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Ivezaj V, Dilip A, Duffy AJ, Grilo CM. Racial differences after bariatric surgery: 24-month follow-up of a randomized, controlled trial for postoperative loss-of-control eating. Surg Obes Relat Dis 2024; 20:261-266. [PMID: 37949690 PMCID: PMC10922356 DOI: 10.1016/j.soard.2023.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 09/01/2023] [Accepted: 09/10/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND While some bariatric surgery outcomes vary by race/ethnicity, less is known about racial/ethnic differences in loss-of-control (LOC) eating and psychosocial outcomes post-surgery. OBJECTIVE This prospective study examined and extended initial short-term findings regarding racial differences in post-bariatric surgery LOC eating and weight loss to longer-term outcomes through 24-month follow-ups. SETTING Academic medical center in the United States. METHODS Participants were 140 patients (46.4% non-White) in a 3-month randomized, controlled trial for LOC eating performed about 6 months after bariatric surgery. Participants were reassessed at 6, 12, 18, and 24 months after treatment ended (about 33 mo after surgery). Doctoral assessors administered the Eating Disorder Examination-Bariatric Surgery Version interview to assess LOC eating and eating-disorder psychopathology at 12- and 24-month follow-ups. The Beck Depression Inventory II was repeated, and measured weight was obtained at all follow-ups. RESULTS White patients had significantly greater percent excess weight loss at all follow-ups than non-White patients (p < .03). White patients reported significantly more LOC eating at 12- (p = .004) and 24-month (p = .024) follow-ups and significantly greater eating disorder psychopathology at 12-month follow-up (p < .028). Racial groups did not differ significantly in eating disorder psychopathology at 24-month follow-ups or in Beck Depression Inventory II depression scores at any follow-ups. CONCLUSIONS Our findings suggest that among patients with LOC eating after bariatric surgery, non-White patients attain a lower percent excess weight loss than White patients but have comparable or better outcomes in LOC eating, associated eating disorder psychopathology, and depression over time.
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Affiliation(s)
- Valentina Ivezaj
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut.
| | - Abhaya Dilip
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut
| | - Andrew J Duffy
- Department of Surgery, Yale School of Medicine, New Haven, Connecticut
| | - Carlos M Grilo
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut; Department of Psychology, Yale University, New Haven, Connecticut
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Smith CE, Dilip A, Ivezaj V, Duffy AJ, Grilo CM. Predictors of early weight loss in post-bariatric surgery patients receiving adjunctive behavioural treatments for loss-of-control eating. Clin Obes 2023; 13:e12603. [PMID: 37257889 PMCID: PMC10524670 DOI: 10.1111/cob.12603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/19/2023] [Accepted: 05/10/2023] [Indexed: 06/02/2023]
Abstract
This study examined baseline patient characteristics as predictors of early weight loss, defined as any weight loss within the first month of treatment, among patients receiving adjunctive behavioural treatments for loss-of-control (LOC) eating about 6 months after bariatric surgery. Participants were 126 patients in a treatment trial for LOC-eating (roughly 6 months postoperatively) categorized by early weight change following 1 month of treatment. Early weight-loss, defined as any weight loss following 1 month of treatment, and weight-gain, defined as any weight gain, groups were compared on sociodemographic and clinical variables assessed using a battery of reliably administered diagnostic and clinical interviews and established self-report measures, and on surgery-related variables (time since surgery, percent total [%TWL], and percent excess weight loss). Most patients (n = 99; 78.6%) lost weight after the first month of adjunctive treatments. Black patients (n = 24; 61.5%) were significantly less likely to achieve early weight loss compared to patients identifying as White (n = 60; 83%) or 'other' (n = 15; 100%) which was not predicted by any other sociodemographic variable. Severity of eating-disorder psychopathology, psychiatric comorbidity, and a broad range of psychosocial measures were not significantly predictive of early weight changes. Duration since surgery and percent weight loss from time of surgery to study enrolment 6-months post-surgery differed by early weight-loss and weight-gain groups. Findings suggest that among post-bariatric surgery patients receiving adjunctive behavioural treatments for LOC-eating, baseline patient characteristics, aside from race and surgery-related variables, do not predict early weight loss.
