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Pekkurnaz D. Causal effect of obesity on the probability of employment in women in Turkey. ECONOMICS AND HUMAN BIOLOGY 2023; 51:101301. [PMID: 37651829 DOI: 10.1016/j.ehb.2023.101301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/11/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
This study aims to investigate the causal effect of obesity on the employment probability of women in Turkey via the instrumental variable approach by using data from the 2018 Turkey and Demographic Health Survey. Obesity prevalence in the area of living and the overweight status of the oldest child, which are the most common types of instruments seen in the literature, are used as instruments. Consistent with the OLS result, the 2SLS estimate indicates that obese women are statistically significantly less likely to be employed when the overweight status of the child is used as an instrument. On the other hand, the statistically significant effect of obesity disappears when the area level obesity prevalence is used as the instrument. In addition, obesity in women decreases the likelihood of employment in the services sector and full-time jobs and employment with social security. Although the results of this study do not indicate the source of the effect found, the presence of a causal relationship for women should not be ignored when the economic burden of obesity for Turkey is considered.
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Affiliation(s)
- Didem Pekkurnaz
- Başkent University, Faculty of Economics and Administrative Sciences, Department of Economics, Bağlıca Campus, Fatih Sultan Mahallesi, Eskişehir Yolu 18. Km, Etimesgut, 06790 Ankara, Turkey.
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Carr MM, Lou R, Macdonald-Gagnon G, Peltier MR, Funaro MC, Martino S, Masheb RM. Weight change among patients engaged in medication treatment for opioid use disorder: a scoping review. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:551-565. [PMID: 37200510 PMCID: PMC10840392 DOI: 10.1080/00952990.2023.2207720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 04/14/2023] [Accepted: 04/23/2023] [Indexed: 05/20/2023]
Abstract
Background: Medication treatment for opioid use disorder (MOUD) is an instrumental tool in combatting opioid use and overdose. Excess weight gain associated with MOUD initiation is a potential barrier that is not well understood.Objectives: Conduct a scoping review of available studies investigating the effect of MOUD on weight.Methods: Included studies consisted of adults taking any type of MOUD (e.g. methadone, buprenorphine/naloxone, naltrexone) with data on weight or body mass index for at least two time points. Evidence was synthesized using qualitative and descriptive approaches, and predictors of weight gain including demographics, comorbid substance use, and medication dose were examined.Results: Twenty-one unique studies were identified. Most studies were uncontrolled cohort studies or retrospective chart reviews testing the association between methadone and weight gain (n = 16). Studies examining 6 months of methadone treatment reported weight gain ranging from 4.2 to 23.4 pounds. Women appear to gain more weight from methadone than men, while patients using cocaine may gain less. Racial and ethnic disparities were largely unexamined. Only three case reports and two nonrandomized studies examined the effects of either buprenorphine/naloxone or naltrexone, and potential associations with weight gain were not clear.Conclusion: The use of methadone as an MOUD appears to be associated with mild to moderate weight gain. In contrast, there is little data supporting or refuting weight gain with buprenorphine/naloxone or naltrexone. Providers should discuss the potential risk for weight gain with patients as well as prevention and intervention methods for excess weight gain.
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Affiliation(s)
- Meagan M. Carr
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Raissa Lou
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | | | - MacKenzie R. Peltier
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Melissa C. Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Steve Martino
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Robin M. Masheb
- U.S. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, CT, USA
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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Berman MI, Park J, Kragenbrink ME, Hegel MT. Accept Yourself! A Pilot Randomized Controlled Trial of a Self-Acceptance-Based Treatment for Large-Bodied Women With Depression. Behav Ther 2022; 53:913-926. [PMID: 35987548 DOI: 10.1016/j.beth.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 03/04/2022] [Accepted: 03/16/2022] [Indexed: 11/15/2022]
Abstract
A pilot parallel randomized controlled trial compared a self-acceptance, non-weight-loss intervention, Accept Yourself! (AY), to a weight loss program, Weight Watchers (WW), in order to provide preliminary safety, feasibility, and efficacy data in preparation for a definitive RCT of AY as an intervention to enhance the mental and physical health of larger-bodied women with Major Depressive Disorder (MDD). Adult women with MDD and a Body Mass Index ≥30 were eligible. Nineteen women were randomized by random number table into AY (n = 9) or WW (n = 10). Intake, pretreatment, posttreatment, 3-, 6-, 9-, and 12-month follow-up assessments occurred at a rural academic medical center. Primary outcomes included depression severity and cardiovascular fitness. Chi-square and t-tests assessed attrition and participant preferences for treatment; other analyses used intention-to-treat, linear mixed-effects models for repeated measures, including all participants' available data. Both groups improved in self-reported, F(5, 43.81) = 7.45, p < .001, partial η2 = .38, and blinded-clinician-rated depression, F(6, 62.03) = 10.41, p < .001, partial η2 = .5. AY was superior to WW in self-reported depression, F(5, 43.81) = 2.72, p = .03, partial η2 = .11. Neither group improved in fitness. Eating disorder symptoms and weight gain worsened in WW. AY appeared safe, feasible, and offered initial evidence of efficacy for depression; it should be investigated in a definitive RCT, with modifications to increase potency. WW may not be suitable as a comparator intervention for AY because of risk to participants.
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Affiliation(s)
| | - John Park
- Geisel School of Medicine at Dartmouth
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Kamolthip R, Saffari M, Fung XCC, O'Brien KS, Chang YL, Lin YC, Lin CY, Chen JS, Latner JD. The mediation effect of perceived weight stigma in association between weight status and eating disturbances among university students: is there any gender difference? J Eat Disord 2022; 10:28. [PMID: 35193673 PMCID: PMC8864835 DOI: 10.1186/s40337-022-00552-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 02/04/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The study aimed to examine the association between perceived weight stigma (PWS), weight status, and eating disturbances. We hypothesized that PWS would partially mediate the association between weight status and eating disturbances among university students. METHODS The study involved 705 undergraduate students (379 females and 326 males) recruited from Hong Kong and Taiwan Universities (399 Hong Kong; 306 Taiwan participants). Our sample was from one Hong Kong university (located in Kowloon) and five Taiwan universities (three located in Southern Taiwan, one located in Central Taiwan, and one located in North Taiwan). Participants' mean age was 20.27 years (SD = 1.79). All participants completed a demographic information sheet, the Three-Factor Eating Questionnaire-18 (TFEQ-R18), and the PWS questionnaire. PROCESS macro models were used to analyze potential mediations. RESULTS We found a significantly higher PWS scores in a high weight group for females and males. There was a significant difference between weight status and eating disturbances. Moreover, PWS partially mediated the association between weight status and eating disturbances for both genders. CONCLUSIONS PWS is associated with weight status and eating disturbances, making it an important target for health improvement among young adults. Further studies are needed to corroborate such associations in participants from other societies and cultures.
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Affiliation(s)
- Ruckwongpatr Kamolthip
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701401, Taiwan
| | - Mohsen Saffari
- Health Research Center, Life Style Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.,Health Education Department, Faculty of Health, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Xavier C C Fung
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Kerry S O'Brien
- School of Social Sciences, Faculty of Arts, Monash University, Melbourne, VIC, Australia
| | - Yen-Ling Chang
- Department of Family Medicine, Cardinal Tien Hospital, New Taipei, Taiwan
| | - Yi-Ching Lin
- Department of Early Childhood and Family Education, National Taipei University of Education, No.134, Sec. 2, Heping E. Rd., Da-an District, Taipei City, 106, Taiwan.
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701401, Taiwan. .,Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, 701401, Taiwan. .,Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 701401, Taiwan. .,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, 701401, Taiwan.
| | - Jung-Sheng Chen
- Department of Medical Research, E-Da Hospital, No. 6, Yida Rd., Yanchao Dist., Kaohsiung, 82445, Taiwan.
| | - Janet D Latner
- Department of Psychology, University of Hawaii at Manoa, Honolulu, HI, USA
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Khodari BH, Shami MO, Shajry RM, Shami JA, Names AA, Alamer AA, Moafa AM, Hakami RO, Almuhaysin GS, Alqassim AY. The Relationship Between Weight Self-Stigma and Quality of Life Among Youth in the Jazan Region, Saudi Arabia. Cureus 2021; 13:e18158. [PMID: 34703692 PMCID: PMC8530152 DOI: 10.7759/cureus.18158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Studies on the role of weight self-stigma on the quality of life of young adults are limited. Therefore, the present study aimed to examine the relationship between different forms of weight self-stigma (self-devaluation and fear of enacted stigma) and the quality of life among Saudi youth in the Jazan region. METHODS A cross-sectional study was performed using a sample of 399 participants who were invited through social media platforms. We used Arabic, validated versions of the weight self-stigma questionnaire (WSSQ) and the World Health Organization quality of life questionnaire. Data analysis was performed by independent samples t-test and analysis of variance with Tukey's post hoc test. RESULTS The study sample consisted of 399 participants aged 21.12 years ± 2.91 years. A total of 264 (66.2%) were female. The overall weight self-stigma score of the study population was 34.81 ± 10.73 on the WSSQ. The analysis showed a significant association between weight self-stigma and quality of life and body mass index (BMI; p < 0.01). In addition, participants who were overweight and obese had more self-devaluation and fear of enacted stigma than did participants with normal weight. Participants with high weight self-stigma had lower quality of life than did those with less weight self-stigma. CONCLUSIONS The results of this study show that weight self-stigma is negatively correlated with the individual's quality of life. Weight self-stigma was positively associated with BMI.
