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

Influence of mental and behavioral factors on weight loss after bariatric surgery: A systematic review and meta-analysis

INTRODUCTION

Multiple factors are related to lower weight loss after bariatric surgery. This review and meta-analysis evaluates the influence of several mental and behavioral factors on weight loss.

METHOD

Six electronic databases were searched. Percentage excess weight loss (%EWL) was calculated for all moderator and non-moderator groups of the variables: symptoms of depression, anxiety and binge eating, compliance, physical activity, quality of life, and body image. All moderators, surgery types, and follow-up moments were analyzed separately.

RESULTS

In total, 75 articles were included in the review; 12 meta-analyses were conducted. Higher postoperative compliance to follow-up was associated with 6.86%-13.68% higher EWL. Preoperative binge eating was related to more weight loss at 24- and 36-month follow-up (7.97% and 11.79%EWL, respectively). Patients with postoperative binge eating symptoms had an 11.92% lower EWL. Patients with preoperative depressive symptoms lost equal weight compared to patients without symptoms.

CONCLUSION

Despite the high heterogeneity between studies, a trend emerges suggesting that the presence of postoperative binge eating symptoms and lower postoperative compliance may be associated with less weight loss after bariatric-metabolic surgery. Additionally, preoperative depressive symptoms and binge eating do not seem to significantly impact weight loss.

Is binge eating associated with poor weight loss outcomes in people with a high body weight? A systematic review with meta-analyses

OBJECTIVES

This systematic review aimed to compare the weight change in people with or without binge eating who underwent various weight loss treatments.

METHODS

We searched for studies in PubMed, American Psychological Association, and Embase from inception to January 2022. The studies selected included assessment of binge eating and body weight before and after weight loss treatment in people of any age. The meta-analyses were conducted using Comprehensive Meta-Analysis (CMA). We used Egger's regression test, the funnel plot, and the Trim and Fill test to assess the risk of publication bias.

RESULTS

Thirty-four studies were included in the systematic review, with a total of 10.184 participants. The included studies were divided into three categories according to types of weight loss treatments, namely, (1) bariatric surgery; (2) pharmacotherapy isolated or combined with behavioral interventions; and (3) behavioral and/or nutritional interventions. The meta-analyses showed no significant difference in weight loss between people with or without binge eating engaged in weight loss treatments, with an overall effect size of - 0.117 (95% CI - 0.405 to 0.171; P = 0.426).

CONCLUSIONS

Our findings showed no difference in weight loss in people with or without pre-treatment binge eating who received various weight loss treatments. Weight loss treatments should not be withheld on the basis that they will not be effective in people with pre-treatment binge eating, albeit their safety and longer term impacts are unclear.

LEVEL OF EVIDENCE

Level I, at least one properly designed randomized controlled trials; systematic reviews and meta-analyses; experimental studies.

Evolution of the basal metabolic rate after Roux-en-Y gastric bypass: a systematic review and meta-analysis

Patients who undergo Roux-en-Y gastric bypass (RYGB) exhibit a reduction in total basal metabolic rate (BMR) after surgery, which seems to be intimately related to the amount of postoperative weight loss. The objective was to perform a systematic review and meta-analysis of the literature to determine and evaluate BMR changes after RYGB. The search was performed in certified databases, and the strategy was structured according to the PRISMA ScR. The quality evaluation of the articles included in this review was assessed with two different bias risk tools (ROBINS-I and NIH) according to each study design. Two meta-analyses were elaborated based on the results. 163 articles were selected (from 2016 to 2020), and 9 articles met the inclusion criteria. All of the selected studies evaluated only adult patients, mostly women. Postoperative BMR diminished in all of the included studies after surgery compared to preoperative values. The follow-up periods were 6, 12, 24 and 36 months. Eight articles were used for the meta-analysis after the quality assessment, a total of 434 participants. Compared to baseline values, mean postoperative reductions of 356.66 kcal/d after 6 months (p < 0.001) and 432.89 kcal/d (p < 0.001) after 1 year were observed. The BMR decreases during the first years after Roux-en-Y gastric bypass, especially during the first year postsurgery.

