Accuracy of self-reported weight among bariatric surgery candidates: the influence of race and weight cycling

Agreement between self-reported and measured weight, height, and derived BMI by educational attainment across racial and ethnic groups of US women

OBJECTIVE

Underreporting of weight and overreporting of height is consistently shown among women, thereby reducing accuracy of estimation of body mass index-and thus obesity-in epidemiologic studies that rely on self-reported data. Additionally, misreporting has been shown to differ by socioeconomic status and race and ethnicity, which can result in differential misclassification and bias that can obfuscate associations with obesity across groups in multiethnic and socioeconomically varying populations. Therefore, we sought to assess agreement between self-reported and objectively measured weight, height, and derived body mass index (BMI) across levels of educational attainment within racial and ethnic groups in a population-based cohort of US women.

METHODS

Among self-identified White, Black, and Latina women enrolled in the Sister Study (2003-2009), we assessed mean differences in self-reported vs. objectively measured weight, height, and derived BMI. Using adjusted linear and multinomial logistic regression, we compared measurement error among participants reporting some college/vocational school or ≥college vs. ≤high school. We assessed BMI agreement using Bland-Altman plots and weighted kappa (k) statistics.

RESULTS

Among 18,638 participants (age: mean ± standard deviation = 56 ± 9.0 years), 84% identified as White, 10% Black, and 5% Latina. Approximately half (49%) attained a college education. Weight and height were generally underreported. Higher underreporting of weight among participants with ≥college vs. ≤high school was of larger magnitude among Black and Latina vs. White participants. Bland-Altman results revealed that agreement in continuous BMI was good among White participants but generally fair among Black and Latina participants. Categorical BMI agreement was consistently high with minor variation by race and ethnicity and educational attainment (weighted k range = 0.92-0.93).

CONCLUSIONS

Despite higher measurement error in weight among Black and Latina participants with ≥college education, self-reported and objectively measured BMI categories showed high agreement across groups. Results support the utility of self-reported data that reliably estimate BMI category across socioeconomic, racial, and ethnic groups in this cohort.

Long-term Follow-up 15 Years After Duodenal Switch or Gastric Bypass for Super Obesity: a Randomized Controlled Trial

BACKGROUND

In super obesity, Roux-en-Y gastric bypass (RYGB) may be insufficient why some surgeons advocate biliopancreatic diversion with duodenal switch (BPD/DS), a more malabsorptive procedure. There is a paucity of evidence regarding results beyond 10 years, especially after BPD/DS. The aim of this randomized controlled trial was to compare the long-term outcome of BPD/DS, and RYGB in patients with super obesity, i.e., body mass index (BMI) > 50 kg/m2.

METHODS

This is a 13- to 17-year follow-up study of a single-center, single-blinded randomized trial in which 47 patients (BMI > 48 and eligible for bariatric surgery) were randomized 1:1 to BPD/DS and RYGB (25 men, 24 BPD/DS, 39.1 ± 9.9 years, BMI 54.5 ± 6.1 kg/m2). The primary outcome was weight loss. The study was financed by Swedish governmental funding of clinical research (ALF).

TRIAL REGISTRATION NUMBER

ISRCTN10940791.

RESULTS

Thirty-four (18 BPD/DS) of the living 42 patients (81.0%) participated. BPD/DS resulted in higher BMI loss (20.4 ± 7.9 vs. 12.4 ± 8.6, p = .008) and higher percent of total body weight loss (37.5% ± 12.2 vs. 22.8% ± 14.8, p = .004). BPD/DS was associated with lower fasting glucose, glycated hemoglobin (HbA1c), and low-density lipoprotein (LDL) as well as lower hemoglobin. Adverse events were more common after BPD/DS (2.7 vs. 0.9 per patient, p = .004). The global assessment tool BAROS (Bariatric Analysis and Reporting Outcome System) demonstrated superior scores for BPD/DS (p = .047).

CONCLUSION

When compared to RYGB, BPD/DS results in superior weight loss and metabolic control as well as superior BAROS score, however, at the cost of more adverse events.

Weight self-perception and weight loss attempts in Chinese cardiovascular patients and non-cardiovascular patients: evidence from a population-based study

BACKGROUND

Weight loss is a significant improvement for individuals with overweight or obesity, especially for cardiovascular patients. The driving effects of weight self-perception and attempts to lose weight are vital in weight management, yet weight misperception is a direct culprit for the undesirability of weight control and obesity prevention. This study aimed to investigate weight self-perception and misperception and weight loss attempts in Chinese adults, especially among cardiovascular and non-cardiovascular patients.

METHODS

We collected data from China HeartRescue Global Evaluation Baseline Household Survey 2015. Questionnaires were used to assess self-reported weight and cardiovascular patients. We used kappa statistics to check the consistency between weight self-perception and BMI. Logistic regression models were fitted to identify risk factors associated with weight misperception.

RESULTS

A total of 2690 participants were enrolled in the household survey, while 157 respondents were cardiovascular patients. According to questionnaire results, 43.3% of cardiovascular patients thought they were overweight and obese, while the percentage is 35.3% among non-cardiovascular patients. Kappa statistics indicated higher consistency of self-reported weight and actual weight among cardiovascular patients. Multivariate analysis showed weight misperception was significantly associated with gender, education level, and actual BMI. Lastly, 34.5% of non-cardiovascular patients and 35.0% of cardiovascular patients were trying to lose weight or keep weight. The majority of these people adopted combined strategies of controlling diet and exercise to lose or maintain weight.

CONCLUSIONS

Weight misperception was highly prevalent among cardiovascular or non-cardiovascular patients. Obese respondents, women, and individuals with lower education levels were more vulnerable to make weight misperception. However, no difference in the purpose of weight loss attempts was indicated among cardiovascular and non-cardiovascular patients.

The impact of psychological distress on weight regain in post-bariatric patients during the COVID-19 pandemic: A latent profile analysis

OBJECTIVE

The COVID-19 pandemic has caused a global health crisis disrupting healthcare delivery for people with severe obesity who have undergone bariatric surgery. This study examined the role of psychological distress during the first Italian COVID-19 lockdown in predicting post-operative outcomes in post-bariatric patients reaching the end of the 12-18 months follow-up during the lockdown. By using a person-centered approach, groups of patients with different psychological distress profiles were identified. We hypothesized that compared to post-bariatric patients with low psychological distress, post-bariatric patients with high psychological distress will be more at risk of weight regain.

METHODS

A total of 67 patients (71.6% female, M_age = 45.9) participated in this observational retrospective cohort study. Patients' anthropometric data were gathered from medical records while the weight at the end of the lockdown through phone interviews. Psychological distress, operationalized with anxiety symptoms, depressive symptoms, and sleep disturbances, was assessed by an online self-report questionnaire.

RESULTS

Significant differences were highlighted in the high and low psychological distressed group in weight changes, F(1,58) = 5.2, p < 0.001, η² = 0.3. Specifically, compared to post-bariatric patients in the low psychological distress group, those in the high psychological distressed group reported weight regained (95% CI = 1.0, 2.6).

CONCLUSION

Results highlight the need to target post-bariatric patients with high psychological distress who are at risk for weight regain during the COVID-19 pandemic. Interventions mitigating psychological distress and obesogenic behaviors during future pandemics or in post-COVID times are needed in vulnerable post-bariatric patients reporting high psychological distress.

Long-Term Outcomes after Adolescent Bariatric Surgery

BACKGROUND

Metabolic and bariatric surgery (MBS) is a safe and effective treatment option for adolescents with severe obesity, but no long-term studies are available with more than10 years of follow-up data to document sustained improved outcomes.

