021-00263-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
While significant weight loss occurs post-bariatric surgery, partial weight regain is common. Psychological and dispositional variables have been examined as predictors of weight change, but most studies have focused on the relationship of preoperative constructs to shorter-term postoperative outcomes. The goal of the current study was to examine associations between weight loss and postoperative psychosocial and behavioral factors up to an average of 13.7 years after surgery. The current study was conducted at a large bariatric center in a Midwestern U.S. city. The sample was comprised of 125 adult patients who participated in the second wave of a long-term bariatric surgery outcome study, examining weight history, physical activity, and psychological health and functioning. Correlations between percent total weight loss (%TWL) and psychosocial and behavioral variables were examined. The variables that had significant correlations with %TWL were used in stepwise linear regressions to determine their contribution to %TWL. These same variables were tested to determine differences among those in the highest and lowest weight loss quartiles. Life satisfaction, conscientiousness, positive affect, and regular exercise were positively associated with weight loss in the entire sample and were significantly higher among those in the highest versus the lowest weight-loss quartile. Experiencing a stressful event and food addiction symptoms were negatively associated with weight loss. Positive affect, fewer food addiction symptoms, and regular exercise significantly predicted weight loss, accounting for 23% of the variance in %TWL. Long-term weight loss maintenance after bariatric surgery may be related to positive affect, conscientiousness, regular physical activity, and an addictive-type relationship with food. Future studies should explore these relationships and develop approaches to deal with the interaction between dispositional tendencies and lifestyle factors.
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Martin-Fernandez KW, Marek RJ, Heinberg LJ, Ben-Porath YS. Six-year bariatric surgery outcomes: the predictive and incremental validity of presurgical psychological testing. Surg Obes Relat Dis 2021; 17:1008-1016. [PMID: 33640259 DOI: 10.1016/j.soard.2021.01.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Research identifying preoperative psychosocial predictors of bariatric surgery outcomes has yielded inconsistent results with minimal examination of longer-term outcomes. Utilizing a broadband measure of personality and psychopathology during the preoperative evaluation helps to identify preoperative risk factors for suboptimal bariatric surgery outcomes. OBJECTIVE Examine predictors of outcome and the incremental contribution of presurgical psychological testing to various long-term bariatric surgery outcomes. SETTING Academic medical center. METHOD A total of 168 postoperative patients (average of 6 postoperative years) consented to participate in the outcome study. Participants were weighed by the trained research/clinical staff and completed a battery of self-report questionnaires, including measures assessing eating attitudes and behaviors and weight-related quality-of-life (QoL). Patients had completed the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) as part of the institution's routine preoperative psychosocial evaluation. Weight loss was calculated as percent total weight loss (%TWL) and percent weight regain (%WR) was calculated as a percentage of maximum weight loss. Other preoperative data were obtained from a review of each patient's electronic medical record (EMR). From the initial sample, 145 patients were retained for analyses in the present study. RESULTS Preoperative problematic eating variables predicted long-term postoperative problematic eating behaviors and body image concerns. Scores on preoperative MMPI-2-RF scales measuring Demoralization, Dysfunctional Negative Emotions, Antisocial Behaviors, and Hypomanic Activation were consistent incremental predictors of 6-year outcomes, accounting for an additional 3%-24% of the variability in postoperative eating behaviors and QoL. CONCLUSIONS The preoperative psychological evaluation can be used to identify predictors of long-term bariatric surgery outcomes. Identification of these risk factors provides important targets for pre- and postoperative clinical interventions to maximize surgical outcomes.
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Affiliation(s)
| | - Ryan J Marek
- Department of Primary Care, Sam Houston State University College of Osteopathic Medicine, Conroe, Texas
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Martin-Fernandez KW, Ben-Porath YS. Associations among eating disorder symptoms and the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) in college students. Eat Weight Disord 2020; 25:1311-1320. [PMID: 31471887 DOI: 10.1007/s40519-019-00764-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To identify associations between eating disorder (ED) attitudes and behaviors and scores on the MMPI-2-RF in college students. METHODS The study included 425 undergraduate students (38.5% males and 61.5% females) with a mean age of 19.13 (SD = 1.77). Measures included the MMPI-2-RF and the Eating Disorder Examination Questionnaire. Correlations and relative risk ratios were computed between MMPI-2-RF scores and ED variables. RESULTS Scores on several MMPI-2-RF Scales were associated with the presence of subthreshold ED symptoms. Manifestations of emotional/internalizing dysfunction were associated with all ED symptom presentations. CONCLUSIONS The results of this study identified narrowly defined personality and psychopathology constructs relevant to, and found across college students experiencing various subthreshold ED symptoms. Considering this additional information in ED screening or treatment planning could reduce the likelihood of subthreshold symptoms worsening and increase the effectiveness of ED interventions with at-risk college student populations. LEVEL OF EVIDENCE Level III, evidence obtained from well-designed cohort or case-control analytic studies.