Preoperative Weight Loss via Very Low Caloric Diet (VLCD) and Its Effect on Outcomes After Bariatric Surgery

INTRODUCTION

The effect of preoperative weight loss via very low caloric diet (VLCD) on long-term weight loss post-bariatric surgery (BS) is conflicting. We analysed its impact on weight loss and other outcomes post-BS.

METHODS

Patients (n = 306) who underwent sleeve gastrectomy or gastric bypass from 2008 to 2018 were studied. VLCD was prescribed for 14 days preoperatively. Patients were followed up for 5 years. Postoperative weight loss was compared in patients with preoperative weight gain or weight loss < 5% (WL < 5%), and weight loss ≥ 5% (WL ≥ 5%). Preoperative WL compared weight before and after VLCD; postoperative WL compared post-VLCD weight and follow-up weight. Total weight loss (TWL) encompassed pre- and postoperative WL.

RESULTS

WL was < 5% in 87.3% and ≥ 5% in 12.7%. There was no significant difference in complication rate, duration of surgery or length of stay, regardless of surgical type. Patients with WL < 5% lost more weight postoperatively compared with WL ≥ 5% for up to 60 months (%postoperative WL at 1 month: WL < 5% = 13.7%, WL ≥ 5% = 10%, p = <0.001; 60 months: WL < 5% = 30.6%, WL ≥ 5% = 23.9%, p = 0.041). However, when TWL and percentage of excess body mass index loss (%EBMIL) were measured, there was no difference beyond 6 months. A predictive multivariable model for 1-year %EBMIL was formed. Significant variables included pre-VLCD BMI and preoperative WL, and the relationship between the two.

CONCLUSION

Preoperative WL via VLCD was associated with reduced postoperative WL after BS, with no significant effect on complications, long-term TWL or %EBMIL. This challenges the notion that preoperative WL via VLCD should be mandated for better postoperative outcomes.

A review of the psychosocial aspects of clinically severe obesity and bariatric surgery

For the past 2 decades, clinically severe obesity (operationalized as a body mass index ≥40 kg/m2) has increased at a more pronounced rate that less severe obesity. As a result, the surgical treatment of obesity (bariatric surgery) has become a more widely accepted, yet still underutilized, treatment for persons with severe obesity and significant weight-related health problems. Psychologists play a central role on the multidisciplinary team involved in the preoperative assessment and postoperative management of patients. They also have played a central role in clinical research which has enhanced understanding of the psychosocial and behavioral factors that contribute to the development of severe obesity as well as how those factors and others contribute to postoperative outcomes. This article, written specifically for psychologists and other mental health professionals who currently work with these patients or are considering the opportunity to do so in the future, reviews these contributions over the past 20 years. The article highlights how this work has become a fundamental part of international clinical care guidelines, which primarily focus on preoperative psychosocial screening. The article also outlines avenues for future research in the field, with a specific focus on the need for additional behavioral and psychosocial interventions to promote lifelong success after bariatric surgery. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Psychological Outcomes and Predictors of Weight Loss in Adolescents With Severe Obesity Following a Reversible Endoscopic Bariatric Procedure