METHODS

A total of 96 patients who completed MBS at 21 years of age or younger in a tertiary academic center 2002 to 2010 were contacted for a telehealth visit. Body weight, comorbidity status, social/physical function status, and long-term complications were evaluated 10 to 18 years after surgery.

RESULTS

Mean participant (83% female, 75% Hispanic) age at MBS was 18.8 (±1.6) years (median age 19 years, range 15-21 years), and median pre-MBS BMI was 44.7 kg/m 2 (SD 6.5). At follow-up (mean 14.2 [±2.2] years) post-MBS (90.6% Roux-en-Y gastric bypass [RYGB] or 8.3% laparoscopic adjustable gastric banding [LAGB]) mean total body weight decreased by 31.3% (interquartile range [IQR] 20.0% to 38.9%); 32.0% (IQR, 21.3% to 40.1%) among RYGB participants and 22.5% (IQR, 0.64% to 28.3%) among LAGB participants. Patients with pre-MBS hyperlipidemia (14.6%), asthma (10.4%), and diabetes/hyperglycemia (5.2%) reported 100% remission at follow-up (p < 0.05 for all). Pre-post decrease in hypertension (13.5% vs 1%, p = 0.001), sleep apnea (16.7% vs 1.0%, p < 0.001), gastroesophageal reflux disease (13.5% vs 3.1%, p = 0.016), anxiety (7.3% vs 2.1%, p = 0.169), and depression (27.1% vs 4.2%, p < 0.001) were also found.

CONCLUSIONS

Significant sustained reductions in weight and comorbidities, and low rates of long-term complications, a decade or more after completing MBS as an adolescent were found. These findings have important implications for adolescents who may be considering MBS for weight reduction and overall health improvements that extend into adulthood.

Association between weight-loss history and weight loss achieved in clinical obesity management: Retrospective chart review

OBJECTIVE

Weight history and its association with the weight loss achieved in a publicly funded clinical obesity management program were examined in 9348 patients.

METHODS

Weight history (frequency and magnitude of weight losses) was collected through questionnaires at enrollment, and weight change was assessed with retrospective electronic medical chart review.

RESULTS

The majority of patients reported developing overweight prior to the age of 40 years and having lost at least 4.5 kg (10 lb) of weight at least once in their lifetime. Those who had an earlier onset of overweight had a higher frequency of past weight loss and had more cumulative weight loss over their lifetime. In women, but not men, earlier age of overweight onset and lifetime weight loss were associated with modestly greater weight loss at the clinic.

CONCLUSIONS

Women with greater weight-loss history also have modestly greater weight loss at the obesity management clinic. Thus, successful long-term obesity management, particularly for women, may include a series of repeated attempts at weight loss that should not be viewed as failures but could be viewed instead as practice.

The accuracy of patient-reported weight prior to total joint arthroplasty and arthroscopy of the lower extremity

PURPOSE

The accuracy of preoperative patient-reported weight was never evaluated in patients undergoing lower extremity procedures. The purpose of this study was to: (1) compare the disparity between patient-reported and measured weights in patients undergoing lower extremity total joint arthroplasty (LE-TJA) and arthroscopy; and (2) investigate the association between patient-specific factors (patient age, BMI, zip code, and psychiatric comorbidities) and the accuracy of patient-reported weight.

METHODS

Preoperative self-reported weights were retrospectively compared to measured weights in 400 LE-TJA and 85 control arthroscopy patients. The difference between reported and measured weights was calculated. Additionally, the percent of accurate reporting within 0.5, 1, and 5 kg ranges of the measured weight was calculated. Outcomes were compared between surgical modalities as well as between patient-specific factors.

RESULTS

There was low disparity (p = 0.838) between patient-reported and measured weights among LE-TJA (mean difference 0.18 ± 3.63 kg; p = 0.446) and that of arthroscopy (0.27 ± 4.08 kg; p = 0.129) patients. Additionally, LE-TJA patients were equally likely to report weights accurately within 0.5 kg of the measured weight (74% vs. 71.76%; p = 0.908). LE-TJA and arthroscopy patients had similar reporting accuracy within 1 and 5 kg of the measured weights (p > 0.05).

CONCLUSION

Preoperative patient-reported weights demonstrated acceptable accuracy in both LE-TJA and lower extremity arthroscopic orthopaedic patient populations making it a potentially reliable parameter of preoperative assessment.

Pictogram Is a Valid Instrument to Classify At-Risk Adult Population Based on Abdominal Obesity: Results from Pars Cohort Study

BACKGROUND

Abdominal obesity is associated with increased risk of myocardial infarction and death events. Thus, obtaining data on the status of abdominal obesity is important in risk factor assessment and prevention of non-communicable diseases. This study aimed to evaluate the validity of using pictograms to classify abdominal obesity indices (waist circumference [WC], waist-hip ratio [WHR], and waist-height ratio [WHtR]) into normal and at-risk categories and determine the effects of demographic characteristics on this validity.

METHODS

This cross-sectional study used data from Pars Cohort Study (PCS). Participants chose the most similar pictogram scores to their body size at 15, 30 years, and current age. Optimal normal/at-risk cut-off values for pictograms were calculated using sensitivity/specificity plots. Receiver operating characteristic curves were used to evaluate the validity of pictograms. Validity measures were analyzed across different subgroups of demographic characteristics.

RESULTS

A total of 9263 participants (46% males) were included in the study. The estimated area under the curves were 84% for WC, 77% for WHR, and 89% for WHtR in males, and 84% for WC, 73% for WHR, and 90% for WHtR in females. Optimal pictogram cutoffs to classify central obesity for WC, WHR, and WHtR were 4, 4, and 5 in males and 4, 4, and 6 in females, respectively. The majority of demographic characteristics were not associated with the validity of pictograms.

CONCLUSION

Using pictograms to determine normal and at-risk categories of abdominal obesity indices is valid among adult population with a wide range of demographic characteristics. However, the results need to be interpreted with caution in those with a positive history of weight fluctuation.

Effect of COVID-19 Lockdowns on Physical Activity, Eating Behavior, Body Weight and Psychological Outcomes in a Post-Bariatric Cohort

PURPOSE

Little is known about the consequences of COVID-19 lockdowns on physical activity (PA), eating behavior, and mental health in post-bariatric surgery (BS) patients. We aimed to analyze the relations between changes in PA during COVID-19 lockdowns and changes in body weight and a comprehensive set of lifestyle and psychological outcomes in patients who have undergone BS.

MATERIAL AND METHODS

In April-May 2020 (lockdown#1), we performed an online survey in a cohort of 937 adults who underwent BS and were followed-up at our university medical center for at least one year. We assessed changes in PA, eating behavior, body weight, fatigue, and depression (PHQ-9). In November-December 2020 (lockdown#2), we recorded body weight in 280 patients who had reported decreased PA during lockdown #1.

RESULTS

During lockdown #1 (N = 420 patients included, 44% response rate), decreased PA was reported by 67% patients. Compared to those who reported increased or unchanged PA, patients with decreased PA were more likely to report a ≥ 5% weight gain (OR (95% CI): 3.15 (1.46-7.65), increased fatigue (2.08 (1.36-3.23)), a worsening of eating behavior (2.29 (1.47-3.58)), and moderate-to-severe depressive symptoms (4.74 (2.14-11.76)). During lockdown #2 (N = 225 patients, 80% response rate), significant weight gain since before lockdown #1 was reported (+ 2.8 (95% CI: 1.7-3.8) kg, p < 0.001), with 36% patients reporting a ≥ 5% weight gain.

