Changes in desired body shape after bariatric surgery

Bariatric surgery frequently leads to rapid weight loss post-surgery that may impact participants' ability to gauge a realistic ideal body shape. In the present study, 57 obese participants' perception of their current and ideal body shape pre and post gastric bypass surgery were assessed. Results indicate prior to surgery, participants reported a 4 point difference between current and desired body shape. One year post surgery, as their own body shape decreased, so did the size of their ideal body shape (4.1-3.3). These findings suggest a consequence of rapid weight loss may suggest to participants that unrealistic body shapes are attainable. Implications for patient counseling are discussed.

Exploratory study to decrease postprandial anxiety: Just relax!

OBJECTIVE

Critical first steps in the treatment of anorexia nervosa (AN) include re-nutrition and weight restoration, both highly anxiety provoking for patients. We explored the impact of progressive muscle relaxation (PMR), guided imagery (GI), self-directed relaxation (SR), and control (C) on reducing postprandial anxiety in 64 females with AN.

METHOD

Participants began the study upon hospital admission. They received relaxation training after lunch for 15 days. Pre- and post-session anxiety and treatment acceptability ratings were made daily.

RESULTS

Although all conditions improved relaxation and decreased anxiety, feelings of fullness, and thoughts about weight, the three active conditions significantly reduced anxiety and increased relaxation more than C (p < .0001). Participants significantly enjoyed the three active treatments, were more likely to recommend them to a friend, and were more likely to use either PMR or GI again versus C (p < .0001).

CONCLUSION

Relaxation may be a valuable component for reducing postprandial anxiety in AN.

Considerations for the use of the Beck Depression Inventory in the assessment of weight-loss surgery seeking patients

BACKGROUND

The Beck Depression Inventory (BDI) is an assessment frequently used in pre-surgical evaluation for patients seeking bariatric surgery. Items on the BDI reflect both cognitive and somatic symptoms associated with depression. However, many patients seeking bariatric surgery have medical symptomatology and health concerns independent of the syndrome of depression, and thus scores on the BDI may inflate their actual level of depression. With depression viewed by some clinicians as contraindicated for bariatric surgery, clarification of the BDI items is necessary.

METHODS

Pre-surgical BDIs of 259 bariatric patients were reviewed. An exploratory factor analysis was conducted to examine the factor structure of the BDI in this population. Independent sample t-tests compared the means of the cognitive and somatic items.

RESULTS

A clear two-factor solution emerged on the BDI, indicating items mapped on to either a cognitive or a somatic domain. The patients in the present sample also were more likely to endorse somatic and health-related symptoms on the BDI.

CONCLUSIONS

The factor structure of the BDI in this population is similar to that in other non weight-loss surgery populations. However, this population is more likely to endorse somatic complaints that may not be indicative of depression, rather an acknowledgement of actual medical complaints. Thus, assessors should be mindful of specific symptom endorsement, rather than a total depression score when utilizing the BDI to help determine surgery suitability.

Depressed mood in class III obesity predicted by weight-related stigma

BACKGROUND

Greater depressed mood in Class III obese surgery-seeking clients may be due to weight-related stigma, weight-related physical disability (e.g. mobility) or the presence of binge-eating (BE).

METHODS

60 Class III obese surgery-seeking adults were administered the Beck Depression Inventory (BDI), weight-related physical disability (IWQOL-PF) and another weight-related stigma (IWQOL-PD), and assessed for BE (SCID-1 or Questionnaire of Eating and Weight Patterns) before surgery.

RESULTS

In a hierarchical regression analysis, BMI, gender, and age of obesity onset did not account for a significant portion of the variance in BDI scores in the first step. The second step of the model was statistically significant (F(3,53)=8.469, P<0.000), accounting for 33.6% of the variance in BDI scores. IWQOL-PD scores were the only significant predictor of BDI scores (b=0.518, P=0.001), and this independently contributed to 32.6% of the variance in BDI scores.

CONCLUSION

This suggests that depressed mood seen in Class III obese surgery-seeking individuals may be most related to weight-related stigma rather than BE status, or weight-related physical disability.

Emotional Eating in a Morbidly Obese Bariatric Surgery-Seeking Population

BACKGROUND

The impact of presurgical eating patterns on postoperative outcomes is poorly understood. The results of previous studies are mixed regarding the impact of presurgical binge eating on weight loss after surgery. However, many patients describe other maladaptive eating patterns prior to surgery, such as eating in response to emotions. The goals of this study were to describe presurgical emotional eating patterns in morbidly obese individuals, determine whether these individuals were binge eaters, and assess the effect of this eating behavior on weight loss after surgery.

METHODS

Prior to surgery, 144 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns (QEWP) or QEWP-Revised (QEWP-R) and the Emotional Eating Scale to assess eating patterns prior to surgery. Their eating behavior, levels of depression, and weight were assessed after surgery.

RESULTS

High emotional eaters tended to have higher levels of depression, binge eating, and eating in response to external cues than low emotional eaters prior to surgery. However, there appeared to be a distinct group of individuals who were high emotional eaters but who did not engage in binge eating. At a mean of 8 months after surgery, High Emotional Eaters and Low Emotional Eaters were indistinguishable on these subscales and there were no differences in weight lost.

CONCLUSIONS

RYGBP has an equally positive impact on eating behavior and weight loss for both High Emotional Eaters and Low Emotional Eaters. Further replication is needed with longer follow-up times and larger samples.