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Affiliation(s)
- Katy W Martin-Fernandez
- Department of Psychological Sciences, Kent State University, 144 Kent Hall, Kent, OH, 44242, USA.
| | - Yossef S Ben-Porath
- Department of Psychological Sciences, Kent State University, 144 Kent Hall, Kent, OH, 44242, USA
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18
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Braun TD, Quinn DM, Stone A, Gorin AA, Ferrand J, Puhl RM, Sierra J, Tishler D, Papasavas P. Weight Bias, Shame, and Self-Compassion: Risk/Protective Mechanisms of Depression and Anxiety in Prebariatic Surgery Patients. Obesity (Silver Spring) 2020; 28:1974-1983. [PMID: 32808737 PMCID: PMC8650800 DOI: 10.1002/oby.22920] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/30/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Psychopathology in bariatric surgery patients may contribute to adverse postoperative sequelae, including weight regain, substance use, and self-harm. This cross-sectional study aimed to advance the understanding of the risk and protective paths through which weight bias associates with depressive and anxiety symptoms in bariatric surgery candidates (BSC). METHODS BSC recruited from a surgical clinic (N = 213, 82.2% women, 43 [SD 12] years, mean BMI: 49 [SD 9] kg/m2 ) completed measures of experienced weight bias (EWB), internalized weight bias (IWB), body and internalized shame, and self-compassion; anxiety and depression screeners were accessed from medical charts. Multiple regression and PROCESS bootstrapping estimates tested our hypothesized mediation model as follows: EWB→IWB→body shame→shame→self-compassion→symptoms. RESULTS After accounting for EWB and IWB, internalized shame accounted for greater variance in both end points than body shame. EWB was associated with greater anxiety through risk paths implicating IWB, body shame, and/or internalized shame. Protective paths associated EWB with fewer depressive and anxiety symptoms among those with higher self-compassion. CONCLUSIONS The findings suggest a potentially important role for weight bias and shame in psychological health among BSC and implicate self-compassion, a trainable affect-regulation strategy, as a protective factor that may confer some resiliency. Future research using longitudinal and causal designs is warranted.
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Affiliation(s)
- Tosca D Braun
- Department of Psychiatry and Human Behavior, The Miriam Hospital and Alpert Medical School of Medicine, Brown University, Providence, Rhode Island, USA
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Diane M Quinn
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Andrea Stone
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Amy A Gorin
- Department of Psychological Sciences, Institute for Collaboration on Health, Intervention, & Policy, University of Connecticut, Storrs, Connecticut, USA
| | - Jennifer Ferrand
- Institute of Living, Division of Health Psychology, Hartford Hospital, Hartford, Connecticut, USA
| | - Rebecca M Puhl
- Department of Human Development & Family Sciences, Rudd Center for Food Policy & Obesity, University of Connecticut, Storrs, Connecticut, USA
| | - Jessica Sierra
- Institute of Living, Division of Health Psychology, Hartford Hospital, Hartford, Connecticut, USA
| | - Darren Tishler
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
| | - Pavlos Papasavas
- Surgical Weight Loss Center, Hartford Hospital, Hartford, Connecticut, USA
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Farup PG. Are the Results of a Combined Behavioural and Surgical Treatment of Morbid Obesity Satisfactory and Predictable? Nutrients 2020; 12:E1997. [PMID: 32635628 PMCID: PMC7400840 DOI: 10.3390/nu12071997] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 06/30/2020] [Accepted: 06/30/2020] [Indexed: 01/08/2023] Open
Abstract
Treatment of subjects with morbid obesity (Body Mass Index (BMI) > 40 kg/m2 or > 35 kg/m2 with obesity-related complications) often fails. This study explored the biopsychosocial predictors of dropout and weight loss during a combined behavioural and surgical weight-reduction program. Behavioural treatment for six months was followed by bariatric surgery and a visit six months after surgery. The success criterion was the loss of ≥50% of excess BMI above 25 kg/m2 (%EBMIL). Thirty-one men and 113 women with BMI 43.5 kg/m2 (SD 4.3) and 41.8 kg/m2 (SD 3.6), respectively, were included; 115 underwent bariatric surgery (Gastric sleeve: 23; Roux-en-Y gastric bypass: 92), and 98 had a follow-up visit six months after surgery. The mean %EBMIL at follow-up was 71.2% (SD 18.5). Treatment success was achieved in 86 subjects. Assuming success in 17 subjects who did not attend the follow-up visit (best possible outcome), 103 out of 144 subjects (72%) achieved successful weight reduction. Cohabitation was the only predictor of accomplishing surgery. Neither weight loss during behavioural therapy nor biopsychosocial factors were found to be clinically significant predictors of weight loss after surgery. The success rate of less than three in four subjects was unsatisfactory. There is a need to improve the regimen and to determine effective alternative interventions.