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Affiliation(s)
| | | | - Reem M Shajry
- Family Medicine, Ministry of Health Holdings, Jazan, SAU
| | | | - Abdellh A Names
- College of Medicine, Jazan University, Jazan, SAU
- Cardiology, Jazan University, Jazan, SAU
| | | | | | | | | | - Ahmad Y Alqassim
- Family and Community Medicine Department, Faculty of Medicine, Jazan University, Jazan, SAU
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Wang Z, Dang J, Zhang X, Moore JB, Li R. Assessing the relationship between weight stigma, stress, depression, and sleep in Chinese adolescents. Qual Life Res 2020; 30:229-238. [PMID: 32909163 DOI: 10.1007/s11136-020-02620-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Weight stigma is defined as the social devaluation of people with overweight or obesity, and its negative effects on the health of adolescents from western countries are well documented, but little is known about the relationships with health behaviors and outcomes in Asian youth. The prevalence of obesity among Chinese adolescents continues to increase, potentially causing negative evaluations of youth with obesity, and potentially reduced quality of life. The health effects of these negative evaluations of Chinese youth with obesity have received little attention. PURPOSE The purpose of this study was to examine relationships between weight stigma, stress, depression, and sleep in Chinese adolescents. METHODS We utilized a cross-sectional study conducted in Wuhan, China. Sociodemographic, weight stigma, stress, depression, and sleep data were collected through a self-reported questionnaire. Descriptive statistics, t test, correlations, and mediation analyses were performed. A total of 1626 adolescents between 14 and 19 years of age were included in the analysis. RESULTS The data showed that adolescents with weight stigma presented significantly higher level of stress and depression, lower global sleep quality, longer sleep latency, and shorter sleep duration than those without weight stigma (p < 0.05). Stress and depression mediated the relationship between weight stigma and global sleep quality (SE = 0.007, 95% CI = 0.053 to 0.081). CONCLUSION These findings suggest that adolescents who experience weight stigma may have increased stress and depressive symptoms, which are associated with poorer global sleep quality and more daytime dysfunction.
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Affiliation(s)
- Zhanxia Wang
- Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, 430071, Hubei, China
| | - Jiajia Dang
- Department of Preventive Medicine, School of Health Sciences, Wuhan University, Wuhan, 430071, China
| | - Xinge Zhang
- Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, 430071, Hubei, China
| | - Justin B Moore
- Department of Implementation Science, Wake Forest School of Medicine, Winston-Salem, NC, 27101, USA
| | - Rui Li
- Department of Healthcare Management, School of Health Sciences, Wuhan University, 115 Donghu Road, Wuhan, 430071, Hubei, China.
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Rao WW, Zong QQ, Zhang JW, An FR, Jackson T, Ungvari GS, Xiang Y, Su YY, D'Arcy C, Xiang YT. Obesity increases the risk of depression in children and adolescents: Results from a systematic review and meta-analysis. J Affect Disord 2020; 267:78-85. [PMID: 32063576 DOI: 10.1016/j.jad.2020.01.154] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/28/2019] [Accepted: 01/26/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Clinical depression (including major depression, dysthymia, and unspecified depression) is common in children and adolescents with obesity and overweight. The objective of this systematic review and meta-analysis was to examine prevalence of clinical depression among overweight and obese children. METHODS PubMed, EMBASE, Web of Science, Medline, Cochrane library, and PsycINFO databases were systematically and independently searched by three researchers from the inception dates to April 01, 2019. The fixed-effects model was used to perform meta-analysis. Data analyses were performed with STATA Version 12.0. RESULTS Eleven studies with 69,893 subjects were included; 5 studies examined major depressive disorder (MDD), while the remaining 6 studies examined other types of clinical depression. In the overweight and obese group, the prevalence of clinical depression ranged from 1.7% to 26.7% in obese subjects and from 4.0% to 16.9% in overweight subjects. In studies on MDD, prevalence ranged from 10.1% to 26.7% in obese subjects and from 9.0% to 16.9% in overweight subjects. The odd ratios (ORs) of clinical depression ranged from 0.92 to 4.39 between obese subjects and healthy controls (i.e., normal-weight controls), and ranged from 0.96 to 1.67 between overweight subjects and controls. Compared to healthy controls, obese (OR = 1.851, 95% CI: 1.410-2.429) but not overweight (OR = 1.068, 95% CI: 0.889-1.283) children and adolescents were more likely to have MDD. CONCLUSION Obese children and adolescents had a significantly higher risk for MDD compared with healthy controls. Considering the negative health outcomes of depression, regular screening and effective treatments should be implemented for obese children and adolescents.
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Affiliation(s)
- Wen-Wang Rao
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
| | - Qian-Qian Zong
- School of Nursing, Capital Medical University, Beijing, China; The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Ji-Wen Zhang
- School of Nursing, Capital Medical University, Beijing, China
| | - Feng-Rong An
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Todd Jackson
- Department of Psychology, Faculty of Social Sciences, University of Macau, Macau, SAR, China
| | - Gabor S Ungvari
- The University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | - Yifan Xiang
- Pui Ching Middle School Macau, Macau SAR, China
| | - Ying-Ying Su
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Carl D'Arcy
- School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada; Department of Psychiatry, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China.
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Puzhko S, Schuster T, Barnett TA, Renoux C, Rosenberg E, Barber D, Bartlett G. Evaluating Prevalence and Patterns of Prescribing Medications for Depression for Patients With Obesity Using Large Primary Care Data (Canadian Primary Care Sentinel Surveillance Network). Front Nutr 2020; 7:24. [PMID: 32258046 PMCID: PMC7090027 DOI: 10.3389/fnut.2020.00024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 02/25/2020] [Indexed: 12/28/2022] Open
Abstract
Introduction: Depression is a serious disorder that brings a tremendous health and economic burden. Many antidepressants (AD) have obesogenic effects, increasing the population of obese patients at increased risk for a more severe disease course and poor treatment response. In addition, obese patients with depression may not be receiving the recommended standard of care due to "obesity bias." It is important to evaluate prescribing pharmacological treatment of depression in patients with obesity. Objectives: To describe the prevalence and patterns of AD prescribing for patients with depression and comorbid obesity compared with normal weight patients, and to examine the association of prescribing prevalence with obesity class. Methods: Study sample of adult patients (>18 years old) with depression was extracted from the national Canadian Primary Care Sentinel Surveillance Network (CPCSSN) Electronic Medical Records database for 2011-2016. Measures were prescribing of at least one AD (outcome) and body mass index (BMI) to categorize patients into weight categories (exposure). Data were analyzed cross-sectionally using descriptive statistics and mixed effects logistic regression model with clustering on CPCSSN networks and adjusting for age, sex, and the comorbidities. Results: Of 120,381 patients with depression, 63,830 patients had complete data on studied variables (complete cases analysis). Compared with normal weight patients, obese patients were more likely to receive an AD prescription (adjusted Odds Ratio [aOR] = 1.17; 95% Confidence Interval [CI]: 1.12-1.22). Patients with obesity classes II and III were 8% (95% CI: 1.00, 1.16) and 6% (95% CI: 0.98, 1.16) more likely, respectively, to receive AD. After imputing missing data using Multiple Imputations by Chained Equations, the results remained unchanged. The prevalence of prescribing >3 AD types was higher in obese category (7.27%, [95% CI: 6.84, 7.73]) than in normal weight category (5.6%; [95% CI: 5.24, 5.99]). Conclusion: The association between obesity and high prevalence of AD prescribing and prescribing high number of different AD to obese patients, consistent across geographical regions, raises a public health concern. Study results warrant qualitative studies to explore reasons behind the difference in prescribing, and quantitative longitudinal studies evaluating the association of AD prescribing patterns for obese patients with health outcomes.