CONCLUSIONS

PA may counteract detrimental effects of COVID-19 lockdown on post-BS weight trajectories and mental health outcomes. Follow-up measures are needed in this setting to assess the long-term impact of lockdown.

Psychological Functioning and Health Behaviors Associated with Weight Loss Patterns up to 13.7 Years After Weight Loss Surgery

Weight loss surgery produces dramatic health improvements immediately after surgery, including rapid declines in diabetes. However, less is known about its long-term effects. 124 St. Vincent Bariatric Center patients completed questionnaires on weight and psychological functioning a mean of 7.7 and 13.7 years post-surgery (T1 and T2, respectively). Because mean weight data may mask differing weight trajectories, participants were categorized based on weight over time. Most participants underwent Roux-En-Y gastric bypass (90.3%) and were Caucasian (96%), female (81.5%), and married (69.1%). Mean age at T2 was 64; mean %EWL was 64.9%. Most patients fit into one of three weight change patterns, reaching weight nadir, and regaining by T1 and then, by T2, experiencing (1) Weight Loss (n = 36), (2) Weight Maintenance (n = 37), or (3) Continued Weight Gain (n = 39). Groups differed significantly on body satisfaction, weighing frequency, and conscientiousness, with Weight Gainers significantly lower than other groups on conscientiousness and body satisfaction, and Weight Losers reporting higher frequency of weighing than Maintainers. Bariatric patients can maintain substantial weight loss and positive psychological functioning for many years post-surgery, although weight regain is associated with less body satisfaction. Conscientiousness may signify medical adherence, whereas frequent weighing may be a behavior that promotes ongoing weight loss.

An analysis of weight loss efforts and expectations in a Canadian Cohort: A retrospective medical chart review

The weight loss history and weight loss goals were examined in 4108 patients referred to a publicly funded evidence-based clinical weight management program using a retrospective chart review. The majority of patients were white females, aged of 50.1 ± 13.7 years and a BMI of 39.0 ± 7.5 kg/m² . Pregnancy was the most common reason for weight gain in women (17.7%) and while the reasons in men are more varied (injury, stress and medication: all ~5%). Over 50% of patients cited no specific reason for their weight gain. Self-directed diet and exercise were the most commonly used self-reported weight loss methods. Women were more likely to report using medication and bariatric surgical weight loss methods than men (P < .05), and only 5% of women and 12.8% men report never having tried to lose weight in the past. Patients had an ideal weight loss goal of 28.9% to 34.4%, which was similar to the patient's lowest reported adult weight. Approximately 70% of patients enrolling at the clinic had previously lost at least 4.5 kg (10 lb) one or more times and 16.7% lost weight at least 5 times in their life, but patient weight at enrolment was similar to their highest adult reported weight. Thus, most patients referred to this clinical weight management program have previously attempted self-directed diet and exercise weight loss. Patients were close to their highest adult weight and had very large weight loss goals, similar to what is typically achieved only by surgical intervention, despite having already had several bouts of weight loss.

Examining Weight Bias and Loss-of-Control Eating among Individuals Seeking Bariatric Surgery

OBJECTIVE

Externalized weight bias (EWB), directed towards others, and internalized weight bias (IWB), directed towards the self, are thought to exacerbate obesity and disordered eating and may be important factors to assess and understand among individuals seeking bariatric surgery. This study examined clinical correlates (pre-surgical BMI, depressive symptoms, weight self-efficacy, and shape/weight overvaluation) of both EWB and IWB among individuals presenting for bariatric surgery with and without regular loss-of-control eating (LOC eating).

METHODS

A total of 316 adults presenting for bariatric surgery completed established self-report measures to assess EWB, IWB, depressive symptoms, weight self-efficacy, and core symptoms of disordered eating including LOC eating and overvaluation of shape/weight.

RESULTS

IWB and EWB were not associated with pre-surgical BMI, age, or sex, but were both significantly higher among White than non-White participants. Adjusting for race, IWB and EWB were significantly associated with greater eating disorder psychopathology and depressive symptoms and with less weight-related self-efficacy. Participants who endorsed regular LOC eating (53.5% of the sample) endorsed significantly lower weight self-efficacy and higher IWB, EWB, depressive symptoms, and overvaluation of shape/weight.

CONCLUSIONS

Findings suggest that regular LOC eating is common among individuals seeking bariatric surgery and associated with a range of heightened eating disorder and psychosocial concerns including both IWB and EWB. Future research exploring the longitudinal significance of the relationship between these two forms of weight bias and LOC eating is indicated.

A preliminary study on the psychosocial impact of COVID-19 lockdown in post-bariatric surgery women: the importance of eating behavior, health care access, and social support

This study aims to characterize the psychosocial impact of COVID-19 lockdown for post-bariatric surgery (≥ 36 months) women and its association with disordered eating and psychological distress. The medium to long-time follow up is a period of increased susceptibility for poorer weight outcomes which might be triggered by the lockdown. Twenty-four participants responded to an online questionnaire and a telephone interview. About half (n = 14; 58.3%) reported perceived weight gain during the lockdown, 13 (54.1%) limited access to social support, and 12 (50%) limited access to medical care. Co-habiting with a higher number of persons during lockdown was associated with fewer difficulties in dealing with emotionally activating situations, less fear of gaining weight, less fear of losing control over eating, and less disordered eating. The global perceived psychosocial impact of lockdown was significantly correlated with difficulties in dealing with emotionally activating situations and stress symptoms. Results highlight the need to monitor post-bariatric patients, facilitate health care access, and promote social support during the lockdown period.

Eating behaviors and weight outcomes in bariatric surgery patients amidst COVID-19

Background

Recent studies suggest that eating habits are an area particularly affected by the lockdown imposed by many countries to curb the COVID-19 epidemic. Individuals that received bariatric surgery may represent a particularly susceptible population to the adverse effects of lockdown for its potential impact on eating, psychological, and weight loss outcomes.

Objectives

This study seeks to investigate the incremental impact of COVID-19 lockdown on treatment outcomes of postbariatric patients in the risk period for weight regain.

Setting

Main hospital center.

Methods

This work uses data from an ongoing longitudinal study of bariatric patients assessed before surgery (T₀), 1.5 years after sugery (T₁), and 3 years after surgery (T₂). Two independent groups were compared: the COVID-19_Group (n = 35) where T₀ and T₁ assessments were conducted before the pandemic started and T₂ assessment was conducted at the end of the mandatory COVID-19 lockdown; and the NonCOVID-19_Group (n = 66), covering patients who completed T₀, T₁, and T₂ assessments before the epidemic began. Assessment included self-report measures for disordered eating, negative urgency, depression, anxiety, stress, and weight outcomes.

Results

General linear models for repeated measures showed that the COVID-19_Group presented significantly higher weight concern (F = 8.403, P = .005, ƞ²_p = .094), grazing behavior (F = 7.166, P = .009, ƞ²_p = .076), and negative urgency (F = 4.522, P = .036, ƞ²_p = .05) than the NonCOVID-19_Group. The COVID-19_Group also showed less total weight loss (F = 4.029, P = .05, ƞ²_p = .04) and larger weight regain at T₂, with more COVID-19_Group participants experiencing excessive weight regain (20% versus 4.5%).

Conclusion

These results show evidence for the impact of the coronavirus outbreak on eating-related psychopathology and weight outcomes in postbariatric surgery patients.

Predictors of Weight Loss and Weight Gain in Weight Management Patients during the COVID-19 Pandemic

OBJECTIVE

To examine the associations between patient struggles, health, and weight management changes during the COVID-19 pandemic.

METHODS

585 patients attending a publicly funded clinical weight management program responded to an electronic survey.