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Affiliation(s)
- Per G Farup
- Department of Research, Innlandet Hospital Trust, N-2381 Brumunddal, Norway
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20
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Järvholm K, Bruze G, Peltonen M, Marcus C, Flodmark CE, Henfridsson P, Beamish AJ, Gronowitz E, Dahlgren J, Karlsson J, Olbers T. 5-year mental health and eating pattern outcomes following bariatric surgery in adolescents: a prospective cohort study. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:210-219. [DOI: 10.1016/s2352-4642(20)30024-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/29/2019] [Accepted: 11/29/2019] [Indexed: 01/06/2023]
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Oltmanns JR, Rivera JR, Cole J, Merchant A, Steiner JP. Personality psychopathology: Longitudinal prediction of change in body mass index and weight post-bariatric surgery. Health Psychol 2020; 39:245-254. [PMID: 31944798 PMCID: PMC7021354 DOI: 10.1037/hea0000842] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Bariatric surgery is an effective treatment for obesity, which has been increasing worldwide. However, bariatric surgery causes dramatic physical changes that can cause significant stress. Prior research has found that psychological variables such as personality traits and levels of psychopathology can influence success after bariatric surgery (in terms of body mass index [BMI] reduction and weight loss). However, most prior studies have been limited by small sample sizes, inconsistent follow up, and categorical assessment of psychopathology. METHOD The present study examines the predictive utility of the Personality Assessment Inventory (PAI) scales for three bariatric surgery outcomes (BMI reduction, weight loss, and percent excess weight loss [%EWL]) across 10 follow-up points 5 years after surgery. It also examines the largest sample of bariatric surgery-completing patients (N = 2,267) on the PAI to date. Latent growth modeling was used to examine change in the outcome variables. RESULTS Results indicate that personality and psychopathology variables predicted less BMI reduction, weight loss, and %EWL 5 years after surgery and also affected the trajectories of change in the outcome variables across time. The PAI scales predicted more variance in the 5-year BMI outcomes than did age and gender. The most robust effects were for scales assessing phobias, traumatic stress, identity problems, and negative relationships. CONCLUSION The PAI may be useful to clinical health psychologists who conduct recommended psychological evaluations with potential bariatric surgery candidates. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | | | - Jonathan Cole
- Bluegrass Health Psychology
- St. Joseph’s Center for Weight Loss Surgery
| | - Amanda Merchant
- Bluegrass Health Psychology
- St. Joseph’s Center for Weight Loss Surgery
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Imperatori C, Bianciardi E, Niolu C, Fabbricatore M, Gentileschi P, Di Lorenzo G, Siracusano A, Innamorati M. The Symptom-Checklist-K-9 (SCL-K-9) Discriminates between Overweight/Obese Patients with and without Significant Binge Eating Pathology: Psychometric Properties of an Italian Version. Nutrients 2020; 12:E674. [PMID: 32121618 PMCID: PMC7146623 DOI: 10.3390/nu12030674] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 02/23/2020] [Accepted: 02/28/2020] [Indexed: 02/06/2023] Open
Abstract
A general personality and psychopathology evaluation is considered to be crucial part of the multidisciplinary assessment for weight-related problems. The Symptom Checklist-90-Revised (SCL-90-R) is commonly used to assess general psychopathology in both overweight and obese patients seeking weight-loss treatment. The main purpose of the present research was to investigate the psychometric properties of the brief form of the SCL-90-R (i.e., the SCL-K-9) in a clinical sample (N = 397) of patients seeking weight-loss treatment (i.e., bariatric surgery and a nutritional weight-loss program). The results of the confirmatory factor analysis supported a one-factor solution of the SCL-K-9, with all nine items loading significantly on the common latent factor (lambdas ≥ 0.587). The ordinal α (= 0.91), the inter-item mean indices of correlation (rii = 0.53), and the convergent validity were also satisfactory. A receiver operating characteristic curves procedure showed that both SCL-90-R and SCL-K-9 were able to classify patients with and without significant binge eating pathology according to the Binge Eating Scale (BES) total score. Overall, our results suggest that the SCL-K-9 has adequate psychometric properties and can be applied as a short screening tool to assess general psychopathology in overweight/obese individuals seeking weight-loss treatment and at follow-up interviews when time restraints preclude the use of the full-length form.
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Affiliation(s)
- Claudio Imperatori
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy; (M.F.); (M.I.)
| | - Emanuela Bianciardi
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
| | - Cinzia Niolu
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
| | - Mariantonietta Fabbricatore
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy; (M.F.); (M.I.)
| | - Paolo Gentileschi
- Bariatric Surgery Unit, Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy;
| | - Giorgio Di Lorenzo
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
- IRCCS Fondazione Santa Lucia, Via Ardeatina 306, 00179 Roma, Italy
| | - Alberto Siracusano
- Psychiatric Chair, Department of Systems Medicine, University of Rome “Tor Vergata”, Via Cracovia, 50, 00133 Roma, Italy; (E.B.); (C.N.); (G.D.L.); (A.S.)
| | - Marco Innamorati
- Cognitive and Clinical Psychology Laboratory, Department of Human Science, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy; (M.F.); (M.I.)
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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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Disordered eating after bariatric surgery: clinical aspects, impact on outcomes, and intervention strategies. Curr Opin Psychiatry 2019; 32:504-509. [PMID: 31343419 PMCID: PMC6768715 DOI: 10.1097/yco.0000000000000549] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Disordered eating behaviors (DEBs) are associated with poor weight outcomes following bariatric surgery. We describe DEBs most relevant to this population, their associations with weight outcomes, and emerging data on interventions for DEBs. RECENT FINDINGS Loss of control eating episodes and grazing have been the most well studied DEBs in bariatric samples. Although DEBs often remit after surgery even without targeted intervention, a subgroup of patients have persistent or newly developed DEBs postoperatively. Preoperative DEBs have little effect on weight outcomes, whereas preoperative impulse control-related features commonly associated with DEBs (e.g., inhibitory control) may have stronger predictive value. Postoperatively, DEBs appear to exert robust effects on concurrently measured weight. Postoperative interventions hold promise for optimizing treatment outcomes. SUMMARY We recommend the following to improve clinical care and move research forward: a common language for DEB constructs is needed to improve cross-talk among researchers and care providers; diagnostic schemes and assessment tools may require tailoring for the bariatric population; mechanisms underlying improvements in DEBs following surgery should be clarified; ongoing monitoring of DEBs in the postoperative period is warranted; and a stepped-care approach may improve weight outcomes in a cost-effective manner.
