Obesity as a defense mechanism

Adverse Childhood Experiences in Obesity and Hypertension Among Young Adults in Delhi-NCR, India

OBJECTIVES

Despite growing evidence linking adverse childhood experiences (ACEs) with physical health conditions such as obesity and hypertension, research in low- and middle-income countries (LMICs), including India, remains limited. This study aims to examine the relationship between ACE exposure and the risk of overweight/obesity and hypertension among young adults in Delhi-NCR, India.

METHODS

The present cross-sectional study involved 1702 young adults of both sexes. Participants were recruited from two universities in Delhi-NCR, India. ACEs were measured using the ACE-International questionnaire (ACE-IQ), while anthropometric (weight, height, waist circumference, and hip circumference) and blood pressure parameters were assessed using standard protocols.

RESULTS

The prevalence of overweight/obesity increased with higher ACE categories, from 38% among participants with no ACEs to 49.7% among those with ≥ 4 ACEs (p = 0.006). Linear regression showed a significant positive association between ACE scores and BMI (β = 0.182, p = 0.004), waist circumference (WC; β = 0.351, p = 0.022), and waist-to-height ratio (WHtR; β = 0.002, p = 0.026). Odds ratio analysis revealed that participants with 3 or more ACEs had increased odds of being overweight/obese compared to unexposed individuals. No consistent associations were found between ACE exposure and blood pressure parameters. Among specific ACE domains, household mental illness was associated with higher odds of both general and central obesity, and bullying showed the highest odds for overweight/obesity.

CONCLUSIONS

ACE-exposed young adults may be at a higher risk of overweight/obesity; however, the risk of hypertension may not be immediate. Early intervention may help offset the risk of obesity and related disorders among ACE-exposed youth.

Prevalence of adverse childhood experiences and effect on outcomes in bariatric surgery patients: a systematic review and meta-analysis

Adverse childhood experiences (ACEs) are defined as childhood maltreatment (sexual, physical, and emotional abuse and neglect) and other childhood traumatic experiences. Published prevalence estimates for ACEs in bariatric samples vary greatly and evidence on the association between ACEs and bariatric surgery weight loss and psychosocial outcomes is inconclusive. A systematic literature search on PubMed/Medline, PsycInfo, Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health Literature), and Open Grey for studies published until August 30, 2021, yielded 21 publications for qualitative synthesis: 20 reporting on prevalence of ACEs in bariatric surgery candidates and patients, and 10 on the association of ACEs with outcomes. In meta-analysis, overall moderate to high heterogeneity was observed for prevalence estimates and moderate heterogeneity was observed for associations. Prevalence estimate for at least 1 form of ACEs (6 studies, n = 1368 patients) was 51% (95% confidence interval [CI]: 32%-70%). Effect size (Hedge's g) for the difference between the groups of patients reporting any or a high number of ACEs versus no or a low number of ACEs was calculated from means, standard deviations and group size, or P values. Based on 7 studies (n = 946 patients), the association between ACEs and weight loss was not significant (Hedge's g = -.15 [95% CI: -.38 to .09]; I² = 53%), regardless of short- or long-term follow-up (P = .413) and the proportion of patients in each study receiving Roux-en-Y gastric bypass (RYGB) (β = .0005, P = .868). Preliminary findings based on 3 short- and long-term studies (n = 414 patients) showed that ACEs were significantly (P = .001) associated with higher postoperative depressive symptoms (Hedge's g = .50 [95% CI: .22-.78]; I² = 36%). Associations between ACEs and other psychosocial outcomes such as eating pathology were reported narratively. There is a need for additional long-term studies using validated assessment tools for ACEs to evaluate the effect of ACEs on weight and psychosocial outcomes after bariatric surgery.

Weight stigma and posttraumatic stress disorder symptoms in individuals seeking bariatric surgery

BACKGROUND

After bariatric surgery, some patients experience adverse psychiatric outcomes, including substance use, suicidality, and self-harm. These factors are commonly associated with posttraumatic stress disorder (PTSD) and related symptoms (PTSD-S) that develop following adverse childhood experiences (ACEs) and traumatic events. However, emerging evidence suggests that chronic discrimination also may contribute to PTSD-S. Weight-based discrimination is salient for people with obesity but has received little attention in relation to PTSD-S.

OBJECTIVE

Our study examined factors that may contribute to the link between experienced weight stigma (WS), which is common in individuals seeking bariatric surgery, and PTSD-S.

SETTING

Teaching hospital and surgical weight loss center in the United States.

METHODS

A total of 217 participants completed self-report surveys of experienced and internalized WS, ACEs, and PTSD-S. Demographics and trauma history were obtained from patient medical records. A stepwise multiple regression examined associations between experienced WS and internalized WS with PTSD-S, co-varying demographics, ACEs, and trauma, followed by examination of whether findings held co-varying anxiety/depressive symptoms in a participant subset (n = 189).

RESULTS

After accounting for covariates in step 1 and ACEs and trauma in step 2 (ΔR² = .14), experienced WS and internalized WS accounted for substantial PTSD-S variance in steps 2 and 3 (ΔR² = .12 and .13, respectively; overall model R² =.44; P < .001). Findings held after co-varying anxiety/depressive symptoms.

CONCLUSIONS

Over and above ACEs and trauma, experienced WS and internalized WS may contribute to PTSD-S. Longitudinal research is needed to better elucidate the pathways underlying these associations.

'I want the way I look to matter less': A case study describing psychological aspects of changing appearance

There is a need for a better understanding of psychological processes when appearance is changed dramatically through surgery. The aim of this article is to shed light on how complex the process of changing appearance can be, and highlight the importance of including a psychological perspective to the treatment offered to children and adolescents with a visible condition affecting appearance. In order to illustrate some psychological aspects involved in a change of appearance, the case study of a young woman born with a cleft palate is presented. Through orthognathic surgery, an operation that changes the relationship and position of the upper and lower jaw, this young woman experienced a dramatic change in appearance. As a result of a new attractive appearance, she experienced new and different social interactions, which challenged her in surprising ways. Unexpectedly, an unknown past of childhood sexual abuse was triggered by romantic experiences due to her new appearance, and she developed signs of post-traumatic stress disorder (PTSD) and depression. This article presents central themes from the therapy and clinical interventions, which were mainly based on a solution-oriented and cognitive framework, and considers how the change of appearance affected the way this young woman behaved, felt and thought about herself after the surgery. Clinical implications of the case are discussed and their relevance to another research field - dramatic weight loss among those suffering from obesity - is suggested.

Unconscious agendas in the etiology of refractory obesity and the role of hypnosis in their identification and resolution: a new paradigm for weight-management programs or a paradigm revisited?

Hypnosis has long been recognized as an effective tool for producing behavioral change in the eating disorders anorexia and bulimia. Despite many studies from the latter half of the last century suggesting that hypnosis might also be of value in managing obesity situations, the efficacy of hypnotherapy for weight reduction has received surprisingly little formal research attention since 2000. This review presents a brief history of early clinical studies using hypnosis for weight reduction and describes a hypnotherapeutic approach within which a combination of instructional/pedagogic and exploratory therapeutic sessions can work together synergistically to maximize the potential for sustained weight loss. Hypnotic modulation of appetite- and satiation-associated peptides and hormone levels may yield additional physiological benefits in Type 1 and Type 2 diabetes.