RESULTS

Over half of the patients reported worsened overall health, mental health, physical activity, or diet during the pandemic. Approximately 30% of patients lost ≥3% of their body weight and 21% gained ≥3% of their body weight between March and July of the pandemic. Reports of social isolation was associated with increased odds for weight loss in women (OR = 2.0, 1.2-3.3), while low motivation (OR = 1.9, 1.0-3.7), depression (OR = 2.5, 1.0-6.3), and struggles with carbohydrate intake (OR = 2.1, 1.0-4.3) were associated with weight gain. Cooking more at home/eating less take out was associated with increased likelihood of weight loss (OR = 2.1, 1.1-3.9) and lower odds for weight gain (OR = 0.2, 0.1 to 0.97). Working from home was not associated with weight loss or weight gain (P > 0.6).

CONCLUSION

The COVID-19 pandemic is associated with certain factors that may facilitate weight loss and other factors that promote weight gain. Thus, depending on the patient experience during the pandemic, prevention of weight gain may be more appropriate than weight loss.

Internalized weight bias in patients presenting for bariatric surgery

INTRODUCTION

Internalized weight bias (IWB) is significantly related to poor psychosocial health outcomes in patients with increased body mass index (BMI). The objective of this study was to evaluate the psychometric properties and correlates of the Weight-Bias Internalization Scale in a pre-surgical bariatric population.

METHODS

Self-report measures were administered to patients prior to surgery. Measures assessed internalized weight bias, body dissatisfaction, depression, anxiety, quality of life, and eating behaviors. Statistical methods included confirmatory factor analysis to examine the factor structure [of the WBIS] in this population, descriptive statistics, correlations, and hierarchical linear regression between continuous variables to determine patterns of associations, and t-tests to compare levels of IWB between the current sample and previously documented samples.

RESULTS

Confirmatory factor analysis indicated an acceptable fit using a one-factor structure for the WBIS, with one item removed. Mean WBIS in the current sample was comparable to that documented in a community sample of adults with overweight and obesity, as well as a sample of adolescents seeking bariatric surgery. Additionally, IWB was positively associated with body dissatisfaction, restrained, emotional, and external eating, depression, and anxiety, and negatively associated with quality of life. Further, individuals endorsing episodes of loss of control over eating had significantly higher WBIS scores.

CONCLUSIONS

This study highlights the strong pattern of associations with measures of body image, disordered eating, and quality of life point toward the relevance of IWB to bariatric patients' experiences. Future studies to explore the longitudinal effects of IWB in a post-bariatric population are needed particularly to understand psychosocial and surgical health outcomes.

Childhood maltreatment in bariatric patients and its association with postoperative weight, depressive, and eating disorder symptoms

PURPOSE

The present study aimed to compare prevalence rates of childhood maltreatment between patients with severe obesity undergoing bariatric surgery and patients without a surgical procedure. Second purpose was to calculate the association between childhood maltreatment and outcomes 6 and 12 months after a bariatric procedure.

METHODS

Childhood maltreatment was assessed using the Childhood Trauma Questionnaire (CTQ) and compared between 120 bariatric surgery patients and 346 non-surgery patients with severe obesity. For the bariatric surgery subgroup, linear mixed models with repeated measures were used to analyze the predictive value of childhood maltreatment on weight outcomes and psychopathology. Additionally, between- and within-group comparisons were calculated to compare patients with and without childhood maltreatment regarding BMI and weight loss (%TWL, %EWL), depression severity (BDI-II), eating disorder psychopathology (EDE-Q), and suicidal ideation (BSS), at baseline, 6- and 12-month assessment.

RESULTS

Prevalence rates for childhood maltreatment, depression and suicidal ideation were significantly higher in non-surgery compared to bariatric surgery patients. Within the surgery group, no significant interaction effect between childhood maltreatment and time was found. Hence, childhood maltreatment did not impact the course of body weight, depression and eating disorder psychopathology from pre- to post-surgery.

CONCLUSIONS

Significantly higher rates of childhood maltreatment were found within non-surgery patients with obesity in comparison to bariatric surgery patients. Childhood maltreatment did not predict poorer outcomes after surgery. Since history of childhood maltreatment may increase the risk for psychological disturbances, regular screening and, if necessary, psychological support should be offered to both groups.

LEVEL OF EVIDENCE

Evidence obtained from well-designed cohort or case-control analytic studies, Level III.

CLINICAL TRIAL REGISTRATION

Deutsches Register Klinischer Studien-German Clinical Trials Register: DRKS00003976.

A comparison of measured versus self-reported anthropometrics for assessing obesity in adults: a literature review

Aims: Up-to-date information on the accuracy between different anthropometric data collection methods is vital for the reliability of anthropometric data. A previous review on this matter was conducted a decade ago. Our aim was to conduct a literature review on the accuracy of self-reported height, weight, and body mass index (BMI) against measured values for assessing obesity in adults. To obtain an overview of the present situation, we included studies published after the previous review. Differences according to sex, BMI groups, and continents were also assessed. Methods: Studies published between January 2006 and April 2017 were identified from a literature search on PubMed. Results: Our search retrieved 62 publications on adult populations that showed a tendency for self-reported height to be overestimated and weight to be underestimated when compared with measured values. The findings were similar for both sexes. BMI derived from self-reported height and weight was underestimated; there was a clear tendency for underestimation of overweight (from 1.8%-points to 9.8%-points) and obesity (from 0.7%-points to 13.4%-points) prevalence by self-report. The bias was greater in overweight and obese participants than those of normal weight. Studies conducted in North America showed a greater bias, whereas the bias in Asian studies seemed to be lower than those from other continents. Conclusions: With globally rising obesity rates, accurate estimation of obesity is essential for effective public health policies to support obesity prevention. As self-report bias tends to be higher among overweight and obese individuals, measured anthropometrics provide a more reliable tool for assessing the prevalence of obesity.

Lifetime Self-Harm Behaviors Are Not More Prevalent in Bariatric Surgery Candidates than in Community Controls with Obesity

OBJECTIVE

The study aimed at investigating the lifetime prevalence of 22 self-harm behaviors in bariatric surgery candidates (pre-bariatric surgery group; PSG) compared to community controls with obesity (obese community group; OCG).

METHODS

The Self-Harm Inventory (SHI) was administered to the PSG (n = 139, BMI ≥ 35 kg/m2) and to the OCG (n = 122, BMI ≥ 35 kg/m2).

RESULTS

Group comparison of cumulative SHI scores indicated a trend towards less endorsed SHI items in the PSG compared to the OCG (medianPSG = 1.00, IQRPSG = 2.00, medianOCG = 1.00, IQROCG = 2.25, U = 7.241, p = 0.033, η2 = 0.02). No significant group differences were found with regard to the rate of suicide attempts (12.4% vs. 9.4% for OCG vs. PSG). At least one type of lifetime self-harm behavior was admitted by 51.8% of the PSG and 63.9% of the OCG (χ2(1) = 3.91, p = 0.048). The results of logistic regressions using Firth's bias reduction method with at least one SHI item endorsed as dependent variable, group as categorical predictor (PSG as baseline), and age or BMI or PHQ-4 as continuous control variable indicated that only PHQ-4 had a positive effect on the odds ratio.

CONCLUSION

The results suggest that self-harm (including suicidal attempts) is not more prevalent in bariatric surgery candidates than in community control participants with obesity. Further studies are needed to investigate self-harm in bariatric surgery patients, prior and following surgery, compared to non-operated patients with obesity.

Accuracy of Self-Reported Weight Among Adolescent and Young Adults Following Bariatric Surgery

PURPOSE

This study evaluates accuracy of self-reported weight in adolescent bariatric surgery patients.