Introduction: Adolescent and children obesity is a growing concern worldwide. Bariatric surgery is used as an effective treatment for adolescents with obesity and provides physical and mental health benefits. Application of alternative, minimally invasive, safe, and reversible endoscopic procedures, such as the Duodenojejunal bypass liner (DJBL), has been recently suggested as an effective treatment for adolescents with obesity. We explored specific psychological outcomes of adolescents with obesity during a year of follow-up after undergoing a reversible endoscopic bariatric procedure, and a year after removal. We were also interested in identifying psychological factors that could predict successful weight loss after the procedure. Methods: Nineteen adolescent with severe obesity undergoing DJBL procedure were psychologically assessed in an open-label, prospective clinical trial (NTC0218393), at the implantation of device and at the removal of device after 12 months. Control group of 26 adolescents with severe obesity were recruited from the same outpatient clinic undergoing only conservative treatment. In addition, adolescents from the intervention group were followed for 12 months after the removal of the device. The Youth Self Report (YSR) was used to assess adolescents' emotional and behavioural problems; The Multidimensional Body-Self Relations Questionnaire (MBSRQ) to assess body image and The Eating Disorder Examination Questionnaire (EDE-Q) to assess attitudes and behaviours related to eating disorder. Results: Significant improvements in somatic complain (F = 12.478, p = 0.001), emotional and behavioural problems (F = 7.169, p = 0.011) and food restraining (F = 9.605, p = 0.004) were found in the intervention group at device removal compared to the control group. Moreover, at the time of device removal compared to baseline, improvements in several psychological outcomes were found (F = 32.178 p = 0.000 for emotional and behavioural problems). Adolescents also became more satisfied with their appearance (F = 6.789, p = 0.019). Majority of observed changes remained stable at the next follow up a year after the device removal. Significant predictors of successful weight loss at device removal were fewer overeating episodes (B = 0.147, p = 0.022) and lower body satisfaction (B = 0.932, p = 0.013). Discussion: Following a reversible bariatric procedure, improvements of psychological (emotional and behavioural) factors were found in adolescents with severe obesity. Psychological predictors of successful weight loss were identified, showing the greatest importance of eating behaviour and body satisfaction in successful weight loss.

Preoperative Binge Eating and Weight Loss After Bariatric Surgery: A Systematic Review and Meta-analysis

BACKGROUND

Several studies have investigated if bariatric surgery candidates with binge eating disorder (BED) are at risk for suboptimal postoperative weight loss. The aim of this systematic review with meta-analysis was to evaluate the association between binge eating diagnosed preoperatively and weight loss after bariatric surgery.

METHODS

MEDLINE, EMBASE, CENTRAL, LILACS, and other specialized databases were searched on August 2020. Clinical trials and observational studies including individuals who had undergone any type of bariatric surgical treatment with preoperative evaluation of BED and at least one postoperative measure of weight were initially selected. Four reviewers independently screened for eligibility. The mean difference was calculated using the random-effects model.

RESULTS

Nineteen studies, comprising 3223 participants (80.25% women; median age 41 years), met the inclusion criteria for meta-analysis. At 6 months postoperative, the percentage of total weight loss (%TWL) was not significantly different between BED and non-BED groups [6 studies, 914 participants: - 0.75% (95% CI, - 2.79 to 1.29; I² = 0%)], even when analyzing only those three studies that included gold standard assessment tools. No significant differences were found at 12, 24, 36, or 60 months.

CONCLUSIONS

Pre-bariatric BED seems to have little or no influence on weight loss after surgery. However, many questions remain unanswered because of the use of different measures across studies. The heterogeneity among studies emphasizes the importance of investigators using the same assessment measures.

Associations of lifetime traumatic experience with dysfunctional eating patterns and postsurgery weight loss in adults with obesity: A retrospective study

This study aimed to examine the associations of lifetime traumatic experience with presurgery and postsurgery eating pathology and postoperative weight loss in a sample of adult bariatric surgery patients using electronic medical record (EMR) data. Presurgery lifetime exposure to traumatic event, presurgery and postsurgery dysfunctional eating patterns, and post-operative total and excess weight losses were extracted from electronic medical records of 200 adult bariatric surgery patients in 2013 and 2014. Logistic regression analyses were conducted. During their lifetime, 60.5% of the patients (81.5% women, age = 44.4 ± 11.5 years; BMIpre = 44.9 ± 5.5 kg/m² ) reported that they were exposed to a traumatic event. Before surgery, trauma exposure was associated with impulsive, compulsive, or restrictive eating patterns (OR = 2.40), overeating or disturbed eating (OR = 1.55), and grazing or night eating behaviours (OR = 1.72). After surgery, trauma exposure was associated with lower total weight loss at 6 (OR = 2.06) and 24 months (OR = 2.06), and to overeating or disturbed eating (OR = 1.53) 12 months after surgery. Bariatric surgery candidates with a history of trauma exposure could benefit from closer medical, dietetic, and/or psychological follow-up care to avoid insufficient postoperative weight loss as well as reappearance of dysfunctional eating patterns after surgery.

