Five-year changes in psychiatric treatment status and weight-related comorbidities following bariatric surgery in a veteran population

BACKGROUND

Although bariatric surgery is an established treatment for obesity, less is known regarding the long-term effects of surgery on psychiatric function. This paper reports changes in psychiatric treatment status, weight, and weight-related comorbidities over 5 years of follow-up among a population of veterans completing bariatric surgery.

METHODS

We assessed 55 veterans undergoing bariatric surgery at a single Veteran Affairs medical center for 5 years post-surgery. Patients completed a pre-surgery clinical interview with a licensed psychologist. Using computerized medical records, we tracked pre- to post-surgery involvement with antidepressants, anxiolytics, psychotherapies, and overall psychiatric treatment visits along with changes in weight and metabolic function.

RESULTS

Rates of antidepressant use and/or involvement with psychotherapy for depression declined from 56.4 % at pre-surgery to 34.6 % at 5 years post-surgery, p = 0.01. Anxiolytic use and/or involvement with psychotherapy for anxiety, however, increased from 23.6 to 32.7 % pre- to 5 years post-surgery. Average psychiatric treatment volume remained similar to pre-surgery status across follow-up. These mixed indicators of psychiatric improvement occurred despite marked metabolic improvements from surgery. Mean percent excess weight loss = 51.7 and 41.3 (1 and 5 years post-surgery, respectively), systolic blood pressure (-6.8 mmHg (14.3)/-6.1 mmHg (12.8), respectively), glucose levels (-18.6 mg/dL (30.2)/-10.0 mg/dL (25.9), respectively), triglycerides (-78.2 mg/dL (96.7)/-69.1 mg/dL (102.2), respectively) and high-density lipoproteins (+7.1 (9.9)/+11.3 (11.3), respectively) levels each improved.

CONCLUSIONS

We report evidence of decreased antidepressant use and depression therapies following bariatric surgery, but no improvements on rates of anxiolytic use and anxiety therapies or on overall psychiatric treatment involvement. Despite metabolic improvements, bariatric patients with psychiatric histories may warrant ongoing attention to mental health.

What is eating you? Stress and the drive to eat

Non-human animal studies demonstrate relationships between stress and selective intake of palatable food. In humans, exposure to laboratory stressors and self-reported stress are associated with greater food intake. Large studies have yet to examine chronic stress exposure and eating behavior. The current study assessed the relationship between stress (perceived and chronic), drive to eat, and reported food frequency intake (nutritious food vs. palatable non-nutritious food) in women ranging from normal weight to obese (N=457). Greater reported stress, both exposure and perception, was associated with indices of greater drive to eat-including feelings of disinhibited eating, binge eating, hunger, and more ineffective attempts to control eating (rigid restraint; r's from .11 to .36, p's<.05). These data suggest that stress exposure may lead to a stronger drive to eat and may be one factor promoting excessive weight gain. Relationships between stress and eating behavior are of importance to public health given the concurrent increase in reported stress and obesity rates.

Behavioural weight management for the primary careprovider

Primary care providers (PCPs) provide the majority of weight management care in clinical settings; however, they often lack the time or resources to apply strategies recommended in treatment guidelines. This review surveyed randomized clinical trials and prospective weight management studies from 1990 to present to identify evidence-based behavioural strategies for weight management applicable to the PCP treatment environment. Data supported, time-limited weight management strategies included self-monitoring, portion control, sleep hygiene, restaurant eating and television viewing. The current review suggests that a number of behavioural strategies are available to enhance the effectiveness of PCPs weight management interventions. Increasing PCP awareness of these evidence-based strategies may increase their attention to overweight and obesity concerns in clinical encounters and encourage more collaborative efforts with patients towards weight management goals.

Psychiatric factors and weight loss patterns following gastric bypass surgery in a veteran population

BACKGROUND

Although pre-surgical psychological evaluations are commonly administered to patients considered for weight loss surgeries, the value of these evaluations for predicting weight loss success has been questioned. In this study, we addressed this issue by examining patient's total number of psychiatric indicators rather than individual psychological factors as predictors of weight loss/weight regain.