MATERIALS AND METHODS

During follow-up visits, participants self-reported weight and had weight measured. The differences between self-reported and measured weights were analyzed from 60 participants.

RESULTS

Participants were 70% (n = 42) female, 72% (n = 43) white, mean age of 20.8 years and a median body mass index of 36.6 kg/m². At an average of 3.5 years following surgery, females underestimated weight (0.5 kg, range: -18.7 to 5.6 kg), while males overestimated (1.1 kg, range: -7.8 to 15.2 kg). Most (80%, n = 48) reported within 5 kg of measured weight. The majority of adolescents who previously underwent bariatric surgery reported reasonably accurate weights, but direction of misreporting varied by gender.

CONCLUSION

Self-reported weights could be utilized when measured values are unavailable without markedly biasing the interpretation of outcomes.

Inaccurate self-report of height and its impact on misclassification of body mass index in postmenopausal women

OBJECTIVE

Self-reported height is commonly used in population obesity research. Evidence has also shown a positive association between depression and obesity. We examined the extent of height misreporting and its impact on body mass index (BMI) calculations and classification, and explored whether depression is associated with height misreporting.

METHODS

The Buffalo Osteoporosis and Periodontal Disease Follow-up Study enrolled 1,015 postmenopausal women between 2002 and 2006. Participants self-reported their height on a questionnaire before stadiometer measurement at the clinical visit. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. Odds ratios and 95% CI for association between depression and height misreporting were estimated using logistic regression.

RESULTS

Overall, 446 women (43.9%) misreported height by greater than 1/2 inch, of which 296 (29.2%) underestimated and 150 (14.8%) overestimated their height. Height misreporting influenced BMI calculations by ≥1 unit in 12% of women, and influenced classification into WHO BMI categories in 8% of women. After adjusting for age, race, education, and measured BMI, women with significant depressive symptoms were more likely to misreport their height (odds ratio = 1.65, 95% CI, 1.04-2.61).

CONCLUSIONS

Height misreporting was common in older women and significantly influenced BMI calculations and classification. Obtaining objective data is thus important for studies investigating obesity-disease associations in this population, especially in those with significant depressive symptoms.

Sustained effects of a psychoeducational group intervention following bariatric surgery: follow-up of the randomized controlled BaSE study

BACKGROUND

Evidence regarding the efficacy of psychosocial interventions after bariatric surgery is rare and shows conflicting results.

OBJECTIVES

The Bariatric Surgery and Education (BaSE) study aimed to assess the efficacy of a psychoeducational group intervention in patients after bariatric surgery.

SETTING

The BaSE study was a randomized, controlled, multicenter clinical trial involving 117 patients who underwent bariatric surgery. Patients received either conventional postsurgical visits or, in addition, a 1-year psychoeducational group program. The present study evaluated the sustained effects of the intervention program. Mean follow-up duration was 37.9 months (standard deviation [SD] 8.2 months) after surgery.

METHODS

Outcome measures were as follows: body mass index (BMI), weight loss, self-efficacy, depression severity, and health-related quality of life (HRQOL). Groups were compared using an intention-to-treat approach with a mixed model for repeated measurements.

RESULTS

A total of 74 patients (63.2%) completed the follow-up (T5) assessment. Mean weight loss for all patients was 43 kg (SD 15.5 kg) at T5 (mean BMI 35.1 kg/m²). Mean excess weight loss was 60.4%. The effects of the surgery during the first postsurgical year were reflected, on average, by both decreasing weight and psychosocial burden. At the T5 time point, patients had slowly started to regain weight and to deteriorate regarding psychosocial aspects. However, at T5, patients who had participated in the intervention program (n = 39) showed significantly lower depression severity scores (p = .03) and significantly higher self-efficacy (p = .03) compared to the control group (n = 35). The 2 groups did not differ regarding weight loss and quality of life.

CONCLUSION

Psychoeducational intervention shows sustained effects on both depression severity scores and self-efficacy.

Ethnic Considerations for Metabolic Surgery

Obesity and diabetes represent twin health concerns in the developed world. Metabolic surgery has emerged as an established and enduring treatment for both obesity and diabetes. As the burden of obesity and diabetes varies upon the basis of ethnicity, it is also apparent that there may be differences for indications and outcomes for different ethnic groups after metabolic surgery. Whereas there appears to be evidence for variation in weight loss and complications for different ethnic groups, comorbidity remission particularly for diabetes appears to be free of ethnic disparity after metabolic surgery. The impacts of access, biology, culture, genetics, procedure, and socioeconomic status upon metabolic surgery outcomes are examined. Further refinement of the influence of ethnicity upon metabolic surgery outcomes is likely imminent.

Long-term outcomes of laparoscopic sleeve gastrectomy: a Lebanese center experience

BACKGROUND

Long-term data of laparoscopic sleeve gastrectomy (LSG) are still scarce in the Middle East.

OBJECTIVES

The aim of this study was to assess the efficacy and safety at 5 years and beyond.

SETTING

Tertiary referral hospital between April 2007 and March 2015.

METHODS

A retrospective review of 76 patients who underwent LSG at the senior author's institution between April 2007 and March 2010.

RESULTS

Mean preoperative body mass index (BMI) was 42.8±7.1 kg/m². Follow-up rates were 90.4%, 86.3%, and 77.8% at 5, 6, and 7 years, respectively. Percentage of excess weight loss (%EWL) was 69.8%±28.7% at 5 years, 70.6%±32.7% at 6 years, and 76.6%±21.2% at 7 years, respectively. Mean total weight loss was 26.5%±8.7%, 24.9%±8.8%, and 26.6%±6.0% at 5, 6, and 7 years, respectively. %EWL at 5-years was significantly higher for patients with a preoperative BMI<45 kg/m² (83.1% versus 46.3%, P<.0001). LSG improved or resolved diabetes, hypertension, and asthma in 87.5%, 68%, and 81.7% of patients, respectively. New onset gastroesophageal acid reflux disease developed in 21.2% of patients. Long-term complications included hiatal hernias necessitating repair (1.4%), incisional hernias (2.7%), and symptomatic gallstones (9.6%), as well as depression necessitating admission (4.1%).

CONCLUSION

In the present patient population, LSG resulted in satisfactory %EWL and co-morbidity resolution after 5 years. The results were excellent for patients with a BMI<45 kg/m². De novo acid reflux symptoms developed in 1 of 5 patients. Cholelithiasis necessitating cholecystectomy was the most common long-term complication.

The internalization of weight bias is associated with severe eating pathology among lean individuals

OBJECTIVE

The internalization of weight bias is associated with clinically significant eating pathology among overweight adults. However, these relationships have not yet been assessed in lean individuals, who may perceive themselves to be overweight and subsequently internalize weight bias. The aim of the present study, therefore, was to determine whether lean individuals internalize weight bias and if the internalization of weight bias among lean respondents is associated with eating pathology.

METHOD

Participants were 197 lean (mean BMI: 22.28±1.89, range 15.80-24.98) adults who completed the Weight Bias Internalization Scale (WBIS) and measures of disordered eating behaviors and attitudes via an anonymous online survey.

RESULTS

Based on convergence of responses from the EDE-Q and QEWP-R, and using DSM-5 behavioral criteria, 10% and 15% of participants were classified into a binge eating and binge/purge group, respectively. WBIS scores were significantly higher among those with binge and/or purge behaviors compared to those without eating pathology. Bivariate correlations revealed positive associations between WBIS score and BMI, depression, and all EDE-Q subscales (restraint, eating concern, shape concern, weight concern). Logistic regressions indicated that internalized weight bias was significantly associated with binge/purge behaviors (OR=4.67, 95% CI: 2.38-9.17, p<.001) and binge eating (OR=2.29, 95% CI: 1.26-4.19, p<.01).