Does Laparoscopic Sleeve Gastrectomy Improve Depression, Stress and Eating Behaviour? A 4-Year Follow-up Study

BACKGROUND

Laparoscopic sleeve gastrectomy (LSG) is a restrictive bariatric surgery procedure and currently the second most performed technique worldwide. Follow-up data on depression, stress and eating behaviour are scarce. The aim of this longitudinal study was to investigate the medium-term effects of LSG on mental health and eating behaviour and their influence on weight loss by using a comprehensive interview-based assessment.

METHODS

Seventy-five individuals, who had undergone LSG at a university hospital, were included in the study. Symptoms of disordered eating were assessed using a structured clinical interview (eating disorder examination) and the Three-Factor Eating Questionnaire with depressive symptoms and stress assessed via the Patient Health Questionnaire.

RESULTS

Mean interval from LSG to follow-up (FU) examination was 48 ± 13.3 months. The total body weight loss was 24.2 ± 12.0 %. Depressive symptom scores improved from pre-operative to FU (9 [IQR 5-14] vs. 6 [IQR 2-10], p = 0.002) as did stress scores (8.7 ± 4.6 vs. 6.3 ± 4.7, p = 0.001). At FU, 11 % of patients reported loss-of-control eating and 39 % grazing, paralleled by increased body mass index, stress and depressive symptoms. Prior to LSG, nine patients fulfilled the diagnostic criteria of binge eating disorder but only one at FU.

CONCLUSIONS

Post-surgical mental health appears to be highly relevant in terms of weight loss maintenance. It is likely that the surgical outcome could be positively influenced if patients at risk of developing mental health issues or eating disorders were identified and monitored in order to offer targeted interventions.

Variation of Binge Eating One Year after Roux-en-Y Gastric Bypass and Its Relationship with Excess Weight Loss

BACKGROUND

Bariatric surgery is the most effective treatment for obesity classes II and III. However, some patients do not get the desired results or initially lose and then regain the lost weight. Identifying these individuals early on and treating them adequately remains a challenge. As binge eating directly affects food intake, the study of this symptom and its relation to bariatric surgery and its results is increasing, because it appears to have an influence on the results of surgery.

OBJECTIVES

This study aimed to see how binge eating changes, measured with the Binge Eating Scale, interferes in the % excess weight loss one year after Roux-en-Y gastric bypass.

METHODS

We conducted a cross-sectional study with 149 patients older than 18 years who were evaluated one year after undergoing Roux-en-Y gastric bypass. The variation in the intensity of binge eating was measured with the pre- and postoperative Binge Eating Scale scores.

RESULTS

The variation of one unit in the Binge Eating Scale implied an inverse variation of 0.41% of % excess weight loss (p<0.05). The correlation coefficient between the variation of binge eating and the % excess weight loss was -0.186 (p = 0.033). The correlation coefficient between the binge eating symptoms one year after surgery and the % excess weight loss was -0.353 (p<0.001).

CONCLUSIONS

There was a correlation between the variation of binge eating one year after gastric bypass and the % excess weight loss. The correlation between binge eating and the % excess weight loss was greater after the surgery than it was at the preoperative stage. This study provides new, valuable information on the intensity and variation of binge eating symptoms one year after gastric bypass, which, to the best of our knowledge, have not been studied in depth earlier.