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Baffoe SKA, Rohrer JE, Goes J. Length of stay by uncomplicated diabetes bariatric surgery patients: A laparoscopic adjustable banding versus laparoscopic sleeve gastrectomy. J Eval Clin Pract 2019; 25:779-787. [PMID: 30426595 DOI: 10.1111/jep.13068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 10/02/2018] [Accepted: 10/15/2018] [Indexed: 01/28/2023]
Abstract
RATIONALE, AIMS, AND OBJECTIVE Bariatric surgery is an effective procedure for morbidly obese patients when all else fails. The purpose of this study was to compare the hospital length of stay (LOS) for two surgical procedures, laparoscopic adjustable gastric banding (LAGB) and laparoscopic sleeve gastrectomy (LSG). METHODS This study was a retrospective cross-sectional analysis of the Nationwide Inpatient Sample (NIS) from 2009 to 2014. Patients who received bariatric surgery as indicated by International Classification of Diseases, Ninth Revision (ICD-9) procedure codes were selected (N = 4001). Cases were limited to uncomplicated diabetic patients. Differences in the odds of long vs short (2< and ≥2) stay for a patient receiving LSG were compared with LAGB while adjusting for hospital volume, hospital size, patient age, gender, ethnicity, season, and year using logistic regression analysis. RESULTS The odds for LSG (odds ratio [OR] = 0.100, 0.066-0.150, P < 0.001) patients for long LOS are lower when compared with LAGB. In the stratified logistic regression model, both male (OR = 0.157, 0.074-0.333, P < 0.001) and female (OR = 0.077, 0.046-0.127, P < 0.001) had reduced odds of extended LOS for LSG. Discharged patients in the year 2012 (OR = 0.660, 0.536-0.813, P < 0.001) had decreased odds of having a longer LOS when compared with the year 2014. Both government, nonfederal (OR = 0.452, 0.251-0.816, P = 0.008), and private investor-owned (OR = 0.421, 0.244-0.726, P < 0.001) patients had similar odds for long duration of stay when compared with government or private. Urban non-teaching (OR = 1.954, 1.653-2.310, P < 0.001) patients had higher odds for long LOS in comparison with urban teaching. New England patients' (OR = 0.365, 0.232-0.576, P < 0.001) odds for extended LOS were lower when compared with pacific. Both patients who received care in low (OR = 1.330, 1.109-1.595, P = 0.002) and medium (OR = 1.639, 1.130-2.377, P = 0.009) volume hospital had increased odds for long duration of stay. Female patients in the stratified logistic regression model with high (OR = 1.330, 1.109-1.595, P < 0.002) volume had elevated odds of extended LOS when compared with very low volume hospital. CONCLUSION Among the uncomplicated diabetic patients, LSG provides a substantially low odds of extended LOS after adjusting for covariates when compared with LAGB. The finding of the relative reduction in LOS for LSG suggests opportunities for improvement both for cost reduction for third party insurance payers and greater efficacy and outcomes for patients.
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Affiliation(s)
| | - James E Rohrer
- SAGE Publications Inc, Thousand Oaks, California, USA.,Walden University, Minneapolis, Minnesota, USA.,School of Health Sciences, Walden University, Minneapolis, Minnesota, USA
| | - James Goes
- Walden University, Minneapolis, Minnesota, USA.,School of Health Sciences, Walden University, Minneapolis, Minnesota, USA
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Presurgical Psychological Evaluation: Risk Factor Identification and Mitigation. J Clin Psychol Med Settings 2019; 27:396-405. [PMID: 31473887 DOI: 10.1007/s10880-019-09660-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Presurgical psychological evaluations (PPEs) are becoming an established component of the surgical process, though methods of conducting PPEs are variable. There is a lack of clarity about the goals of PPEs, the types of information that should be included, and the process for integrating information and making recommendations to the referring physicians/surgeons. This review proposes an empirically supported model for PPEs that is systematic, but flexible enough to be utilized across the broad range of surgical evaluations. This five-step method is termed the Risk Identification and Mitigation (RIM) model and is discussed in detail. The RIM model presented in this review can both serve as a structure to be utilized in under-researched PPE areas and as a stimulus for future empirical investigations.
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Internalizing, Externalizing, and Interpersonal Components of the MMPI-2-RF in Predicting Weight Change After Bariatric Surgery. Obes Surg 2019; 30:127-138. [DOI: 10.1007/s11695-019-04133-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Heriseanu AI, Hay P, Touyz S. Grazing behaviour and associations with obesity, eating disorders, and health-related quality of life in the Australian population. Appetite 2019; 143:104396. [PMID: 31386867 DOI: 10.1016/j.appet.2019.104396] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/23/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Grazing, including a compulsive subtype, represents an eating behaviour of recent interest in obesity and eating disorders (ED), however, there is little information regarding its prevalence and correlates in the general population. The current study aimed to report on the distribution of compulsive grazing (CG) and non-compulsive grazing (NCG) in the Australian population, and to assess associations with obesity, ED, and health-related functioning. METHODS A representative sample of 3047 individuals aged ≥15 years (50.8% female) completed a cross-sectional survey in 2016 assessing grazing, quality of life, BMI, and ED symptoms. Prevalence data were obtained, and logistic regressions and multivariate analyses were conducted to examine relationships between grazing and obesity, ED, and health-related quality of life. RESULTS The point prevalence of regular NCG was 38.04% (95% CI [36.33, 39.78]; n = 1159) and CG was 10.24% (95% CI [9.21, 11.37]; n = 312). Persons with regular CG had almost twice the odds of a BMI ≥ 30 than of a BMI in the "healthy" range compared to those with no grazing. CG presented stronger associations with ED features and binge-type ED diagnostic groups than NCG, with high rates found in BED-Broad and BN, although some associations with ED features were also present for NCG. Those with both ED and obesity had an 11-fold increase in the odds of engaging in CG than in no grazing, compared to those without. Mental health-related quality of life was lower in those who engaged in CG in the population, as well as in those with obesity. CONCLUSIONS Grazing, especially when associated with a more severe sense of loss of control, is a problematic eating behaviour in the general population, as well as in persons with high BMI, a binge-type ED, or both.