METHODS

Sixty adult veterans completed gastric bypass surgery or laparoscopic gastric banding after completing a multidisciplinary evaluation for surgical clearance, including a psychological assessment. Patients were subsequently followed for 24 month to examine changes in weight, body mass index, and risk of weight regain.

RESULTS

Nearly three fourths of the sample carried either a single (40.0%) or multiple psychiatric diagnoses (33.4%). Nearly half (47.5%) of the sample ceased losing weight after 1 year, with 29.5% regaining weight after this point. Neither psychiatric nor biomedical factors effectively predicted 1-year weight loss totals; however, we observed a significant linear relationship between the number of psychiatric factors and post-1-year weight changes (r = 0.33, p = 0.01). After adjusting for demographic and biomedical factors, patients with two or more psychiatric diagnoses were found to be significantly more likely to experience weight loss cessation or weight regain after 1-year (OR = 6.4, 95% CI = 1.3-12.4) relative to those with zero or one psychiatric diagnosis.

CONCLUSIONS

Assessing mental health factors in terms of the total number of psychiatric conditions improved the prediction of weight loss surgery outcomes in this veteran sample. An expanded model for understanding how psychological factors may affect weight loss surgery may improve the utility of pre-bariatric psychological assessments.

An experimental test of the effects of dieting on bulimic symptoms: The impact of eating episode frequency

Prospective studies suggest dieting increases bulimic symptoms, but experiments suggest that dieting decreases bulimic symptoms. One possible explanation for the conflicting findings is that real world dieting involves less healthy dieting techniques, such as meal skipping, than prescribed diets. We tested whether the manipulation of eating episode frequency during dieting impacted bulimic symptoms. We expected that people on a diet involving fewer eating episodes would exhibit greater increases in bulimic symptoms than people on a diet involving more frequent eating episodes or waitlist controls. Participants on both 6-week diets lost more weight than controls, confirming dieting was manipulated, and showed greater reductions in bulimic symptoms than controls; however, the dieting conditions did not differ on either outcome. Results provide further experimental evidence that dieting does not increase bulimic symptoms, but suggests that eating episode frequency has little impact on this outcome.

Relation of successful dietary restriction to change in bulimic symptoms: a prospective study of adolescent girls

Recent experimental evidence that dietary restriction results in decreased bulimic and depressive symptoms seems inconsistent with findings from prospective studies and etiologic theory. However, because the dieting manipulated in these experiments may be unrepresentative of real-world weight loss dieting, the authors tested whether successful dietary restriction was associated with decreases in these outcomes by using longitudinal data from a school-based study of 496 adolescent girls. Moderately overweight participants who evidenced successful dietary restriction showed significantly greater decreases in bulimic symptoms than weight-matched participants who did not show successful dietary restriction; however, there were no effects for depressive symptoms. In conjunction with past experimental findings, results seem to imply that successful dietary restriction curbs bulimic symptoms, suggesting that current etiologic models may need revision.

The effect of experimental presentation of thin media images on body satisfaction: a meta-analytic review

OBJECTIVE

The effect of experimental manipulations of the thin beauty ideal, as portrayed in the mass media, on female body image was evaluated using meta-analysis.

METHOD

Data from 25 studies (43 effect sizes) were used to examine the main effect of mass media images of the slender ideal, as well as the moderating effects of pre-existing body image problems, the age of the participants, the number of stimulus presentations, and the type of research design.

RESULTS

Body image was significantly more negative after viewing thin media images than after viewing images of either average size models, plus size models, or inanimate objects. This effect was stronger for between-subjects designs, participants less than 19 years of age, and for participants who are vulnerable to activation of a thinness schema.

CONCLUSION

Results support the sociocultural perspective that mass media promulgate a slender ideal that elicits body dissatisfaction. Implications for prevention and research on social comparison processes are considered.