DISCUSSION

These novel findings suggest that lean individuals may internalize weight bias. Importantly, the internalization of weight bias among lean individuals is associated with clinically significant eating pathology.

The association of "food addiction" with disordered eating and body mass index

INTRODUCTION

The contribution of an addictive process to elevated body mass index (BMI) and disordered eating is an area of growing interest. Yet, little is known about how "food addiction" may be related to disordered eating and obesity. The ability of addictive-like eating to account for eating pathology not captured by traditional eating disorders is unknown. No prior research has examined the association of "food addiction" with bulimia nervosa (BN). Finally, little is understood about the association of "food addiction" with patterns of dieting and weight gain. The current study was conducted to address these gaps in the literature.

MATERIAL AND METHODS

Participants (N=815) were recruited from online advertisements nationwide and completed measures related to "food addiction", BMI, weight history, and disordered eating.

RESULTS

Addictive-like eating was associated with elevated current and lifetime highest BMI, weight cycling, and eating pathology. The prevalence of "food addiction" was higher in participants with BN than in those with binge eating disorder (BED). "Food addiction" continued to be related to clinically relevant variables, especially elevated BMI, even when participants did not meet criteria for BED or BN. The co-occurrence of "food addiction" with eating disorders appears to be associated with a more severe variant of eating pathology.

DISCUSSION

An addictive-type response to highly palatable food may be contributing to eating-related problems, including obesity and eating disorders. BN relative to BED appears to be more strongly associated with "food addiction." Additionally, the concept of "food addiction" appears to capture clinically relevant information in participants who do not meet criteria for either BN or BED. Further examination of "food addiction" may be important in understanding the mechanisms underlying certain types of problematic eating behavior.

Association between health-related quality of life and body mass after adjustable gastric banding: a nonlinear approach

OBJECTIVE

To estimate the relationship between health utilities and body mass index (BMI) among a cohort of obese patients who underwent laparoscopic adjustable gastric banding (LAGB).

METHODS

We used a cross-sectional survey to ascertain demographic, clinical, and health utility data from patients who had undergone LAGB in Washington State from 2004 to 2010. The EuroQol five-dimensional (EQ-5D) questionnaire was used for health utility estimation. We calculated adjusted EQ-5D questionnaire indices across BMI categories by using a two-part model. We also used logistic regression to examine the relationship between BMI and the likelihood of reporting problems on each of the EQ-5D questionnaire dimension.

RESULTS

Data were obtained from 790 subjects. The mean adjusted EQ-5D questionnaire indices for all obese BMI categories were significantly lower than those in the normal weight category. The relationship between BMI and EQ-5D questionnaire indices was nonlinear. Respondents classified as morbidly obese II (BMI > 50 kg/m(2)) had the greatest decrement (-0.15, 95% confidence interval -0.28 to -0.01) in EQ-5D questionnaire indices. The association between EQ-5D questionnaire indices and BMI at the time of the survey was weaker after adjusting for weight loss after LAGB. Respondents with higher BMI were more likely to report having problems in the mobility, usual/activity, pain/discomfort, and anxiety/depression dimensions (trend test, P < 0.05), but not for the self-care dimension (trend test, P = 0.08).

CONCLUSIONS

The EQ-5D questionnaire has a negative and nonlinear relationship with BMI for obese patients who had LAGB. The relationship is confounded by weight loss. Within the EQ-5D questionnaire dimensions, patients are more likely to report having problems in the mobility, usual/activity, pain/discomfort, and anxiety/depression dimensions in higher BMI categories, but not in the self-care dimension.

The comparative effectiveness of sleeve gastrectomy, gastric bypass, and adjustable gastric banding procedures for the treatment of morbid obesity

OBJECTIVE

To evaluate the comparative effectiveness of sleeve gastrectomy (SG), laparoscopic gastric bypass (RYGB), and laparoscopic adjustable gastric banding (LAGB) procedures.

BACKGROUND

Citing limitations of published studies, payers have been reluctant to provide routine coverage for SG for the treatment of morbid obesity.

METHODS

Using data from an externally audited, statewide clinical registry, we matched 2949 SG patients with equal numbers of RYGB and LAGB patients on 23 baseline characteristics. Outcomes assessed included complications occurring within 30 days, and weight loss, quality of life, and comorbidity remission at 1, 2, and 3 years after bariatric surgery.

RESULTS

Matching resulted in cohorts of SG, RYGB, and LAGB patients that were well balanced on baseline characteristics. Overall complication rates among patients undergoing SG (6.3%) were significantly lower than for RYGB (10.0%, P < 0.0001) but higher than for LAGB (2.4%, P < 0.0001). Serious complication rates were similar for SG (2.4%) and RYGB (2.5%, P = 0.736) but higher than for LAGB (1.0%, P < 0.0001). Excess body weight loss at 1 year was 13% lower for SG (60%) than for RYGB (69%, P < 0.0001), but was 77% higher for SG than for LAGB (34%, P < 0.0001). SG was similarly closer to RYGB than LAGB with regard to remission of obesity-related comorbidities.

CONCLUSIONS

With better weight loss than LAGB and lower complication rates than RYGB, SG is a reasonable choice for the treatment of morbid obesity and should be covered by both public and private payers.

The influence of a defendant's body weight on perceptions of guilt

OBJECTIVE

To investigate the influence of a defendant's weight on simulated jurors' perceptions of guilt.

DESIGN AND METHODS

Participants were 471 lean and overweight adults (mean body mass index: 25.34±5.91) who read a vignette describing a case of check fraud while viewing one of four images of the alleged defendant (a lean male, a lean female, an obese male or an obese female). Participants rated the defendant's culpability on a 5-point Likert scale and completed measures of anti-fat attitudes.

RESULTS

Male respondents endorsed greater overall weight bias than females (F (1470)=23.815, P<0.01, η(2)=0.048). A three-way interaction was detected between participant sex, defendant sex and defendant weight on perceptions of guilt such that when the defendant was female, male participants were significantly more likely to find her guilty if she was obese than if she was lean (guilt ratings=4.05±0.83; 3.31±1.03, respectively; F(1467)=5.935, P=0.015, R(2)=0.060). In addition, lean male participants were significantly more likely to believe that the obese female defendant met criteria for check fraud, and indicated greater belief she would be a repeat offender, compared with the lean female defendant (t(90)=2.081, P=0.040; t(90)=2.395 P=0.019, respectively). There were no differences in perceptions of guilt or responsibility between the obese male and the lean male defendants.

CONCLUSION

The results of this novel study indicate that both weight and gender of a defendant may affect juror perceptions of guilt and responsibility.

The impact of age and BMI on impairment due to disordered eating in a large female community sample

The impact of age and BMI on functional impairment in eating disorders was assessed by the Clinical Impairment Assessment (CIA) scale in a representative community sample. The CIA was administered to 1080 women aged 16-50 years (M=36.2, SD=9.5) with a range of BMI from 13.5 to 55.0 (M=24.6, SD=4.9) randomly selected from the Norwegian National Population Register. The average global CIA score was 5.3 (SD=8.5). Impairment tended to decrease with age (r(s)=-.20, p<.01), yet increased with greater BMI (r(s)=.31, p<.01). Approximately 30% of the participants with obesity scored in the clinical range compared to 7% of the underweight and normal-weight participants. Data supported the utility and feasibility of the CIA as a measure of functional impairment secondary to weight, shape, and eating concerns. It is recommended that age and BMI be considered during the interpretation of CIA data.