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Affiliation(s)
- Andreea I Heriseanu
- School of Psychology, University of Sydney, Australia, Clinical Psychology Unit, University of Sydney, Level 3 M02F, 94 Mallett Street, Camperdown, NSW, 2050, Australia.
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Australia, School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia; Campbelltown Hospital, South West Sydney Local Health District (SWSLHD), Australia, PO Box 149, Campbelltown, NSW, 2560, Australia.
| | - Stephen Touyz
- School of Psychology, University of Sydney, Australia, Clinical Psychology Unit, University of Sydney, Level 3 M02F, 94 Mallett Street, Camperdown, NSW, 2050, Australia; InsideOut Institute, Level 2, The Charles Perkins Centre, The University of Sydney, Johns Hopkins Drive, Camperdown, NSW, 2006, Australia.
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Psychometric Characteristics of the Revised Illness Perception Questionnaire (IPQ-R) in People Undergoing Weight Loss Surgery. J Clin Psychol Med Settings 2019; 27:79-88. [PMID: 31069587 DOI: 10.1007/s10880-019-09624-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The Illness Perception Questionnaire-Revised (IPQ-R) has been used extensively across many health conditions to measure patient illness and treatment perceptions. The constructs have an association with treatment adaptation and adherence which, in turn, are considered core factors involved in bariatric surgery outcome. This study examines the factorial validity and internal reliability of a modified (IPQ-R) in bariatric surgery candidates. After wording modifications, participants (N = 310) completed the IPQ-R as part of standard pre-surgery assessments. After removal of two items, confirmatory factor analysis (CFA) supported the original 7-factor solution of the Beliefs scale, with good to marginal subscale internal consistency. Exploratory factor analysis (EFA), with two items removed only partially supported the original 5-factor Causal Attributions scale. Internal consistency was unacceptably low for two subscales. Further research is needed to generate new items which better fit the IPQ-R to this population before research can explore the relevance of illness perceptions.
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Monteleone AM, Cascino G, Solmi M, Pirozzi R, Tolone S, Terracciano G, Parisi S, Cimino M, Monteleone P, Maj M, Docimo L. A network analysis of psychological, personality and eating characteristics of people seeking bariatric surgery: Identification of key variables and their prognostic value. J Psychosom Res 2019; 120:81-89. [PMID: 30929713 DOI: 10.1016/j.jpsychores.2019.03.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 03/05/2019] [Accepted: 03/06/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The interplay among personality traits, anxiety and eating symptoms in candidates for bariatric surgery has never been investigated through the network analysis approach. Thus, we aimed to use this method to identify the key psychological traits that characterize these individuals and to assess their role as predictors of surgical outcomes. METHODS One-hundred-eighty-five candidates for bariatric surgery filled in the State Trait Anxiety Inventory (STAI), the Revised Restraint Scale, the Power of Food Scale and the Temperament and Character Inventory-Revised (TCI-R) questionnaires. All these variables were included in a network analysis. Then, the most central network nodes were entered as independent variables in a regression model that included 9-month follow-up weight outcomes as the dependent variable. RESULTS The network has showed a good stability. TCI-self directedness and harm avoidance scores and STAI state and trait anxiety scores were the nodes with the highest centrality in the network. Weight outcomes were assessed in 64 patients at follow-up. Among central nodes, low TCI-self directedness was found to be the only significant independent predictor of worse weight outcome. CONCLUSIONS Our findings show for the first time the interplay between personality traits and symptoms in candidates for bariatric surgery combining the network approach with a follow-up evaluation. Low self-directedness has been proved to be the node with highest centrality and the only predictor of short-term weight outcome. These data suggest the importance to take into consideration personality and psychological variables either in the pre-surgery assessment or as possible targets for pre or post-surgery psychotherapeutic interventions. ORCID 0000-0002-6786-4458.
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Affiliation(s)
| | - Giammarco Cascino
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy
| | - Marco Solmi
- Department of Neurosciences, University of Padua, Padua, Italy
| | - Raffaele Pirozzi
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Salvatore Tolone
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Gianmattia Terracciano
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Simona Parisi
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Monica Cimino
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Palmiero Monteleone
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', Section of Neurosciences, University of Salerno, Salerno, Italy.
| | - Mario Maj
- Department of Psychiatry, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ludovico Docimo
- Advanced Medical and Surgical Sciences Department, University of Campania "Luigi Vanvitelli", Naples, Italy.