Pre-surgery binge eating status: effect on eating behavior and weight outcome after gastric bypass

BACKGROUND

The impact of pre-surgical binge eating on postoperative outcomes is poorly understood. Previous studies have found marked preoperative differences between binge eaters (BE) and non-binge eaters (NBE) in hunger and disinhibition using the Three-Factor Eating Questionnaire (TFEQ). Short-term prospective data are mixed regarding whether these differences persist after surgery and if preoperative binge eating impacts postoperative weight outcomes. The purpose of the present study was to compare self-reported eating behavior and weight outcomes between BE and NBE after the first postoperative year.

METHODS

Prior to surgery, 72 Roux-en-Y gastric bypass (RYGBP) patients completed the Questionnaire of Eating and Weight Patterns (QEWP) or QEWP-Revised (QEWP-R), to assess binge eating status which was defined as one objective binge episode per week over the past 6 months. Subjects also completed the TFEQ prior to surgery and again > or = 12 months after surgery.

RESULTS

For BE, higher scores were found for both hunger and disinhibition prior to surgery. At a mean of 18 months after surgery, BE and NBE were indistinguishable on these subscales and there were no differences in weight lost.

CONCLUSIONS

RYGBP surgery has an equally positive impact on eating behavior and weight loss for both BE and NBE. Within a multidisciplinary clinic, preoperative BE status does not appear to be a negative prognostic indicator for RYGBP surgery in the domains of weight loss and disinhibition. Further replication is needed with longer follow-up times and larger samples.

Feasibility and acceptability of CD-ROM-based cognitive-behavioural treatment for binge-eating disorder

We compared preliminary feasibility and acceptability of CD-ROM-delivered CBT for overweight individuals with binge-eating disorder (BED) to 10 weekly group CBT sessions (Group) and to a waiting list control (WL). Attrition was numerically greater in the Group than the CD-ROM condition; although only Group differed significantly from WL in dropout rates. Those in the CD-ROM condition reported continued use of their CD-ROM after treatment. Also, the majority of WL participants elected to receive CD-ROM over Group treatment at the end of the waiting period. Preliminarily, no significant differences emerged across the active treatment groups on most outcome measures. However, there was a significantly greater decline in binge days in the two active groups relative to WL. CD-ROM appears to be an acceptable and at least initially preferred method of CBT delivery for overweight individuals with BED.

Psychosocial outcome of gastric bypass surgery for patients with and without binge eating

BACKGROUND

There is limited data on the prevalence of eating disorder pathology in morbidly obese patients undergoing Roux-en-Y gastric bypass (RYGBP) and the degree to which this may affect surgical outcome. The present study examined surgical outcome between 2 groups of patients undergoing RYGBP: those with pre-surgical binge eating (BE) and those without pre-surgical binge eating (NBE).

METHODS

This study tested the hypothesis that the BE group would demonstrate greater pathology on measures of eating pathology, psychological wellbeing, and quality of life than the NBE group both pre- and post-surgery.

RESULTS

Compared with the NBE group, the BE group had significantly higher levels of disinhibited eating, and hunger, and significantly lower levels of social functioning at pre-surgery and 6 months post-surgery. The BE group had a significantly lower percentage of excess weight lost than the NBE group at 6 months post-surgery.

CONCLUSIONS

These findings indicate a less successful outcome for the BE patients compared with the NBE patients. While there were more distinct differences between the BE and NBE groups before surgery, they were largely impossible to differentiate on psychosocial measures at post-surgery.

Assessment of binge eating disorder in morbidly obese patients evaluated for gastric bypass: SCID versus QEWP-R

OBJECTIVE

Binge eating disorder (BED) has been hypothesized to be associated with poor outcome in gastric bypass surgery (GBP). However, past studies have yielded inconsistent results regarding BED and surgical outcome, which may be due to the variety of measures used to assess BED. The present study examines the utility of two commonly used BED diagnostic tools: the Structured Clinical Interview (SCID) and the Questionnaire of Eating and Weight Patterns-Revised (QEWP-R).

METHOD

Subjects were 168 adult patients evaluated for GBP. BED was assessed using the SCID and the

RESULTS

27% of the sample received a diagnosis of BED using the QEWP-R, compared with 14% using the SCID. Agreement using Cohen's kappa was 0.37. Compared to sub-non-concordant diagnoses of BED, subjects with concordant diagnoses scored on a measure of self-esteem.

DISCUSSION

Although both diagnostic tools use the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV) criteria, each yielded different results. Further studies are needed to determine the most accurate method of assessing BED in this population.

Outcome following gastric bypass surgery: impact of past sexual abuse

BACKGROUND

This study examined gastric bypass (GBP) outcome in 2 groups of morbidly obese females: those with a history of sexual abuse (SA) and those without a history of sexual abuse (NSA).

METHODS

Subjects were assessed preoperatively and at one of two time points following surgery: either 5 to 9 months or 10 to 14 months. Outcome measures included BMI, level of depression as measured through the Beck Depression Inventory (BDI), and level of self-esteem as measured through the Rosenberg Self-Esteem Scale (RSE).T-tests were conducted for pre and post scores between the 2 groups on each of the variables.

RESULTS

Of the 12 tests conducted, the only statistically significant difference was on BDI scores for the 5 to 9 month post-surgery groups, with the SA groups showing a significantly higher level of depression than the NSA group.

CONCLUSIONS

The results suggest that females with a history of sexual abuse are as successful with weight loss following GBP as those without a history of abuse. While females with a history of sexual abuse show significantly more depression 5 to 9 months after surgery, they are indistinguishable from those without a history of abuse 1 year following GBP.Thus, sexual abuse does not appear to be a negative prognostic indicator for GBP.