Risk perception of obesity and bariatric surgery in patients seeking treatment for obesity

Bariatric surgery (BSx) produces clinically relevant weight loss that translates into improved quality of life, decreased mortality, and reduction in medical comorbidities, including cardiovascular (CV) risk. Little is known about patients' decision-making process to undergo BSx, but risk perception is known to influence medical decision-making. This study examined CV and BSx risk perception in obese subjects undergoing BSx (n = 268) versus those managed medically (MM) (n = 273). This retrospective population-based survey of subjects evaluated for BSx had 148 (55%) and 88 (32%) responders in the BSx and MM groups, respectively. Survey questions assessed risk perceptions and habits prior to weight loss intervention. CV risk was calculated using the Framingham Risk Score (FRS). At baseline, BSx subjects had a greater body mass index and greater prevalence of diabetes and depression. Follow-up mean weight loss was greater in the BSx group. BSx subjects perceived obesity as a greater risk to their overall health than the surgical risk. FRS declined in the BSx group (10 to 5%; p < 0.001) while there was no change in the MM group (8 to 8%; p = 0.54). Those without a measurable decrease in CV risk had a greater tendency to perceive the risk of BSx as greater than that of obesity. Obese subjects undergoing BSx are more likely than MM subjects to perceive obesity as a greater risk to their health than BSx. MM subjects generally underestimate their CV risk and overestimate the risk of BSx. Active discussion of CV risk using the FRS and the perception of risk associated with bariatric surgery can enhance patients' ability to make an informed decision regarding their management.

Accuracy of self-reported weight and height and resulting body mass index among obese binge eaters in primary care: relationship with eating disorder and associated psychopathology

OBJECTIVE

This study assessed the accuracy of self-reported weight, height, and body mass index in obese patients with binge-eating disorder (DSM-IV-TR criteria) presenting at primary care clinics and tested whether the degree of inaccuracy was associated with demographic factors or eating disorder and depressive features.

METHOD

Sixty-six participants were interviewed using the Eating Disorder Examination interview, completed the Eating Disorder Examination Questionnaire and the Beck Depression Inventory, and had their height and weight measured between November 2007 and May 2009.

RESULTS

Self-reported and measured weight did not differ significantly, but participants significantly overestimated their height (P < .01), and this discrepancy resulted in a significantly lower self-reported than measured body mass index (P < .05). Discrepancy scores did not differ by eating disorder or depressive symptoms, sex, or ethnicity, although increasing age was associated with overestimation of height and underestimation of body mass index.

CONCLUSIONS

The findings suggest that obese patients with binge-eating disorder in primary care settings are reasonably accurate reporters of weight and height and that the degree of inaccuracy does not appear to be systematically related to eating disorder psychopathology or depressive features.

Accuracy and reliability of self-reported weight and height in the Sister Study

OBJECTIVE

To assess the accuracy and reliability of self-reported weight and height and identify the factors associated with reporting accuracy.

DESIGN

Analysis of self-reported and measured weight and height from participants in the Sister Study (2003-2009), a nationwide cohort of 50 884 women aged 35-74 years in the USA with a sister with breast cancer.

SETTING

Weight and height were reported via computer-assisted telephone interview (CATI) and self-administered questionnaires, and measured by examiners.

SUBJECTS

Early enrolees in the Sister Study. There were 18 639 women available for the accuracy analyses and 13 316 for the reliability analyses.

RESULTS

Using weighted kappa statistics, comparisons were made between CATI responses and examiner measures to assess accuracy and CATI and questionnaire responses to assess reliability. Polytomous logistic regression evaluated factors associated with over- or under-reporting. Compared with measured values, agreement was 96 % for reported height (±1 inch (±2·5 cm); weighted κ = 0·84) and 67 % for weight (±3 lb (±1·36 kg); weighted κ = 0·92). Obese women (BMI ≥ 30 kg/m2) were more likely than normal-weight women to under-report weight by ≥5 % and underweight women (BMI < 18·5 kg/m2) were more likely to over-report. Among normal-weight and overweight women (18·5 kg/m2 ≤ BMI < 30 kg/m2), weight cycling and lifetime weight difference ≥50 lb (≥22·68 kg) were associated with over-reporting.

CONCLUSIONS

US women in the Sister Study were reasonably reliable and accurate in reporting weight and height. Women with normal-range BMI reported most accurately. Overweight and obese women and those with weight fluctuations were less accurate, but even among obese women, few under-reported their weight by >10 %.

Bulimia nervosa in overweight and normal-weight women

The aim of the present study was to examine overweight bulimia nervosa (BN) in a community sample of women. Volunteers (n = 1964) completed self-report questionnaires of weight, binge eating, purging, and cognitive features. Participants were classified as overweight (body mass index ≥25) or normal weight (body mass index <25). Rates of BN within the overweight and normal-weight classes did not differ (6.4% vs 7.9%). Of the 131 participants identified as BN, 64% (n = 84) were classified as overweight BN and 36% (n = 47) as normal-weight BN. The overweight BN group had a greater proportion of ethnic minorities and reported significantly less restraint than the normal-weight BN group. Otherwise, the 2 groups reported similarly, even in terms of purging and depression. In summary, rates of BN did not differ between overweight and normal-weight women. Among BN participants, the majority (two thirds) were overweight. Differences in ethnicity and restraint, but little else, were found between overweight and normal-weight BN. Findings from the present study should serve to increase awareness of the weight range and ethnic diversity of BN, and highlight the need to address weight and cultural sensitivity in the identification and treatment of eating disorders.

The association between mood and anxiety disorders with vascular diseases and risk factors in a nationally representative sample

OBJECTIVE

To investigate the association between mood and anxiety disorders and vascular diseases after controlling for vascular disease risk factors.

METHODS

Using a nationally representative sample of adults (N=5692) from the National Comorbidity Survey-Replication (NCS-R), participants with mood disorders were hierarchically classified as having any lifetime history of mania, hypomania, or major depression. Anxiety disorders were also assessed. The reference group consisted of those without mental disorders. Vascular disease was determined by self-reported history of heart disease, heart attack, or stroke on the NCS-R survey. Vascular risk factors included diabetes, high blood pressure, and obesity.

RESULTS

In multivariate logistic regression models that controlled for obesity, high blood pressure, smoking and diabetes, vascular disease was associated with bipolar disorder in women [odds ratio (OR) 2.80, 95% confidence interval (CI) 1.63-4.80], and major depressive disorder in men (OR 1.85, 95% CI 1.17-2.92). Controlling for anxiety disorders reduced the associations in both men and women, and in fact, anxiety disorders were more strongly associated with vascular diseases in men, whereas bipolar disorder continued to be an important correlate of vascular disease in women.

CONCLUSION

These findings demonstrate the importance of evaluation of sex differences, mood disorder subtype and co-occurring anxiety disorders in assessing the association between mood disorders and vascular diseases. Future research should investigate potential biologic mechanisms for these associations in order to define potential targets for intervention.

Self-perception of weight and its association with weight-related behaviors in young, reproductive-aged women

OBJECTIVES

To examine weight misperceptions and their predictors and association with weight-related behaviors among low-income, multiethnic, reproductive-age women.

METHODS

We assessed perceptions of body weight and weight-related behaviors of women aged 18 to 25 attending one of five publicly funded reproductive clinics in Texas between August 2008 and March 2010. Data were collected through self-administered questionnaires and chart review. Overweight and normal-weight women were divided into four categories based on self-perception of their body weight: overweight misperceivers, overweight actual perceivers, normal-weight misperceivers, and normal-weight actual perceivers. Multivariable logistic regression analyses were performed to examine the predictors of misperception and the association with weight-related behaviors.