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Sarwer DB, Allison KC, Wadden TA, Ashare R, Spitzer JC, McCuen-Wurst C, LaGrotte C, Williams NN, Edwards M, Tewksbury C, Wu J. Psychopathology, disordered eating, and impulsivity as predictors of outcomes of bariatric surgery. Surg Obes Relat Dis 2019; 15:650-655. [PMID: 30858009 DOI: 10.1016/j.soard.2019.01.029] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 02/08/2023]
Abstract
Outcomes of bariatric surgery, while frequently impressive, are not universal and vary between patients and across surgical procedures. Between 20% and 30% of patients experience suboptimal weight loss or significant weight regain within the first few postoperative years. The reasons for this are not fully understood, but likely involve both physiologic processes, behavioral factors, and psychological characteristics. Evidence suggests that preoperative psychosocial status and functioning can contribute to suboptimal weight losses and/or postoperative psychosocial distress. Much of this work has focused on the presence of recognized psychiatric diagnoses and with particular emphasis on mood disorders as well as binge eating disorder. Several studies have suggested that the presence of preoperative psychopathology is associated with suboptimal weight losses, postoperative complications, and less positive psychosocial outcomes. Contemporary psychological theory suggests that it may be shared features across diagnoses, rather than a discrete diagnosis, that better characterizes psychopathology. Mood and substance use disorders as well as binge eating disorder, share common features of impulsivity, although clinicians and researchers often use complementary, yet different terms, such as emotional dysregulation or disinhibition (i.e., loss of control over eating, as applied to food intake), to describe the phenomenon. Impulse control is a central factor in eating behavior and extreme obesity. It also may contribute to the experience of suboptimal outcomes after bariatric surgery, including smaller than expected weight loss and psychosocial distress. This paper reviews the literature in these areas of research and articulates a direction for future studies of these complex relationships among persons with extreme obesity.
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Affiliation(s)
- David B Sarwer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania.
| | - Kelly C Allison
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Rebecca Ashare
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jacqueline C Spitzer
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Courtney McCuen-Wurst
- Center for Weight and Eating Disorders, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caitlin LaGrotte
- Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, Pennsylvania
| | - Noel N Williams
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Michael Edwards
- Department of Surgery, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Colleen Tewksbury
- Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, Philadelphia, Pennsylvania
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Sellbom M. The MMPI-2-Restructured Form (MMPI-2-RF): Assessment of Personality and Psychopathology in the Twenty-First Century. Annu Rev Clin Psychol 2019; 15:149-177. [PMID: 30601687 DOI: 10.1146/annurev-clinpsy-050718-095701] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This article describes the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) and situates the instrument in contemporary psychopathology and personality literature. The historical evolution of the MMPI instruments is highlighted, including how failure to update the test for several decades resulted in increasing disinterest by basic researchers and how the restructuring efforts beginning in the 2000s promised to realign the instrument with basic research. In this regard, the construct validity associated with MMPI-2-RF scores in the context of contemporary dimensional models of psychopathology is considered. Research supporting the applied utility of the MMPI-2-RF scales in a variety of contexts-including mental health screenings, presurgical evaluations, forensic assessment, and public safety screening-is also reviewed. Critiques of the MMPI-2-RF are described and addressed. Finally, a series of recommendations for future updates of the MMPI-2-RF are described along with a path toward the MMPI-3.
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Affiliation(s)
- Martin Sellbom
- Department of Psychology, University of Otago, Dunedin 9054, New Zealand;
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Hawkins M, Lee A, Leung S, Hawa R, Wnuk S, Yanofsky R, Sockalingam S. Prevalence and Factors Associated With Psychiatric Medication Use in Bariatric Surgery Candidates. PSYCHOSOMATICS 2018; 60:449-457. [PMID: 30558795 DOI: 10.1016/j.psym.2018.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 11/22/2018] [Accepted: 11/26/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE We aimed to describe the rates of psychiatric medication use in bariatric surgery candidates and factors associated with psychiatric medication use. METHODS Patients from the Toronto Western Hospital Bariatric Surgery Program were recruited from 2011 to 2014. Data extracted included demographics, clinical factors (e.g., mood disorder, anxiety disorder, eating disorder, Patient Health Questionnaire-9, Generalized Anxiety Disorder 7), and psychiatric medication use. Logistic regression analyses were used to examine the relationship between demographic variables, clinical factors, and psychiatric medication use. Multiple logistic regression was conducted to determine the predictors of clinical factors from demographic variables with psychiatric medication use. RESULTS A total of 262 (35.1%) patients were taking at least 1 psychiatric medication and 105 patients (14.1%) were taking more than 1 psychiatric medication. Antidepressants were the most common psychiatric medication reported. The majority of patients taking a psychiatric medication had a psychiatric illness, with 16.0% not having a lifetime diagnosis of a mental illness. Being male and being employed significantly predicted lower odds of being on a psychiatric medication. Older age significantly predicted higher odds of being on a psychiatric medication. Psychiatric disorders were significantly associated with psychiatric medication use independent of demographic variables. CONCLUSION Our study provides insights into clinical and demographic factors related to psychiatric medication use in bariatric surgery patients. The findings support careful screening and clarification of psychiatric medications, especially in patients without a formal psychiatric diagnosis.