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Affiliation(s)
- Svetlana Puzhko
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Tibor Schuster
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Tracie A Barnett
- Department of Epidemiology and Biostatistics, INRS-Institut Armand-Frappier, Université du Québec à Montreal (UQAM), Laval, QC, Canada
| | - Christel Renoux
- Department of Neurology and Neurosurgery, McGill University, Montréal, QC, Canada.,Department of Epidemiology and Biostatistics, McGill University, Montréal, QC, Canada.,Centre for Clinical Epidemiology, Lady Davis Institute for Medical Research, Jewish General Hospital, Montréal, QC, Canada
| | - Ellen Rosenberg
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - David Barber
- Department of Family Medicine, Faculty of Medicine, Queen's University, Kingston, ON, Canada
| | - Gillian Bartlett
- Department of Family Medicine, Faculty of Medicine, McGill University, Montréal, QC, Canada
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Wnuk S, Parvez N, Hawa R, Sockalingam S. Predictors of suicidal ideation one-year post-bariatric surgery: Results from the Toronto Bari-Psych Cohort Study. Gen Hosp Psychiatry 2020; 63:39-45. [PMID: 30503220 DOI: 10.1016/j.genhosppsych.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 11/16/2018] [Accepted: 11/25/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Previous studies have shown higher rates of death by suicide, suicide attempts, suicidal ideation and non-suicidal self-directed violence (NS-SDV) in bariatric surgery patients. METHODS Data came from the Toronto Bari-Psych Cohort study of adult patients who underwent bariatric surgery between 2010 and 2016. The MINI International Neuropsychiatric Interview was used to obtain lifetime psychodiagnostic data. Information about lifetime suicidal ideation, suicide attempts, NS-SDV and hospitalizations related to any of these phenomena was collected during clinical interview. Pre-surgery sociodemographic data, lifetime psychiatric disorders, mental health symptoms, mental health treatment, suicidal ideation and surgical complications were covariates. Logistic regression analyses were used to examine the relationship between these variables and suicidal ideation one-year post-surgery. RESULTS Among a total of 284 participants, 4.2% reported a past suicide attempt and 15.1% reported past suicidal ideation. One-year post-surgery, no suicide attempts were reported. In the multivariate regression model, a history of suicidal ideation was the strongest predictor of suicidal ideation one-year post-surgery (p < 0.01), followed by younger age (p = 0.05). Mental health symptoms decreased from pre to post-surgery. CONCLUSION One-year post-surgery, a history of suicidal ideation was the strongest predictor of post-surgery suicidal ideation. Results should be interpreted with caution given the short duration of follow-up.
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Affiliation(s)
- Susan Wnuk
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada.
| | - Neha Parvez
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
| | - Raed Hawa
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada
| | - Sanjeev Sockalingam
- University Health Network, Bariatric Surgery Department, MP4-305, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; University of Toronto, Department of Psychiatry, 250 College Street, 8th floor, Toronto, Ontario M5T 1R8, Canada
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Barzin M, Khalaj A, Tasdighi E, Samiei Nasr D, Mahdavi M, Banihashem S, Valizadeh M. Sleeve gastrectomy vs gastric bypass in improvement of depressive symptoms following one year from bariatric surgery, Tehran Obesity Treatment Study (TOTS). Obes Res Clin Pract 2020; 14:73-79. [PMID: 31924542 DOI: 10.1016/j.orcp.2019.11.002] [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: 05/20/2019] [Revised: 09/30/2019] [Accepted: 11/14/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The Beck Depression Inventory (BDI) has been frequently employed as a measure of depression in studies of obesity, with the majority of studies reporting an improvement in scores following weight loss after bariatric surgery. However, the effects of different bariatric techniques on depression score improvement is uncertain. METHOD The study included 685 obese patients who underwent laparoscopic sleeve gastrectomy (SG) (n = 443) or gastric bypass (GB) (n = 242) and completed BDIs at baseline and 1 year after surgery. RESULTS Mean age of the patients was 38.7 ± 10.9 (84.8% female), and mean body mass index (BMI) was 45.1 ± 6.0 kg/m2. One year after surgery, excess weight loss (EWL %) in the GB group was more than the SG group (65.4% vs 62.8% P = 0.02). At baseline, 29.9% of patients had BDI scores in the normal range (0-9), and respectively 32.4 %, 28.3 % and 9.3 % had mild (10-18), moderate (19-29) and sever (+30) depression score; these corresponding values after 1 year were 60.6, 23.2, 11.8 and 4.4%. Overall, BDI scores fell in both surgery groups after 1 year, in the GB group it was 17.2 ± 10.5 vs 11.1 ± 9.6, and for the SG group 16.1 ± 10.2 vs 9.6 ± 8.9. However BDI score change (ΔBDI) was not significantly different between two surgery groups (-6.04 ± 10.6 vs -6.4 ± 9.5, P = 0.149). CONCLUSION Bariatric surgery had a beneficial effect on weight reduction and BDI score regardless of its type. Further studies with longer follow-up and more samples are needed to clarify the differences between bariatric procedures.
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Affiliation(s)
- Maryam Barzin
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alireza Khalaj
- Tehran Obesity Treatment Center, Department of Surgery, Faculty of Medicine, Shahed University, Tehran, Iran
| | - Erfan Tasdighi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Danial Samiei Nasr
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Mahdavi
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyedshahab Banihashem
- Taleghani Hospital Research Development Committee (Taleghani-HRDC), Shahid Beheshti University of Medical Science, Tehran, Iran.
| | - Majid Valizadeh
- Obesity Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Rigobon AV, Kanagasabai T, Taylor VH. Obesity moderates the complex relationships between inflammation, oxidative stress, sleep quality and depressive symptoms. BMC OBESITY 2018; 5:32. [PMID: 30524737 PMCID: PMC6276225 DOI: 10.1186/s40608-018-0208-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/21/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND The relationship between obesity and depression is complex. This study assessed the impact of body mass index (BMI) on the link between BMI, inflammation, oxidative stress, sleep quality and self-reported depressive symptoms. METHODS We used data from the U.S. National Health and Nutritional Examination Survey 2005-2008 cycles (n = 9133; ≥20y). Depressive symptoms and sleep quality were determined from questionnaires. C-reactive Protein (CRP) was used as a biomarker of inflammation and γ-glutamyltransferase was used to assess oxidative stress. The relationship between depressive symptoms, sleep quality, and biomarkers were assessed with regression models. The moderating effects of BMI and sex were tested. RESULTS BMI was a significant moderator of the relationship between γ-glutamyltransferase and depressive symptoms (p = 0.02), but not CRP or sleep quality. Higher BMI increased odds of depressive symptoms in women (OR (95% CI): 3.92 (1.85-8.30) for BMI ≥25 to < 30 kg/m2; 3.17 (1.53-6.58) for BMI ≥30 to < 35 kg/m2; and 7.38 (2.11-25.76) for BMI ≥35 kg/m2). BMI was also a significant moderator of γ-glutamyltransferase levels in those with vs without depressive symptoms. Those with depressive symptoms had 24% poorer sleep quality compared to those without depressive symptoms after adjusting for inflammation, oxidative stress and other confounders. CONCLUSIONS The link between oxidative stress and depressive symptoms may be particularly relevant for females and people living with obesity. People with depressive symptoms also have a substantial reduction in sleep quality. Thus, research should examine these relationships prospectively to inform and improve the mental health of the adult population in developed countries.
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Affiliation(s)
| | - Thirumagal Kanagasabai
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada
| | - Valerie H. Taylor
- Women’s College Research Institute, University of Toronto, Toronto, Canada
- Women’s College Hospital, 76 Grenville Street Room E947, Toronto, ON M5S 1B2 Canada
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Hayward LE, Vartanian LR, Pinkus RT. Weight Stigma Predicts Poorer Psychological Well-Being Through Internalized Weight Bias and Maladaptive Coping Responses. Obesity (Silver Spring) 2018; 26:755-761. [PMID: 29427370 DOI: 10.1002/oby.22126] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 01/03/2018] [Accepted: 01/04/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Weight-based stigmatization is associated with negative psychological and behavioral consequences, but individuals respond to stigma in different ways. The present study aimed to understand some of the factors that predict how one will cope with weight stigma and how different coping responses predict psychological well-being. METHODS Across four samples, 1,391 individuals who identified as having overweight or obesity completed surveys assessing the frequency of weight stigma experiences, internalized weight bias, coping responses to weight stigma, and psychological distress. RESULTS Frequency of weight stigma predicted greater internalized weight bias, which predicted more frequent use of maladaptive coping responses ("disengagement coping") and less frequent use of adaptive coping responses ("reappraisal coping"), in turn predicting more depression, anxiety, and stress symptoms. CONCLUSIONS The more that individuals with overweight or obesity experience weight stigma and internalize weight bias, the more they report using maladaptive coping and the less they report using adaptive coping when dealing with weight stigma. Maladaptive coping is strongly associated with poorer psychological well-being. Thus, those who experience more frequent weight stigma may be more vulnerable to psychological distress because they appear to be at greater risk of employing maladaptive coping strategies.
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Affiliation(s)
- Lydia E Hayward
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Lenny R Vartanian
- School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Rebecca T Pinkus
- School of Psychology, The University of Sydney, New South Wales, Australia
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Abstract
OBJECTIVE The aim of this study is to identify psychosocial variables associated with the relationship between weight loss and change in depressive symptoms following gastric banding surgery. METHODS Ninety-nine adults completed self-report questionnaires assessing depressive symptoms and other psychosocial variables (self-esteem, body image dissatisfaction, perceived physical health, and perceived weight-based stigmatisation) prior to gastric-band surgery and monthly for 6-month post-surgery. RESULTS Weight, depressive symptoms, and other psychosocial variables improved significantly 1-month post-surgery and remained lower to 6 months. Weight loss from baseline to 1- and 6-months post-surgery significantly correlated with change in depressive symptoms. Body image dissatisfaction and self-esteem accounted for some of the variance in change in depressive symptoms from baseline to 1-month and baseline to 6-months post-surgery. CONCLUSIONS Depressive symptoms improved significantly and rapidly after bariatric surgery, and body image dissatisfaction and self-esteem predicted change in depressive symptoms. Interventions targeting body image and self-esteem may improve depressive symptoms for those undergoing weight loss interventions.