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Affiliation(s)
- Caitlin E. Smith
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Abhaya Dilip
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Andrew J. Duffy
- Yale School of Medicine, Department of Surgery, New Haven, CT, USA
| | - Carlos M. Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
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Ivezaj V, Dilip A, Grilo CM. Psychiatric comorbidity as a prospective predictor of long-term weight and psychosocial outcomes after bariatric surgery. Gen Hosp Psychiatry 2023; 83:51-58. [PMID: 37099869 DOI: 10.1016/j.genhosppsych.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/04/2023] [Accepted: 03/09/2023] [Indexed: 04/28/2023]
Abstract
OBJECTIVES Psychiatric comorbidity is common among the bariatric population although the prognostic significance of psychiatric comorbidity on outcomes is uncertain. This prospective study examined differences in weight and psychosocial functioning outcomes based on lifetime and current (post-surgical) psychiatric comorbidity. METHODS Participants were 140 adults in a RCT for loss-of-control (LOC)-eating approximately six months post-bariatric surgery. Two structured interviews were administered: the Eating Disorder Examination-Bariatric Surgery Version (EDE-BSV) to assess LOC-eating and eating-disorder psychopathology, and the Mini International Neuropsychiatric Interview (MINI) to assess lifetime and current (post-surgical) psychiatric disorders. The EDE-BSV and Beck Depression Inventory (BDI-II) were repeated at post-treatment and 24-month follow-ups. RESULTS Lifetime (75.7%) and current/post-surgical (25%) psychiatric diagnoses were common. Groups with and without psychiatric comorbidity did not differ significantly in weight loss outcomes at any timepoint but psychiatric comorbidity was associated significantly with greater LOC-eating, eating-disorder psychopathology, and depression. CONCLUSIONS Among participants with LOC-eating post-bariatric surgery, lifetime and post-surgical psychiatric comorbidity was not associated with acute or longer-term weight outcomes but predicted poorer psychosocial functioning. Findings challenge prevailing views that psychiatric comorbidity is related to poorer longer-term weight outcomes following bariatric surgery but highlight its clinical significance as it is associated with broad psychosocial difficulties.
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Affiliation(s)
- Valentina Ivezaj
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA.
| | - Abhaya Dilip
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA
| | - Carlos M Grilo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT, USA; Yale University, Department of Psychology, New Haven, CT, USA
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Newsome FA, Dilip A, Armstrong SC, Salloum RG, Cardel MI. Scaling-Up Stage 4 Pediatric Obesity Clinics: Identifying Barriers and Future Directions Using Implementation Science. Obesity (Silver Spring) 2021; 29:941-943. [PMID: 33904257 DOI: 10.1002/oby.23162] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 11/09/2022]
Abstract
Nearly one-fifth of the pediatric population in the United States has obesity. Comprehensive behavioral interventions, with at least 26 contact hours, are the recommended treatment for pediatric obesity; however, there are various barriers to implementing treatment. This Perspective applies the Exploration, Preparation, Implementation, and Sustainment (EPIS) framework to address barriers to implementing multidisciplinary pediatric weight management clinics and identify potential solutions and areas for additional research. Lack of insurance coverage and reimbursement, high operating costs, and limited access to stage 4 care clinics with sufficient capacity were among the main barriers identified. Clinicians, researchers, and patient advocates are encouraged to facilitate conversations with insurance companies and hospital and clinic administrators, increase telehealth adoption, request training to improve competency and self-efficacy discussing and implementing obesity care, and advocate for more stage 4 clinics.
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Affiliation(s)
- Faith A Newsome
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Abhaya Dilip
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
- Department of Food Science and Human Nutrition, University of Florida College of Agricultural and Life Sciences, Gainesville, Florida, USA
| | - Sarah C Armstrong
- Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Michelle I Cardel
- Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA
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Lee AM, Szurek SM, Dilip A, Dillard JR, Miller DR, Theis RP, Zaman N, Krieger J, Thompson LA, Janicke DM, Cardel MI. Behavioral Weight Loss Intervention Preferences of Adolescents with Overweight/Obesity. Child Obes 2021; 17:160-168. [PMID: 33646015 PMCID: PMC8182474 DOI: 10.1089/chi.2020.0296] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Behavioral lifestyle interventions are the foundation of adolescent obesity treatment. Tailoring an intervention using adolescent stakeholder engagement during the development process could improve intervention effectiveness. Methods: Adolescents with overweight/obesity ages 14-19 (n = 41) participated in 11 sex-specific focus groups (girls = 6, boys = 5) and were asked their preferences regarding who should lead the intervention and be involved, what the messaging of the program should be, how to make the program engaging and maintain participation, and how to best measure nutrition intake and activity. Transcripts were coded and analyzed for emergent themes. Results: Mean age was 16.0 ± 1.8 years and participants were racially/ethnically diverse. Adolescents preferred interventions that avoid a focus on "weight loss," and instead emphasize "healthy lifestyle," which represents a more comprehensive goal of targeting physical and mental well-being. Most participants indicated preferences for a relatable instructor with prior weight loss experience. Both sexes preferred optional parental involvement, as some parents were described as helpful, while others were perceived as a hindrance to success. Boys and girls identified incentives, engaging activities, and electronic communication as core components for engagement and retention, with girls emphasizing socialization and building relationships. Sex differences in preferences were observed. Girls had more concerns about intervention participation and preferred interventions to be sex stratified. Conclusions: Behavioral interventions to treat adolescent obesity should focus messaging/content on healthy lifestyles, rather than weight loss, and be sex stratified. Development and implementation of future behavioral interventions for adolescent obesity should consider tailoring to adolescent preferences when possible to improve feasibility, acceptability, and effectiveness.