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Affiliation(s)
- Michael Hawkins
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Lee
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Samantha Leung
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada; Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
| | - Raed Hawa
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada; Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
| | - Susan Wnuk
- Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
| | - Richard Yanofsky
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada; Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Centre for Mental Health, University Health Network, Toronto, Ontario, Canada; Toronto Western Hospital, Bariatric Surgery Program, University Health Network, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
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Binge eating and other eating-related problems in adolescents undergoing gastric bypass: results from a Swedish nationwide study (AMOS). Appetite 2018; 127:349-355. [DOI: 10.1016/j.appet.2018.05.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 05/02/2018] [Accepted: 05/04/2018] [Indexed: 12/26/2022]
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Conceição EM, de Lourdes M, Pinto-Bastos A, Vaz AR, Brandão I, Ramalho S. Problematic eating behaviors and psychopathology in patients undergoing bariatric surgery: The mediating role of loss of control eating. Int J Eat Disord 2018; 51:507-517. [PMID: 29663468 DOI: 10.1002/eat.22862] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/10/2018] [Accepted: 03/11/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study compares different problematic eating behaviors (PEBs; objective [OBE]/subjective [SBE] binge-eating and compulsive [CG]/noncompulsive [NCG] grazing) in relation to the severity of loss of control (LOC) and psychopathology. We also investigate LOC as a mediator between PEBs and psychopathology. METHOD This cross-sectional study assessed a group of patients before bariatric surgery (n = 163), and a group of bariatric patients 12 months or more after surgery (n = 131). Face-to-face assessment: Eating Disorders Examination for binge-eating episodes; Rep(eat) for grazing. LOC was measured by five questions answered in a 5-point Likert scale. Self-report measures: disordered eating, grazing, negative urgency, depression, anxiety, and stress. RESULTS OBEs were reported by 26(8.8%), SBE by 29(9.8%), CG by 35(11.9%), and NCG by 36(12.2%) of patients. The different PEBs differed significantly in the severity of LOC (F(3,120)= 25.81, p < .001). Patients reporting OBEs scored higher and patients with NCG scored lower in most measures than patients with other PEBs. Patients with any PEBs scored higher in all self-report measures than those not reporting any PEBs, with statistical significance reached for uncontrolled eating (F(4,288)= 20.21, p < .001), emotional eating (F(4,288)= 23.10, p < .001), repetitive eating F(4,288)= 18.34, p < .001), and compulsive grazing (F(4,288)= 27.14, p < .001). LOC was found to be a full mediator between PEBs and psychopathology. DISCUSSION There is no evidence that the different PEBs differ in the psychopathology severity, independently of the experience of LOC eating during the eating episodes. We show evidence for the conceptualization of different PEB, including grazing, on a continuous scale of LOC and psychopathology.
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Affiliation(s)
- Eva M Conceição
- School of Psychology, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal
| | - Marta de Lourdes
- School of Psychology, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal
| | - Ana Pinto-Bastos
- School of Psychology, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal
| | - Ana Rita Vaz
- School of Psychology, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal
| | - Isabel Brandão
- Faculty of Medicine, University of Porto, Centro Hospitalar de São João, Porto, Portugal
| | - Sofia Ramalho
- School of Psychology, University of Minho, Campus Gualtar, 4710-057, Braga, Portugal
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Lew HYF, Zainal KA. Agreement of screening tools with established questionnaires used in psychological assessment of bariatric patients. PROCEEDINGS OF SINGAPORE HEALTHCARE 2018. [DOI: 10.1177/2010105818766960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Depression and binge eating contributes to less weight loss after bariatric surgery. The lack of standardized assessment of depression and binge eating in bariatric patients makes it hard to identify and provide treatment to relevant patients. This study aimed to enhance the accuracy of identifying binge eating and depression in bariatric patients before surgery. We determined the agreement of brief screening tools for depression, binge eating and quality of life with established questionnaires used in psychological assessment of bariatric patients. Methods: In total, 120 patients completed both screening tools and established questionnaires before surgery during their psychological assessment sessions. Cohen’s kappa was conducted to determine whether Patient Health Questionnaire-2 agreed with the Beck Depression Inventory II in identifying depression; and if Patient Health Questionnaire-Binge agreed with the Binge Eating Scale in identifying binge eating. To investigate the degree of agreeableness between the RAND 36-Item Health Survey and Moorehead–Ardelt Quality of Life Questionnaire II on quality of life, Bland Altman analysis was performed. Results: Our results show that agreement between Patient Health Questionnaire-2 and Beck Depression Inventory II ( k=0.35) was fair. We found that agreement between Patient Health Questionnaire-Binge and Binge Eating Scale ( k=0.41) was moderate. Conclusions: These results indicate that the respective brief instruments’ identification of depression and binge eating is comparable to established questionnaires. Our results play a role in offering brief screening tools to be included at different points of assessment, together with established questionnaires and clinical interviews for a more accurate and comprehensive assessment.
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Hulme PA, Kupzyk KA, Anthone GJ, Capron KA, Nguyen T. Weight Loss and Timing of J Tube Removal in Biliopancreatic Diversion with Duodenal Switch Patients Who Report Physical or Sexual Abuse. Obes Surg 2018; 28:2361-2367. [PMID: 29512037 DOI: 10.1007/s11695-018-3166-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Bariatric surgery patients who report physical or sexual abuse form a sizeable cohort that stands out due to psychological comorbidity. Their possible vulnerability to suboptimal weight loss remains of interest. Their risk for malnutrition due to inadequate oral intake following surgery is underexplored. OBJECTIVES Study aims were to determine the effect of self-reported physical or sexual abuse in patients undergoing open biliopancreatic diversion with duodenal switch (BPD/DS) on (a) 3-year weight loss trajectories and (b) timing of feeding jejunostomy tube (J tube) removal. Delayed J tube removal served as an indicator for inadequate oral intake. METHODS In this retrospective cohort study, the sample (N = 189) consisted of all patients who underwent primary BPD/DS by the same surgeon during 2009 and 2010 at a Midwestern health system. All patients had a J tube placed during surgery. Longitudinal mixed models were used for testing differences in weight loss trajectories by abuse status. RESULTS There were no significant differences in weight loss trajectories by abuse status. The abused group had the J tube in place a mean of 61.9 days (SD = 39.5) compared to 44.8 days (SD = 32.8) for the not abused group, a significant difference. CONCLUSIONS Our use of the best available statistical methods lends validity to previous findings that suggest physical or sexual abuse does not affect weight loss after bariatric surgery. Increased likelihood of persistent inadequate oral intake in the abused group suggests the need for early multidisciplinary interventions that include mental health and nutrition experts.