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Robinson E, Sutin A, Daly M. Perceived weight discrimination mediates the prospective relation between obesity and depressive symptoms in U.S. and U.K. adults. Health Psychol 2017; 36:112-121. [PMID: 27748611 PMCID: PMC5267562 DOI: 10.1037/hea0000426] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Obesity has been shown to increase risk of depression. Persons with obesity experience discrimination because of their body weight. Across 3 studies, we tested for the first time whether experiencing (perceived) weight-based discrimination explains why obesity is prospectively associated with increases in depressive symptoms. METHOD Data from 3 studies, including the English Longitudinal Study of Ageing (2008/2009-2012/2013), the Health and Retirement Study (2006/2008-2010/2012), and Midlife in the United States (1995/1996-2004/2005), were used to examine associations between obesity, perceived weight discrimination, and depressive symptoms among 20,286 U.S. and U.K. adults. RESULTS Across all 3 studies, Class II and III obesity were reliably associated with increases in depressive symptoms from baseline to follow-up. Perceived weight-based discrimination predicted increases in depressive symptoms over time and mediated the prospective association between obesity and depressive symptoms in all 3 studies. Persons with Class II and III obesity were more likely to report experiencing weight-based discrimination, and this explained approximately 31% of the obesity-related increase in depressive symptoms on average across the 3 studies. CONCLUSION In U.S. and U.K. samples, the prospective association between obesity (defined using body mass index) and increases in depressive symptoms in adulthood may in part be explained by perceived weight discrimination. (PsycINFO Database Record
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Affiliation(s)
- Eric Robinson
- Department of Psychological Sciences, Institute of Psychology, Health & Society, University of Liverpool
| | | | - Michael Daly
- Behavioural Science Centre, Stirling Management School, University of Stirling
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15
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Nolan LJ, Eshleman A. Paved with good intentions: Paradoxical eating responses to weight stigma. Appetite 2016; 102:15-24. [DOI: 10.1016/j.appet.2016.01.027] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/13/2015] [Accepted: 01/19/2016] [Indexed: 11/28/2022]
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Hackman J, Maupin J, Brewis AA. Weight-related stigma is a significant psychosocial stressor in developing countries: Evidence from Guatemala. Soc Sci Med 2016; 161:55-60. [PMID: 27254116 DOI: 10.1016/j.socscimed.2016.05.032] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 12/21/2022]
Abstract
Weight-related stigma is established as a major psychosocial stressor and correlate of depression among people living with obesity in high-income countries. Anti-fat beliefs are rapidly globalizing. The goal of the study is to (1) examine how weight-related stigma, enacted as teasing, is evident among women from a lower-income country and (2) test if such weight-related stigma contributes to depressive symptoms. Modeling data for 12,074 reproductive-age women collected in the 2008-2009 Guatemala National Maternal-Infant Health Survey, we demonstrate that weight-related teasing is (1) experienced by those both underweight and overweight, and (2) a significant psychosocial stressor. Effects are comparable to other factors known to influence women's depressive risk in lower-income countries, such as living in poverty, experiencing food insecurity, or suffering sexual/domestic violence. That women's failure to meet local body norms-whether they are overweight or underweight-serves as such a strong source of psychological distress is particularly concerning in settings like Guatemala where high levels of over- and under-nutrition intersect at the household and community level. Current obesity-centric models of weight-related stigma, developed from studies in high-income countries, fail to recognize that being underweight may create similar forms of psychosocial distress in low-income countries.
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Affiliation(s)
- Joseph Hackman
- School of Human Evolution and Social Change, Arizona State University, United States.
| | - Jonathan Maupin
- School of Human Evolution and Social Change, Arizona State University, United States
| | - Alexandra A Brewis
- School of Human Evolution and Social Change, Arizona State University, United States
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Puhl RM, Phelan SM, Nadglowski J, Kyle TK. Overcoming Weight Bias in the Management of Patients With Diabetes and Obesity. Clin Diabetes 2016; 34:44-50. [PMID: 26807008 PMCID: PMC4714720 DOI: 10.2337/diaclin.34.1.44] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, CT
| | - Sean M Phelan
- Division of Health Care Policy and Research, Mayo Clinic, Rochester, MN
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Translation and validation of the German version of the weight self-stigma questionnaire (WSSQ). Obes Surg 2015; 25:750-3. [PMID: 25663147 DOI: 10.1007/s11695-015-1598-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The experience of stigmatization is widespread among obese patients. The aim of the present study was to translate the English version of the weight self-stigma questionnaire (WSSQ) into German and to evaluate the psychometric properties of the German version in a sample of severely obese persons. Between March and June 2013, in the Outpatient Department of Obesity, University Hospital Heidelberg, 94 obese patients were recruited consecutively. A comprehensive questionnaire was completed by the participants. Significant correlations between WSSQ scores and mental quality of life, weight-related quality of life, depression, shame, guilt, and psychological distress all demonstrated the construct validity of the German version of the WSSQ. Patients with a BMI ≥ 50 showed a significantly higher self-stigma compared to patients with a BMI between 35 and 50.
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Burgmer R, Legenbauer T, Müller A, de Zwaan M, Fischer C, Herpertz S. Psychological outcome 4 years after restrictive bariatric surgery. Obes Surg 2015; 24:1670-8. [PMID: 24682804 DOI: 10.1007/s11695-014-1226-x] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Extreme obesity is associated with severe psychiatric and somatic comorbidity and impairment of psychosocial functioning. Bariatric surgery is the most effective treatment not only with regard to weight loss but also with obesity-associated illnesses. Health-related psychological and psychosocial variables have been increasingly considered as important outcome variables of bariatric surgery. However, the long-term impact of bariatric surgery on psychological and psychosocial functioning is largely unclear. The aim of this study was to evaluate the relationship between the course of weight and psychological variables including depression, anxiety, health-related quality of life (HRQOL), and self-esteem up to 4 years after obesity surgery.By standardized questionnaires prior to (T1) and 1 year (T2), 2 years (T3), and 4 years (T4) after surgery, 148 patients (47 males (31.8 %), 101 females (68.2 %), mean age 38.8 ± 10.2 years) were assessed.On average, participants lost 24.6 % of their initial weight 1 year after surgery, 25.1 % after 2 years, and 22.3 % after 4 years. Statistical analysis revealed significant improvements in depressive symptoms, physical dimension of quality of life, and self-esteem with peak improvements 1 year after surgery. These improvements were largely maintained. Significant correlations between weight loss and improvements in depression, physical aspects of HRQOL (T2, T3, and T4), and self-esteem (T3) were observed.Corresponding to the considerable weight loss after bariatric surgery, important aspects of mental health improved significantly during the 4-year follow-up period. However, parallel to weight regain, psychological improvements showed a slow but not significant decline over time.
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Affiliation(s)
- Ramona Burgmer
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr University Bochum, Alexandrinenstraße 1-3, 44791, Bochum, Germany,
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20
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Burguera B, Jesús Tur J, Escudero AJ, Alos M, Pagán A, Cortés B, González XF, Soriano JB. An Intensive Lifestyle Intervention Is an Effective Treatment of Morbid Obesity: The TRAMOMTANA Study-A Two-Year Randomized Controlled Clinical Trial. Int J Endocrinol 2015; 2015:194696. [PMID: 26257780 PMCID: PMC4518148 DOI: 10.1155/2015/194696] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 06/18/2015] [Indexed: 01/14/2023] Open
Abstract
Bariatric surgery is currently the most effective therapy to induce weight loss in morbidly obese patients. Objective. This controlled, clinical trial with a two-year intervention was aimed at comparing the efficacy of two nonsurgical approaches versus bariatric surgery, on body weight changes and metabolic parameters in morbidly obese patients. Methods. Patients were randomized to an Intensive Lifestyle Intervention (ILI) (n = 60) or Conventional Obesity Therapy (COT) (n = 46). The ILI group received behavioral therapy and nutritional counseling. The COT group received standard medical treatment. They were compared with a third group, Surgical Obesity Group (SOG) (n = 37). Results. Patients who received ILI had a greater percentage of weight loss than patients receiving COT (-11.3% versus -1.6%; p < 0.0044). Interestingly 31.4% of patients included in the ILI group were no longer morbidly obese after just six months of intervention, increasing to 44.4% after 24 months of intervention. The percentage weight loss in SOG was -29.6% after that same period of time. Conclusions. ILI was associated with significant weight loss when compared to COT, in a group of patients with obesity. An ILI approach could be an alternative therapy to patients with obesity, who are not candidates to undergo bariatric surgery. This trial is registered with EudraCT 2009-013737-24.