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Affiliation(s)
- Alexandra M. Lee
- Department of Health Outcomes and Biomedical Informatics and University of Florida College of Medicine, Gainesville, FL, USA
| | - Sarah M. Szurek
- Department of Health Outcomes and Biomedical Informatics and University of Florida College of Medicine, Gainesville, FL, USA
| | - Abhaya Dilip
- Department of Health Outcomes and Biomedical Informatics and University of Florida College of Medicine, Gainesville, FL, USA
| | - Jackson R. Dillard
- Department of Health Outcomes and Biomedical Informatics and University of Florida College of Medicine, Gainesville, FL, USA
| | - Darci R. Miller
- Department of Health Outcomes and Biomedical Informatics and University of Florida College of Medicine, Gainesville, FL, USA
| | - Ryan P. Theis
- Department of Health Outcomes and Biomedical Informatics and University of Florida College of Medicine, Gainesville, FL, USA
| | - Nuzhat Zaman
- Department of Health Outcomes and Biomedical Informatics and University of Florida College of Medicine, Gainesville, FL, USA
| | - Janice Krieger
- Department of Advertising, University of Florida College of Journalism and Communications, Gainesville, FL, USA
| | - Lindsay A. Thompson
- Department of Health Outcomes and Biomedical Informatics and University of Florida College of Medicine, Gainesville, FL, USA.,Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA
| | - David M. Janicke
- Department of Clinical and Health Psychology, University of Florida College of Clinical and Health Psychology, Gainesville, FL, USA
| | - Michelle I. Cardel
- Department of Health Outcomes and Biomedical Informatics and University of Florida College of Medicine, Gainesville, FL, USA.,Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL, USA.,Address correspondence to: Michelle I. Cardel, PhD, MS, RD, Department of Health Outcomes and Biomedical Informatics, Center for Integrative Cardiovascular and Metabolic Diseases, University of Florida College of Medicine, 2197 Mowry Road, Gainesville, FL 32610, USA
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Cardel M, Lee A, Dillard J, Dilip A, Miller D, Theis R, Bernier A, Thompson L, Janicke D, Szurek S. Perceived Barriers and Facilitators to Healthy Lifestyles and Weight Loss Among Adolescents with Overweight and Obesity: A Qualitative Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa063_012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Obesity in adolescence has reached epidemic proportions around the world, with the prevalence of severe obesity increasing at least four-fold over the last 35 years. Provision of evidence-based treatment options that are tailored and relevant to the needs of adolescents is paramount, yet difficult to tailor because little is known regarding barriers and facilitators to adolescent weight loss. Thus, identification of barriers and facilitators to weight loss among adolescents with overweight/obesity (OW/OB) is needed. The objective of this qualitative study was to assess perceived barriers and facilitators to a healthy lifestyle and weight loss among adolescents with OW/OB.
Methods
Using 2018–2019 data from eleven focus groups among adolescents aged 14–19 with OW/OB (n = 41; n = 11 boys and n = 30 girls), a moderated, semi-structured focus group guide was used to identify perceived barriers and facilitators to a healthy lifestyle and weight loss.
Results
Adolescents reported time, access to healthful foods, food cravings, stress, and weight stigma/shaming as barriers to weight loss. Themes around internal and external psychosocial states (support, motivation) and behaviors including modeling, sports, and other physical activities were identified as both barriers and facilitators. Parents were recognized by teens as both helping and hindering weight loss, but overall teens felt their parents were more so facilitators than barriers, particularly as it related to modeling behaviors. Differences were noted by sex, among which girls reported experiencing weight struggles, whereas boys generally stated they did not struggle with weight, despite all participants meeting criterion for OW/OB.
Conclusions
Adolescent boys and girls with OW/OB perceive their weight status differently and identify a variety of barriers and facilitators to a healthy lifestyle and weight loss. Tailoring adolescent weight management interventions to address these perceived barriers and facilitators, along with noted sex differences, has the potential to improve the quality and effectiveness of adolescent obesity interventions.
Funding Sources
National Heart, Lung, and Blood Institute, National Institute of Health, WellCare Health Plans.
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Affiliation(s)
| | | | | | | | | | | | | | - Lindsay Thompson
- Department of Behavioral Nursing Science, College of Nursing, University of Florida
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Dilip A, Cheng G, Joseph J, Kalyanaraman B, Gamblin T. Mitochondria-Targeted Antioxidant and Glycolysis Inhibition? Synergistic Therapy in Hepatocellular Carcinoma. J Surg Res 2013. [DOI: 10.1016/j.jss.2012.10.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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