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Affiliation(s)
- Polly A Hulme
- College of Nursing, South Dakota State University, Wagner Hall 204, Brookings, SD, 57007, USA.
| | - Kevin A Kupzyk
- College of Nursing, University of Nebraska Medical Center, 985330 Nebraska Medical Center, Omaha, NE, 68198-5330, USA
| | - Gary J Anthone
- Department of Surgery, Creighton University, 10506 Burt Circle, Omaha, NE, 68144, USA
| | | | - Thang Nguyen
- Nebraska Medicine, 987400 Nebraska Medical Center, Omaha, NE, 68198-7400, USA
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Pearl RL, Allison KC, Shaw Tronieri J, Wadden TA. Reconsidering the Psychosocial-Behavioral Evaluation Required Prior to Bariatric Surgery. Obesity (Silver Spring) 2018; 26:249-250. [PMID: 29282873 DOI: 10.1002/oby.22063] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/28/2017] [Accepted: 09/29/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Rebecca L Pearl
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Center for Human Appearance, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly C Allison
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jena Shaw Tronieri
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Thomas A Wadden
- Center for Weight and Eating Disorders, Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Mack I, Ölschläger S, Sauer H, von Feilitzsch M, Weimer K, Junne F, Peeraully R, Enck P, Zipfel S, Teufel M. Does Laparoscopic Sleeve Gastrectomy Improve Depression, Stress and Eating Behaviour? A 4-Year Follow-up Study. Obes Surg 2017; 26:2967-2973. [PMID: 27178406 DOI: 10.1007/s11695-016-2219-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric surgery procedure and currently the second most performed technique worldwide. Follow-up data on depression, stress and eating behaviour are scarce. The aim of this longitudinal study was to investigate the medium-term effects of LSG on mental health and eating behaviour and their influence on weight loss by using a comprehensive interview-based assessment. METHODS Seventy-five individuals, who had undergone LSG at a university hospital, were included in the study. Symptoms of disordered eating were assessed using a structured clinical interview (eating disorder examination) and the Three-Factor Eating Questionnaire with depressive symptoms and stress assessed via the Patient Health Questionnaire. RESULTS Mean interval from LSG to follow-up (FU) examination was 48 ± 13.3 months. The total body weight loss was 24.2 ± 12.0 %. Depressive symptom scores improved from pre-operative to FU (9 [IQR 5-14] vs. 6 [IQR 2-10], p = 0.002) as did stress scores (8.7 ± 4.6 vs. 6.3 ± 4.7, p = 0.001). At FU, 11 % of patients reported loss-of-control eating and 39 % grazing, paralleled by increased body mass index, stress and depressive symptoms. Prior to LSG, nine patients fulfilled the diagnostic criteria of binge eating disorder but only one at FU. CONCLUSIONS Post-surgical mental health appears to be highly relevant in terms of weight loss maintenance. It is likely that the surgical outcome could be positively influenced if patients at risk of developing mental health issues or eating disorders were identified and monitored in order to offer targeted interventions.
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Affiliation(s)
- Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.
| | - Sabrina Ölschläger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Helene Sauer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Maximilian von Feilitzsch
- Department of General, Visceral and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Katja Weimer
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Florian Junne
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Riyad Peeraully
- Department of Paediatric Surgery, Queen's Medical Centre, Nottingham, UK
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
| | - Martin Teufel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany
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Duarte-Guerra LS, Coêlho BM, Santo MA, Lotufo-Neto F, Wang YP. Morbidity persistence and comorbidity of mood, anxiety, and eating disorders among preoperative bariatric patients. Psychiatry Res 2017; 257:1-6. [PMID: 28709116 DOI: 10.1016/j.psychres.2017.07.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 07/01/2017] [Accepted: 07/10/2017] [Indexed: 11/26/2022]
Abstract
The current study investigates the patterns of disease persistence and comorbidity of psychiatric disorders among patients with class III obesity in pre-operative period. For 393 treatment-seeking patients with severe obesity recruited from a bariatric center, we ascertained their psychiatric diagnosis through Structured Clinical Interview for DSM-IV (SCID-I). Following, the frequency, persistence and comorbidity pattern of psychiatric disorders in this sample were determined. Current psychiatric disorders were observed in over half of patients during preoperative period, being anxiety disorders the most frequent diagnosis. For lifetime disorders, mood disorders were the most frequent diagnosis. Most of the sample presented 2 or more concurrent lifetime psychiatric disorders. While mood and eating disorders were frequent conditions, anxiety disorders were the most persistent conditions (the highest one month-to-lifetime prevalence ratio) and were significantly correlated with bipolar, depressive and eating disorders. Psychiatric disorders are frequent and enduring conditions among patients looking for bariatric surgery. Comorbid anxiety, mood, and eating disorders are remarkable features in treatment-seeking patients with obesity. Prognostic implications of preoperative psychiatric disorders on surgery outcome should be demonstrated prospectively in intervention studies.
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Affiliation(s)
| | - Bruno Mendonça Coêlho
- Department and Institute of Psychiatry (LIM-23), University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Marco Aurélio Santo
- Department of Surgery, University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Francisco Lotufo-Neto
- Department and Institute of Psychiatry (LIM-23), University of São Paulo Medical School, São Paulo, SP, Brazil
| | - Yuan-Pang Wang
- Department and Institute of Psychiatry (LIM-23), University of São Paulo Medical School, São Paulo, SP, Brazil.
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Using the presurgical psychological evaluation to predict 5-year weight loss outcomes in bariatric surgery patients. Surg Obes Relat Dis 2017; 13:514-521. [DOI: 10.1016/j.soard.2016.11.008] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 02/05/2023]
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