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Affiliation(s)
- Bartolomé Burguera
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Endocrinology and Bariatric Institutes, Cleveland Clinic, 9500 Euclid Avenue M62, Cleveland, OH 44195, USA
| | - Juan Jesús Tur
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Unidad de Investigación, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Antonio Jorge Escudero
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Unidad de Investigación, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - María Alos
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - Alberto Pagán
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Cirugía General, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Baltasar Cortés
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07010 Palma de Mallorca, Spain
- Unidad de Investigación, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | | | - Joan B. Soriano
- Instituto de Investigación Hospital Universitario de la Princesa (IISP), Universidad Autónoma de Madrid, Cátedra UAM-Linde, 28030 Madrid, Spain
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Gilbert J, Stubbs RJ, Gale C, Gilbert P, Dunk L, Thomson L. A qualitative study of the understanding and use of ‘compassion focused coping strategies’ in people who suffer from serious weight difficulties. ACTA ACUST UNITED AC 2014. [DOI: 10.1186/s40639-014-0009-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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22
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Brewis AA. Stigma and the perpetuation of obesity. Soc Sci Med 2014; 118:152-8. [DOI: 10.1016/j.socscimed.2014.08.003] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 08/04/2014] [Accepted: 08/05/2014] [Indexed: 01/30/2023]
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Abstract
Purpose
– The purpose of this paper is to assess multidimensional body image concerns in a sample of obese women seeking bariatric surgery at an outpatient hospital clinic in Hamilton, Ontario, Canada.
Design/methodology/approach
– A sample of obese adult women seeking bariatric surgery at an outpatient medical clinic in Hamilton, Ontario, Canada (n=148) completed various self-report measures of body image concerns, including body image dysphoria, body image quality of life, body image investment, and appearance satisfaction. Participant scores were compared to normative data. Correlations between body image concern measures and body mass index (BMI) were examined.
Findings
– Participants endorsed more body image dysphoria, more negative body image quality of life, and less appearance satisfaction than normative samples. BMI was not correlated with body image concern scores.
Practical implications
– Interventions aimed at reducing body image disturbance in obese women should target multiple components of body image concern. Decisions about who should receive interventions should not be based on BMI status.
Originality/value
– The majority of research on body image concerns focuses exclusively on evaluative constructs such as body image dissatisfaction. The current study examined affective, cognitive, and behavioural body image constructs. A better understanding of the multidimensional nature of body image concerns in obese women seeking bariatric surgery informs the development of effective, targeted interventions.
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Castellini G, Godini L, Amedei SG, Faravelli C, Lucchese M, Ricca V. Psychological effects and outcome predictors of three bariatric surgery interventions: a 1-year follow-up study. Eat Weight Disord 2014; 19:217-24. [PMID: 24737175 DOI: 10.1007/s40519-014-0123-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/01/2014] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Weight loss surgery efficacy has been demonstrated for morbid obesity. Different outcomes have been hypothesized, according to specific bariatric surgery interventions and psychological characteristics of obese patients. The present study compared three different surgery procedures, namely laparoscopic adjustable gastric band (LAGB), Roux-en-Y gastric bypass (RYGB) and biliopancreatic diversion (BPD), in terms of weight loss efficacy and psychological outcomes. METHODS Eighty-three subjects seeking bariatric surgery have been evaluated before and 12 months after surgery intervention, by means of a clinical interview and different self-reported questionnaires, including Eating Disorder Examination Questionnaire, Emotional Eating Scale, Binge Eating Scale, Beck Depression Inventory, Symptom Checklist and State-Trait Anxiety Inventory. RESULTS BPD group (26 subjects) showed the greatest weight loss, followed by RYGB (30 subjects), and LAGB group (27 subjects). All the treatments were associated with a significant improvement of anxiety, depression, and general psychopathology, and a similar pattern of reduction of binge eating symptomatology. BPD group reported a greater reduction of eating disorder psychopathology, compared to the other groups. Pre-treatment emotional eating severity was found to be a significant outcome modifier for the three treatment interventions. CONCLUSIONS These results suggest that all the three types of bariatric surgery significantly improved psychopathology and eating disordered behaviors. They also support the importance of a pre-treatment careful psychological assessment in order to supervise the post-surgical outcome.
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Affiliation(s)
- Giovanni Castellini
- Psychiatric Unit, Department of Neuropsychiatric Sciences, Florence University School of Medicine, Viale Morgagni 85, 50134, Florence, Italy
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25
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Salwen JK, Hymowitz GF, Vivian D, O'Leary KD. Childhood abuse, adult interpersonal abuse, and depression in individuals with extreme obesity. CHILD ABUSE & NEGLECT 2014; 38:425-433. [PMID: 24412223 DOI: 10.1016/j.chiabu.2013.12.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2013] [Revised: 12/03/2013] [Accepted: 12/11/2013] [Indexed: 06/03/2023]
Abstract
This study sought to examine (a) a mediational model of childhood abuse, adult interpersonal abuse, and depressive symptoms and (b) the impact of weight-related teasing on rates and correlates of childhood abuse. Charts of 187 extremely obese individuals seeking psychological clearance for bariatric (weight-loss) surgery were retrospectively examined. Among the participants, 61% reported a history of childhood abuse, 30.5% reported adult interpersonal abuse, and 15% reported clinically significant depressive symptoms. Initially, the relationship between childhood abuse and current depressive symptoms was significant (p<.001). However, the introduction of adult interpersonal abuse as a mediator in the model reduced the magnitude of its significance (Sobel's test p=.01). The associations between childhood abuse and adult interpersonal abuse and between adult interpersonal abuse and depressive symptoms were significant (p<.001 and p=.002, respectively), and the model showed a good fit across multiple indices. Finally, weight-related teasing was a significant moderator in the relationship between childhood and adult interpersonal abuse. Bariatric surgery patients report elevated rates of childhood abuse that are comparable to rates in psychiatric populations (e.g., eating disorders, depression), and higher than those in community samples and other medical populations. The relationship between child abuse and depressive symptomatology may be partially explained by the presence of adult interpersonal abuse; additionally, the relationship between childhood and adult interpersonal abuse was stronger for those who did not endure weight-related teasing than for those who did.
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Affiliation(s)
- Jessica K Salwen
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
| | - Genna F Hymowitz
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
| | - Dina Vivian
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
| | - K Daniel O'Leary
- Department of Psychology, Stony Brook University, Stony Brook, NY 11794-2500, USA
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Parker K, Brennan L. Measurement of disordered eating in bariatric surgery candidates: a systematic review of the literature. Obes Res Clin Pract 2014; 9:12-25. [PMID: 25660171 DOI: 10.1016/j.orcp.2014.01.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 01/09/2014] [Accepted: 01/25/2014] [Indexed: 12/16/2022]
Abstract
Symptoms of disordered eating are common among patients seeking bariatric surgery, and assessment of eating pathology is typical in pre-surgical evaluations. A systematic review was conducted to evaluate the definitions, diagnostic criteria and measures used to assess disordered eating in adults seeking bariatric surgery. The review identified 147 articles featuring 34 questionnaires and 45 interviews used in pre-surgical assessments. The Questionnaire on Eating and Weight Patterns Revised and the Structured Clinical Interview for DSM were the most frequently used questionnaire and interview respectively. Variations to pre-surgical diagnostic criteria included changes to the frequency and duration criteria for binge eating, and inconsistent use of disordered eating definitions (e.g., grazing). Results demonstrate a paucity of measures designed specifically for an obese sample, and only 24% of questionnaires and 4% of interviews used had any reported psychometric evaluation in bariatric surgery candidates. The psychometric data available suggest that interview assessments are critical for accurately identifying binge episodes and other diagnostic information, while self-report questionnaires may be valuable for providing additional information of clinical utility (e.g., severity of eating, shape and weight-related concerns). Findings highlight the need for consensus on disordered eating diagnostic criteria and psychometric evaluation of measures to determine whether existing measures provide a valid assessment of disordered eating in this population. Consistent diagnosis and the use of validated measures will facilitate accurate identification of disordered eating in the pre-surgical population to enable assessment of suitability for surgery and appropriate targeting of treatment for disordered eating to optimise treatment success.
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Affiliation(s)
- Katrina Parker
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Victoria, Australia; School of Psychology and Psychiatry, Monash University, Melbourne, Victoria, Australia
| | - Leah Brennan
- Centre for Obesity Research and Education (CORE), Monash University, Melbourne, Victoria, Australia; School of Psychology, Australian Catholic University, Melbourne, Victoria, Australia.