RESULTS

Twenty-three percent (267/1,162) of overweight and 16% (170/1,062) of normal-weight women were misperceivers. Overweight African-American women were more likely to consider themselves normal weight (28% compared with 15%; odds ratio [OR], 2.84; 95% confidence interval [CI], 1.79-4.50), whereas normal-weight African-American women were less likely than whites to consider themselves overweight (7% compared with 16%; OR 0.40; 95% CI 0.22-0.74). Overweight women who had at least some college education (14% compared with 29%; OR 0.53; 95% CI 0.32-0.86) and used the Internet (18% compared with 28%; OR 0.47; 95% CI 0.31-0.70) were less likely to misperceive their body weight. Normal-weight misperceivers were more likely to report healthy and unhealthy weight-reduction behaviors compared with normal-weight actual perceivers, after adjusting for age, race, ethnicity, and body mass index. Opposite scenarios were observed for overweight misperceivers.

CONCLUSION

Weight misperception is common among both overweight and normal-weight women of reproductive age. Clinicians should provide patient-specific counseling related to healthy weight management goals that take each patient's perceptions into consideration.

Psychological and behavioral correlates of excess weight: misperception of obese status among persons with Class II obesity

OBJECTIVE

This study examined psychological and behavioral correlates of weight status perception in 173 Class II obese adult community volunteers.

METHOD

Participants completed the Eating Disorder Examination-Self-Report (EDE-Q), Three Factor Eating Questionnaire (TFEQ), Beck Depression Inventory, and Rosenberg Self-Esteem Scale online. Key items assessed dieting frequency, weight history, and perceived current weight status (normal weight, overweight, or obese). Actual weight status was determined using NIDDK/CDC classification schemes.

RESULTS

Among participants with Class II obesity, 50.9% incorrectly classified their weight as overweight versus obese, whereas 49.1% accurately perceived their weight status as obese. Inaccurate participants reported significantly less binge eating and less eating disorder psychopathology. Despite similar BMI, inaccurate participants reported less distress regarding overeating and loss of control over eating.

DISCUSSION

Our findings suggest that obesity status underestimation is associated with less eating disorder psychopathology. Underestimation of obesity status may exacerbate risk for negative health consequences because of a failure to recognize and respond to excess weight.

The effects of body mass index on complications and survival outcomes in patients with cervical carcinoma undergoing curative chemoradiation therapy

BACKGROUND

The effect of body mass index (BMI) on treatment outcomes for patients with locally advanced cervical carcinoma who receive definitive chemoradiation is unclear.

METHODS

The cohort in this study included all patients with cervical carcinoma (n = 404) who had stage IB(1) disease and positive lymph nodes or stage ≥IB(2) disease and received treatment at the authors' facility between January 1998 and January 2008. The mean follow-up was 47.2 months. BMI was calculated using the National Institute of Health online calculator. BMI categories were created according to the World Health Organization classification system. Primary outcomes were overall survival, disease-free survival, and complication rate. Univariate and multivariate analyses were performed. Kaplan-Meier survival curves were generated and compared using Cox proportional hazard models.

RESULTS

On multivariate analysis, compared with normal weight (BMI 18.5-24.9 kg/m(2) ), a BMI <18.5 kg/m(2) was associated with decreased overall survival (hazard ratio, 2.37; 95% confidence interval, 1.28-4.38; P < .01). The 5-year overall survival rate was 33%, 60%, and 68% for a of BMI <18.5 kg/m(2) , a BMI from 18.5 kg/m(2) to 24.9 kg/m(2) , and a BMI >24.9 kg/m(2) , respectively. A BMI <18.5 kg/m(2) was associated with increased risk of grade 3 or 4 complications compared with a BMI >24.9 kg/m(2) (radiation enteritis: 16.7% vs 13.6%, respectively; P = .03; fistula: 11.1% vs 8.8%, respectively; P = .05; bowel obstruction: 33.3% vs 4.4%, respectively; P < .001; lymphedema: 5.6% vs 1.2%, respectively; P = .02).

CONCLUSIONS

Underweight patients (BMI <18.5 kg/m(2) ) with locally advanced cervical cancer had diminished overall survival and more complications than normal weight and obese patients.

Accuracy of self-reported weight and height in binge eating disorder: misreport is not related to psychological factors

This study examined the degree of misreport in weight, height, and BMI among overweight adults (n = 392) with binge eating disorder (BED) and tested whether the degree of misreport was associated with eating disorder psychopathology and psychological variables. Male (n = 97) and female (n = 295) participants self-reported height and weight, and were subsequently measured by clinic staff. Participants also completed a series of diagnostic interviews and self-report assessments. Discrepancies between self-reported and measured values were modest. The degree of misreport for weight, height, and BMI was not related to eating disorder features, depression, and self-esteem. Overall, the errors in self-reported weight and height by overweight patients with BED were very slight. The degree of discrepancy between self-reported and measured values was not related to eating disorder or psychological features, suggesting that such data are not biased or systematically related to individual differences in overweight patients with BED.

Psychosocial correlates of binge eating in Hispanic, African American, and Caucasian women presenting for bariatric surgery

Research suggests that that binge eating, stress, and depression are prevalent among individuals seeking bariatric surgery. However, ethnic differences in the prevalence of binge eating and binge eating disorder (BED) in this population remain unclear, as does the impact of depression and stress on any such relationship. Further, no studies to date have examined the prevalence of binge eating in Hispanic women presenting for bariatric surgery. This study sought to (a) compare the prevalence and severity of binge eating symptomatology and BED diagnosis in Hispanic, African American, and Caucasian women presenting for gastric bypass surgery, (b) examine the impact of depressive symptoms and stress on binge eating symptomatology, and (c) investigate whether ethnicity moderated any relationship between depression, stress, and binge eating. Results indicated that Hispanic women exhibited equal rates of binge eating symptomatology, BED, and depressive symptomatology as African American and Caucasian women. However, Caucasian women exhibited greater binge eating symptomatology than African American women, and African American women endorsed greater levels of stress than Caucasian women. Across all ethnic groups, depressive symptomatology, but not stress, significantly predicted binge eating severity. These findings suggest that Hispanic women presenting for bariatric surgery report binge eating rates equivalent to Caucasian and African American women, and that depressive symptoms are an important predictor of binge eating in female bariatric surgery candidates across ethnic groups.

Do quitters have anything to lose? Changes in body mass index for daily, never, and former smokers over an 11-year period (1990—2001)

Aims: The purpose of the present study was to examine whether body mass index (BMI) trajectories differed between daily smokers, never smokers, and former daily smokers among a population-based sample over an 11-year period. Methods: A cohort of 1,166 adults (n = 579 men; n = 587 women) self-reported BMI during a general health interview twice administered in two regions in Norway. Of the participants, 37.5% were never smokers, 31.6% current smokers, and 31% were former smokers. Results: Those who had quit smoking within the past five years had the highest age-adjusted BMI increase, gaining 3 kg and 5 kg more weight on average than current smokers (women and men, respectively). No significant differences in weight gain over the 11-year period existed between never smokers and former smokers who had quit ≥ five years ago. Conclusions: Our finding that former daily smokers (≥ five years since quitting) demonstrated equivalent BMI increases to never smokers (1990—2001) is in line with evidence suggesting that the average body weight of quitters tends to stabilize over time to levels of never smokers. As post-cessation weight gain often represents a barrier to successful quitting, improved knowledge about the temporal and variable effects of smoking cessation on long-term weight outcome may strengthen motivational enhancement and relapse prevention efforts.