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Dutton GR, Lewis TT, Durant N, Halanych J, Kiefe CI, Sidney S, Kim Y, Lewis CE. Perceived weight discrimination in the CARDIA study: differences by race, sex, and weight status. Obesity (Silver Spring) 2014; 22:530-6. [PMID: 23512948 PMCID: PMC3695009 DOI: 10.1002/oby.20438] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Accepted: 02/21/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To examine self-reported weight discrimination and differences based on race, sex, and BMI in a biracial cohort of community-based middle-aged adults. DESIGN AND METHODS Participants (3,466, mean age = 50 years, mean BMI = 30 kg/m²) of the Coronary Artery Risk Development in Young Adults (CARDIA) Study who completed the 25-year examination of this epidemiological investigation in 2010-2011 were reported. The sample included normal weight, overweight, and obese participants. CARDIA participants are distributed into four race-sex groups, with about half being African-American and half White. Participants completed a self-reported measure of weight discrimination. RESULTS Among overweight/obese participants, weight discrimination was lowest for White men (12.0%) and highest for White women (30.2%). The adjusted odds ratio (95% CI) for weight discrimination in those with class 2/3 obesity (BMI ≥ 35 kg/m²) versus the normal-weight was most pronounced: African American men, 4.59 (1.71-12.34); African American women, 7.82 (3.57-17.13); White men, 6.99 (2.27-21.49); and White women, 18.60 (8.97-38.54). Being overweight (BMI = 25-29.9 kg/m²) vs. normal weight was associated with increased discrimination in White women only: 2.10 (1.11-3.96). CONCLUSIONS Novel evidence for a race-sex interaction on perceived weight discrimination, with White women more likely to report discrimination at all levels of overweight and obesity was provided. Pychosocial mechanisms responsible for these differences deserve exploration.
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Affiliation(s)
- Gareth R Dutton
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Preiss K, Brennan L, Clarke D. A systematic review of variables associated with the relationship between obesity and depression. Obes Rev 2013; 14:906-18. [PMID: 23809142 DOI: 10.1111/obr.12052] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 05/19/2013] [Accepted: 05/20/2013] [Indexed: 12/18/2022]
Abstract
Obesity is one of the leading causes of preventable diseases and disability worldwide, and depression is among the leading causes of burden of disease. Both disorders are increasingly prevalent and comorbid. This comorbidity compounds associated health. While there is consistent evidence of a bidirectional obesity depression relationship, little is known about the biopsychosocial variables associated with this relationship. A systematic review was undertaken to identify variables associated with the relationship between obesity (Body mass index > 30 kg m(-2) ) and depression. Forty-six studies were identified. Obesity, educational attainment, body image, binge eating, physical health, psychological characteristics and interpersonal effectiveness were consistently associated with the relationship between obesity and depression. The current review identified potential biopsychosocial variables associated with the relationship between obesity and depression. This knowledge can inform future research examining moderators, mediators and mechanisms of the relationship between obesity and depression. Improved understanding of this relationship will inform identification, prevention and intervention efforts.
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Affiliation(s)
- K Preiss
- School of Psychology and Psychiatry, Faculty of Medicine, Nursing & Health Sciences at Monash University, Melbourne, Victoria, Australia
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Abstract
Despite significant attention to the medical impacts of obesity, often ignored are the negative outcomes that obese children and adults experience as a result of stigma, bias, and discrimination. Obese individuals are frequently stigmatized because of their weight in many domains of daily life. Research spanning several decades has documented consistent weight bias and stigmatization in employment, health care, schools, the media, and interpersonal relationships. For overweight and obese youth, weight stigmatization translates into pervasive victimization, teasing, and bullying. Multiple adverse outcomes are associated with exposure to weight stigmatization, including depression, anxiety, low self-esteem, body dissatisfaction, suicidal ideation, poor academic performance, lower physical activity, maladaptive eating behaviors, and avoidance of health care. This review summarizes the nature and extent of weight stigmatization against overweight and obese individuals, as well as the resulting consequences that these experiences create for social, psychological, and physical health for children and adults who are targeted.
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards Street, New Haven, CT 06511, USA.
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Fettich KC, Chen EY. Coping with obesity stigma affects depressed mood in African-American and white candidates for bariatric surgery. Obesity (Silver Spring) 2012; 20:1118-21. [PMID: 22282108 PMCID: PMC5670735 DOI: 10.1038/oby.2012.12] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Depressed mood in severely obese, bariatric surgery-seeking candidates is influenced by obesity stigma, yet the strategies for coping with this stigma are less well understood. This study hypothesized that coping strategies are significantly associated with depressed mood above and beyond demographic factors and frequency of weight-related stigma, with specific coping strategies differing between racial groups. Severely obese, bariatric surgery-seeking adults (N = 234; 91 African Americans) completed the Beck Depression Inventory (BDI) and Stigmatizing Situations Inventory (SSI). Two hierarchical linear regressions were conducted separately for African Americans and whites. For both racial groups, age, sex, BMI, years overweight, annual income, and education level did not account for a significant portion of the variance in BDI scores. The frequency of stigmatizing situations and coping strategies significantly explained 16.4% and 33.2%, respectively, of the variance for whites, and 25.9% and 25%, respectively, for African Americans (P < 0.001). Greater depressed mood in whites was associated with older age, lower education, fewer positive self-statements, and less self-love and more crying; while in African Americans greater depressed mood was associated only with ignoring the situation (P < 0.05). The study found that regardless of race, depressed mood in severely obese, bariatric surgery-seeking clients is related to the frequency of stigmatizing experiences and associated coping strategies. This suggests that efforts to reduce the deleterious effects of weight-related stigma need to focus both on reducing the frequency of stigmatization and on teaching effective coping strategies. These efforts also need to take into account the client's racial background.
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Affiliation(s)
- Karla C Fettich
- Adult Eating and Weight Disorders Program, Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA.
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31
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Chen EY, Fettich KC, McCloskey MS. Correlates of Suicidal Ideation and/or Behavior in Bariatric-Surgery-Seeking Individuals With Severe Obesity. CRISIS 2012; 33:137-43. [DOI: 10.1027/0227-5910/a000115] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Approximately 10% of severely obese bariatric-surgery-seeking individuals report a lifetime history of suicide attempts, a higher rate than in the general community. Being overweight is associated with weight-related stigma, making an individual more vulnerable to social isolation, a potential risk factor for suicidal ideation and/or behavior. Aims: In this cross-sectional study of surgery-seeking adults with severe obesity, we examined whether weight-related stigma increases (1) the likelihood of suicidal ideation and/or behavior or (2) the degree of loneliness; and whether hypotheses (1) and (2) are supported (3) if loneliness mediates the effect of weight-related stigma on suicidal ideation and/or behavior. Methods: Online questionnaires were administered to 301 women and 95 men seeking bariatric surgery. Results: Approximately 30.3% reported having at least a passing thought of suicide, and 5.55% a suicide attempt during their lifetime. The suicide attempt rate appears lower than other bariatric surgery samples, but possibly higher than community and other surgery sample rates. For severely obese surgery-seeking women, weight-related stigma was associated with suicidal ideation and/or behavior, though this was not mediated by loneliness. Conclusions: Future studies are needed to model and compare suicidal ideation and/or behavior in bariatric-surgery-seeking individuals and control groups.
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Affiliation(s)
- E. Y. Chen
- Adult Eating and Weight Disorders Program, Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
| | - K. C. Fettich
- Adult Eating and Weight Disorders Program, Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - M. S. McCloskey
- Department of Psychology, Temple University, Philadelphia, PA, USA
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Tessier A, Zavorsky GS, Kim DJ, Carli F, Christou N, Mayo NE. Understanding the Determinants of Weight-Related Quality of Life among Bariatric Surgery Candidates. J Obes 2012; 2012:713426. [PMID: 22292114 PMCID: PMC3265129 DOI: 10.1155/2012/713426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/07/2011] [Indexed: 11/17/2022] Open
Abstract
Obesity and its relation to quality of life are multifaceted. The purpose of this paper was to contribute evidence to support a framework for understanding the impact of obesity on quality of life in 42 morbidly obese subjects considering a wide number of potential determinants. A model of weight-related quality of life (WRQL) was developed based on the Wilson-Cleary model, considering subjects' weight characteristics, arterial oxygen pressure (PaO(2)), walking capacity (6-minute walk test, 6MWT), health-related quality of life (HRQL; Physical and Mental Component Summaries of the SF-36 PCS/MCS), and WRQL. The model of WRQL was tested with linear regressions and a path analysis, which showed that as PaO(2) at rest increased 6MWT increased. 6MWT was positively associated with the PCS, which in turn was positively related to WRQL along with the MCS. The model showed good fit and explained 38% of the variance in WRQL.
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Affiliation(s)
- Annie Tessier
- School of Physical and Occupational Therapy, McGill University Health Center, 3654 Promenade Sir William Osler, Montreal, QC, Canada H3G 1V5
| | - Gerald S. Zavorsky
- Human Physiology Laboratory, Marywood University, Scranton, PA 18509, USA
- The Commonwealth Medical College, Scranton, PA 18509, USA
- *Gerald S. Zavorsky:
| | - Do Jun Kim
- School of Physical and Occupational Therapy, McGill University Health Center, 3654 Promenade Sir William Osler, Montreal, QC, Canada H3G 1V5
| | - Franco Carli
- Department of Anesthesia, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, Room D10-144, Montreal, QC, Canada H3G 1A4
| | - Nicolas Christou
- Department of Surgery, Bariatric Clinic, Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, Room S6.24, Montreal, QC, Canada H3A 1A1
| | - Nancy E. Mayo
- School of Physical and Occupational Therapy, McGill University Health Center, 3654 Promenade Sir William Osler, Montreal, QC, Canada H3G 1V5
- Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, Ross 4.29, Montreal, QC, Canada H3A 1A1
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Phelan SM, Griffin JM, Jackson GL, Zafar SY, Hellerstedt W, Stahre M, Nelson D, Zullig LL, Burgess DJ, van Ryn M. Stigma, perceived blame, self-blame, and depressive symptoms in men with colorectal cancer. Psychooncology 2011; 22:65-73. [PMID: 21954081 DOI: 10.1002/pon.2048] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 06/30/2011] [Accepted: 07/08/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND We measured the prevalence of stigma, self-blame, and perceived blame from others for their illness among men with colorectal cancer (CRC) and examined whether these factors were associated with depressive symptoms, independent of clinical and sociodemographic factors. METHODS Self-administered questionnaires were returned in the fall of 2009 by 1109 eligible male US veterans who were diagnosed with CRC at any Veterans Affairs facility in 2008. Questionnaires assessed stigma, feelings of blame, and depressive symptoms as well as other facets of health, cancer characteristics, and quality and type of medical care. We report the prevalence of cancer stigma, self-blame, and perceived blame from others. We used multivariate linear regression to assess the association between these factors and a measure of depressive symptoms. Covariates included several measures of overall health, cancer progression, symptom severity, and sociodemographic factors. RESULTS Thirty one percent of respondents endorsed at least one item in a measure of cancer stigma and 25% reported feeling that it was at least 'a little true' that they were to blame for their illness. All three independent variables were associated with depressive symptoms in bivariate models; cancer stigma and self-blame were significantly associated with depressive symptoms in the multivariate model. CONCLUSIONS Cancer stigma and self-blame are problems for a significant minority of men with CRC and are independent predictors of depressive symptoms. They may represent an important source of stress in men with CRC.
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Affiliation(s)
- Sean M Phelan
- University of Minnesota, Family Medicine and Community Health, Minneapolis, MN 55414, USA.
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Anxiety and depression in bariatric surgery patients: a prospective, follow-up study using structured clinical interviews. J Affect Disord 2011; 133:61-8. [PMID: 21501874 DOI: 10.1016/j.jad.2011.03.025] [Citation(s) in RCA: 236] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/14/2011] [Accepted: 03/14/2011] [Indexed: 12/30/2022]
Abstract
BACKGROUND Candidates for bariatric surgery frequently have co-morbid psychiatric problems. METHODS This study investigated the course and the prognostic significance of preoperative and postoperative anxiety and depressive disorders in 107 extremely obese bariatric surgery patients in a prospective design with face-to-face interviews (SCID) conducted prior to the surgery and postoperatively after 6-12 months and 24-36 months. RESULTS The point prevalence of depressive disorders but not of anxiety disorders decreased significantly after surgery. Preoperative depressive disorders predicted depressive disorders 24-36 months but not 6-12 months after surgery, whereas preoperative anxiety significantly predicted postoperative anxiety disorders at both follow-up time points. Preoperative lifetime and current depressive disorders were unrelated to postoperative weight loss whereas preoperative lifetime, but not current anxiety disorders were of negative prognostic value for postoperative weight loss. Patients with both depressive and anxiety disorders at baseline (current and lifetime) lost significantly less weight after surgery. Postoperative anxiety disorder was not associated with the degree of weight loss at any follow-up time-point; however postoperative depressive disorder was negatively associated with weight loss at the 24-36 month follow-up assessment point. LIMITATIONS Missing data, limited statistical power, self-reported height and weight are the limitations of this study. CONCLUSIONS As opposed to anxiety disorders, the point prevalence of depressive disorders decreased significantly after bariatric surgery. However, the presence of depressive disorders after bariatric surgery significantly predicted attenuated post-surgical improvements and may signal a need for clinical attention.
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Tessier A, Mayo NE, Cieza A. Content identification of the IWQOL-Lite with the International Classification of Functioning, Disability and Health. Qual Life Res 2011; 20:467-77. [PMID: 21061070 DOI: 10.1007/s11136-010-9787-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2010] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The identification of the content of a measure could ensure that the most appropriate measure is chosen to meet a particular objective. Mapping the Impact of Weight on Quality Of Life (IWQOL-Lite) to the International Classification of Functioning, Disability and Health (ICF) will improve the understanding of its structure and aid in the interpretation of the results. METHODS A mapping exercise was performed by 21 raters using the Delphi technique to identify the ICF codes that best describe the content of the items of the IWQOL-Lite. Both French and English versions were linked to validate the French translation. The results were validated on a sample of 122 participants and were also compared to the mapping performed by another group. RESULTS Most of the content of the IWQOL-Lite was identified. All five components of the ICF were represented in the IWQOL-Lite. The mapping differed across languages. The results of the mapping were similar to those obtained by another group. CONCLUSIONS The content of the IWQOL-Lite is compatible with the ICF. The measure has good content validity. The content could be improved by the addition and the specification of some terms. The French translation of some items should be revised.
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Affiliation(s)
- Annie Tessier
- School of Physical and Occupational Therapy, McGill University, Montreal, QC, Canada.
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36
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Abstract
Obesity has been associated with significant stigma and weight-related self-bias in community and clinical studies, but these issues have not been studied among individuals with schizophrenia. A consecutive series of 70 obese individuals with schizophrenia or schizoaffective disorder underwent assessment for perceptions of weight-based stigmatization, self-directed weight bias, negative affect, medication compliance, and quality of life. The levels of weight-based stigmatization and self-bias were compared with levels reported for nonpsychiatric overweight/obese samples. Weight measures were unrelated to stigma, self-bias, affect, and quality of life. Weight-based stigmatization was lower than published levels for nonpsychiatric samples, whereas levels of weight-based self-bias did not differ. After controlling for negative affect, weight-based self-bias predicted an additional 11% of the variance in the quality of life measure. Individuals with schizophrenia and schizoaffective disorder reported weight-based self-bias to the same extent as nonpsychiatric samples despite reporting less weight stigma. Weight-based self-bias was associated with poorer quality of life after controlling for negative affect.
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Rosen-Reynoso M, Alegría M, Chen CN, Laderman M, Roberts R. The relationship between obesity and psychiatric disorders across ethnic and racial minority groups in the United States. Eat Behav 2011; 12:1-8. [PMID: 21184966 PMCID: PMC3052947 DOI: 10.1016/j.eatbeh.2010.08.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 08/03/2010] [Accepted: 08/24/2010] [Indexed: 12/22/2022]
Abstract
CONTEXT Epidemiologic studies of obesity have not examined the prevalence and relationship of mental health conditions with obesity for diverse ethnic and racial populations in the United States. OBJECTIVE (1) To assess whether obesity was associated with diverse psychiatric diagnoses across a representative sample of non-Latino whites, Latinos, Asians, African-Americans, and Afro-Caribbeans; and (2) to test whether physical health status, smoking, sociodemographic characteristics, and psychiatric comorbidities mediate any of the observed associations. DESIGN Our analyses used pooled data from the NIMH Collaborative Psychiatric Epidemiology Surveys (CPES). Analyses tested the association between obesity and psychiatric disorders in a diverse sample of Americans (N=13,837), while adjusting for factors such as other disorders, age, gender, socioeconomic status, smoking and physical health status (as measured by chronic conditions and WHO-DAS scores) in different models. RESULTS The relationship between obesity and last-year psychiatric disorders varied by ethnicity/race. The likelihood of having mood or anxiety disorder was positively associated with obesity for certain racial/ethnic groups, but was moderated by differences in physical health status. Substance-use disorders were associated with decreased odds for obesity in African-Americans. CONCLUSIONS The role of physical health status (as measured by chronic conditions and WHO-DAS scores) dramatically changes the pattern of associations between obesity and psychiatric disorders, suggesting the important role it plays in explaining differential patterns of association across racial and ethnic groups.
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Affiliation(s)
- Myra Rosen-Reynoso
- University of Massachusetts Boston, 100 Morrissey Blvd., Boston, MA 02125-3393, Phone: 617-287-4370, Fax: 617-287-4350
| | - Margarita Alegría
- Center for Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Medical School, 120 Beacon Street, 4 Floor, Somerville, MA 02143, Phone: (617) 503-8440, Fax: (617) 503-8430
| | - Chih-nan Chen
- Center for Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Medical School, 120 Beacon Street, 4 Floor, Somerville, MA 02143, Phone: (617) 503-8440, Fax: (617) 503-8430
| | - Mara Laderman
- Center for Multicultural Mental Health Research, Cambridge Health Alliance and Harvard Medical School, 120 Beacon Street, 4 Floor, Somerville, MA 02143, Phone: (617) 503-8440, Fax: (617) 503-8430
| | - Robert Roberts
- The University of Texas School of Public Health, 1200 Herman Pressler, Room E1017, Houston, Texas 77030, Phone: (713) 500-9291, Fax: (713) 500-9406
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Puhl RM, Heuer CA. Public opinion about laws to prohibit weight discrimination in the United States. Obesity (Silver Spring) 2011; 19:74-82. [PMID: 20508626 DOI: 10.1038/oby.2010.126] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Weight discrimination is pervasive in American society and impairs quality of life for obese persons. With approximately two-thirds of Americans now overweight or obese, vast numbers of people are vulnerable to weight prejudice and its consequences. Currently, no laws exist to prohibit weight discrimination. This study conducted an online survey with a national sample of 1,001 adults (representing demographics of the United States) to examine public support for six potential legislative measures to prohibit weight discrimination in the United States. Results indicated substantial support (65% of men, 81% of women) for laws to prohibit weight discrimination in the workplace, especially for legal measures that would prohibit employers from refusing to hire, terminate, or deny promotion based on a person's body weight. Laws that proposed extending the same protections to obese persons as people with physical disabilities received the least support, suggesting that Americans may not be in favor of considering obesity as a disability. Findings also highlight specific predictors of support (related to sex, age, education, income, body weight, and political ideology). These findings can be used to inform policy makers in efforts to develop antidiscrimination laws. Such measures will rectify health disparities for overweight Americans and facilitate public health efforts to address obesity.
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Affiliation(s)
- Rebecca M Puhl
- Department of Psychology, Rudd Center for Food Policy and Obesity, Yale University, New Haven, Connecticut, USA.
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Andersen JR, Aasprang A, Bergsholm P, Sletteskog N, Våge V, Natvig GK. Anxiety and depression in association with morbid obesity: changes with improved physical health after duodenal switch. Health Qual Life Outcomes 2010; 8:52. [PMID: 20492663 PMCID: PMC2881107 DOI: 10.1186/1477-7525-8-52] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 05/21/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with morbid obesity have an increased risk for anxiety and depression. The "duodenal switch" is perhaps the most effective obesity surgery procedure for inducing weight loss. However, to our knowledge, data on symptoms of anxiety and depression after the duodenal switch are lacking. Furthermore, it has been hypothesized that self-reported physical health is the major predictor of symptoms of depression in patients with morbid obesity. We therefore investigated the symptoms of anxiety and depression before and after the duodenal switch procedure and whether post-operative changes in self-reported physical health were predictive of changes in these symptoms. METHODS Data were assessed before surgery (n = 50), and one (n = 47) and two (n = 44) years afterwards. Symptoms of anxiety and depression were assessed by the "Hospital Anxiety and Depression Scale", and self-reported physical health was assessed by the "Short-Form 36" questionnaire. Linear mixed effect models were used to investigate changes in the symptoms of anxiety and depression. Correlation and linear multiple regression analyses were used to study whether changes in self-reported physical health were predictive of post-operative changes in the symptoms of anxiety and depression. RESULTS The symptom burden of anxiety and depression were high before surgery but were normalized one and two years afterwards (P < 0.001). The degree of improvement in self-reported physical health was associated with statistically significant reductions in the symptoms of anxiety (P = 0.003) and depression (P = 0.004). CONCLUSIONS The novelty of this study is the large and sustained reductions in the symptoms of anxiety and depression after the duodenal switch procedure, and that these changes were closely associated with improvements in self-reported physical health.
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Affiliation(s)
- John Roger Andersen
- Faculty of Health Studies, Sogn og Fjordane University College, Box 523, 6803 Førde, Norway.
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Vogelzangs N, Kritchevsky SB, Beekman ATF, Brenes GA, Newman AB, Satterfield S, Yaffe K, Harris TB, Penninx BWJH. Obesity and onset of significant depressive symptoms: results from a prospective community-based cohort study of older men and women. J Clin Psychiatry 2010; 71:391-9. [PMID: 20021992 PMCID: PMC3277746 DOI: 10.4088/jcp.08m04743blu] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 01/02/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Although several cross-sectional studies have linked obesity and depression, less is known about their longitudinal association and about the relative influence of obesity subtypes. We prospectively examined whether obesity (specifically, abdominal) increased the risk of onset of depression in a population-based sample of older persons. METHOD Participants were 2,547 nondepressed, well-functioning white and black persons, aged 70-79 years, enrolled in the Health, Aging, and Body Composition Study, an ongoing prospective community-based cohort study. Baseline measurements were conducted between April 1997 and June 1998. Overall obesity was assessed by body mass index (BMI) and percent body fat (measured by dual energy x-ray absorptiometry), whereas abdominal obesity measures included waist circumference, sagittal diameter, and visceral fat (measured by computer tomography). Onset of significant depressive symptoms was defined as a Center for Epidemiologic Studies Depression 10-item score > or = 10 at any annual follow-up over 5 years and/or new antidepressant medication use. Persistent depression was defined as depression at 2 consecutive follow-up visits. RESULTS Over 5 years, significant depressive symptoms emerged in 23.7% of initially nondepressed persons. In men, both overall (BMI: hazard ratio [HR] per SD increase = 1.20; 95% CI, 1.03-1.40) and abdominal obesity (visceral fat: HR per SD increase = 1.19; 95% CI, 1.07-1.33) predicted onset of depressive symptoms after adjustment for sociodemographics. When BMI and visceral fat were adjusted for each other, only visceral fat was significantly associated with depression onset (HR = 1.18; 95% CI, 1.04-1.34). Stronger associations were found for persistent depressive symptoms. No associations were found in women. CONCLUSION This study shows that obesity, in particular visceral fat, increases the risk of onset of significant depressive symptoms in men. These results suggest that specific mechanisms might relate visceral fat to the onset of depression.
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Affiliation(s)
- Nicole Vogelzangs
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, AJ Ernststraat 887, 1081 HL Amsterdam, Netherlands.
| | - Stephen B Kritchevsky
- Sticht Center on Aging, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Aartjan TF Beekman
- Psychiatry and EMGO institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Gretchen A Brenes
- Department of Psychiatry and Behavioral Medicine, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Anne B Newman
- Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | - Suzanne Satterfield
- Department of Preventive Medicine, College of Medicine, University of Tennessee, Memphis, TN
| | - Kristine Yaffe
- Department of Psychiatry, Neurology and Epidemiology, University of California, San Francisco, CA
| | - Tamara B Harris
- Laboratory of Epidemiology, Demography and Biometry, Intramural Research Program, National Institute on Aging, Bethesda, MD
| | - Brenda WJH Penninx
- Psychiatry and EMGO institute, VU University Medical Center, Amsterdam, The Netherlands
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Abstract
Stigma and discrimination toward obese persons are pervasive and pose numerous consequences for their psychological and physical health. Despite decades of science documenting weight stigma, its public health implications are widely ignored. Instead, obese persons are blamed for their weight, with common perceptions that weight stigmatization is justifiable and may motivate individuals to adopt healthier behaviors. We examine evidence to address these assumptions and discuss their public health implications. On the basis of current findings, we propose that weight stigma is not a beneficial public health tool for reducing obesity. Rather, stigmatization of obese individuals threatens health, generates health disparities, and interferes with effective obesity intervention efforts. These findings highlight weight stigma as both a social justice issue and a priority for public health.
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Affiliation(s)
- Rebecca M Puhl
- Director of Research and Weight Stigma Initiatives, Rudd Center for Food Policy and Obesity, Yale University, 309 Edwards St, New Haven, CT 06520-8369, USA.
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Ali MR, Rasmussen JJ, Monash JB, Fuller WD. Depression is associated with increased severity of co-morbidities in bariatric surgical candidates. Surg Obes Relat Dis 2009; 5:559-64. [DOI: 10.1016/j.soard.2008.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 09/30/2008] [Accepted: 10/03/2008] [Indexed: 01/22/2023]
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43
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Affiliation(s)
- Rebecca M Puhl
- Rudd Center for Food Policy & Obesity, Yale University, New Haven, Connecticut, USA.
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44
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Entwistle VA. Hurtful comments are harmful comments: respectful communication is not just an optional extra in healthcare. Health Expect 2009; 11:319-20. [PMID: 19076661 DOI: 10.1111/j.1369-7625.2008.00527.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Bibliography. Current world literature. Diabetes and the endocrine pancreas. Curr Opin Endocrinol Diabetes Obes 2008; 15:193-207. [PMID: 18316957 DOI: 10.1097/med.0b013e3282fba8b4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Fischer S, Chen E, Katterman S, Roerhig M, Bochierri-Ricciardi L, Munoz D, Dymek-Valentine M, Alverdy J, le Grange D. Emotional Eating in a Morbidly Obese Bariatric Surgery-Seeking Population. Obes Surg 2007; 17:778-84. [PMID: 17879578 DOI: 10.1007/s11695-007-9143-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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