Cirurgia bariátrica e transtornos alimentares: uma revisão integrativa

RESUMO Objetivo Realizar revisão sobre transtornos alimentares e comportamentos alimentares transtornados relacionados à cirurgia bariátrica. Métodos Revisão integrativa da literatura nas bases de dados PubMed, Lilacs, Bireme, portal SciELO com descritores indexados com critérios de inclusão: oferecer dado sobre a presença ou frequência de transtorno alimentar e/ou comportamentos alimentares disfuncionais previamente e/ou após a cirurgia. Resultados Foram selecionados 150 estudos (14 nacionais e 136 internacionais): 80,6% eram com avaliação de pacientes pré-/pós-cirúrgicos; 12% eram estudos de caso e 7,3% eram estudos de revisão. Diferentes instrumentos foram usados para avaliação, principalmente o Questionnaire on Eating and Weight Patterns, a Binge Eating Scale e Eating Disorders Examination Questionnaire. A compulsão alimentar foi o comportamento mais avaliado, com frequências/prevalências variando de 2% a 94%; no caso do transtorno da compulsão alimentar as frequências/prevalências variaram de 3% a 61%. Houve também a descrição de anorexia e bulimia nervosa, síndrome da alimentação noturna e comportamento beliscador. Alguns estudos apontam melhora dos sintomas no pós-cirúrgico e/ou seguimento enquanto outros apontam surgimento ou piora dos problemas. Conclusão Apesar da variabilidade entre métodos e achados, comportamentos alimentares disfuncionais são muito frequentes em candidatos à cirurgia bariátrica e podem ainda surgir ou piorar após a intervenção cirúrgica. Profissionais de saúde devem considerar de maneira mais cuidadosa tais problemas neste público, dadas às consequências para o resultado cirúrgico e qualidade de vida.

Changes in self-reported eating patterns after laparoscopic sleeve gastrectomy: a pre-post analysis and comparison with conservatively treated patients with obesity

BACKGROUND

Patients with severe obesity need to adapt to surgically induced changes in their eating behaviors to maintain treatment success.

OBJECTIVES

This study examined the effects of laparoscopic sleeve gastrectomy (LSG) on weight loss and on 3 dimensions of eating behavior, namely, cognitive restraint, disinhibition, and hunger. Outcomes of the LSG group were compared with a group of conservatively treated (CT) patients, who underwent a 1-year multimodal weight-reduction group program that included dietary advice, physical exercise, psychoeducation, cognitive-behavioral therapy, training in Jacobson's progressive muscle relaxation, and social group support.

SETTING

The study setting was a multidisciplinary obesity center located in a university hospital.

METHODS

A sample of 102 patients with obesity were investigated using the Three-Factor Eating Questionnaire before and, on average, 19 (±5) months after weight loss intervention. Of the 102 patients, 62 (age 45.8±10.8 years, 71% females) underwent LSG, and 40 patients (age 50.6±11.3 years, 77.5% females) underwent the CT program. Patients were assigned to either the surgical or the nonsurgical intervention group following clinical guidelines and patient preference.

RESULTS

In the LSG group, total weight loss was 25.9±11.0%, excess weight loss was 52.8±24.1%, and body mass index decreased from 51.4±8.1 to 38.0±7.8 kg/m². In the CT group, total weight loss was 5.4±10.6%, excess weight loss was 13.9±27.1%, and body mass index decreased from 40.3±6.7 to 38.0±7.2 kg/m². Significant improvements in self-reported eating behaviors were observed in both groups, that is, an increased cognitive restraint of eating, a decreased disinhibition of eating control, and a reduced degree of perceived hunger. In contrast, whereas Three-Factor Eating Questionnaire scores before weight loss intervention did not differ between groups, LSG patients reported significantly greater reductions in disinhibition and hunger than CT patients did after weight loss intervention. In both groups, greater weight loss was associated with decreased hunger sensations.

CONCLUSION

In the second follow-up year, LSG was associated with greater weight loss and greater improvements in self-reported eating behaviors compared with conservative treatment.

Patients' long-term experiences following obesity surgery with a focus on eating behaviour: A qualitative study

This study explored long-term consequences of obesity surgery. Interpretative phenomenological analysis was used to analyse transcripts of 10 interviews with patients who underwent surgery 8 or more years ago. Experiences were described under three broad themes: eating behaviours, relationship with food and quality of life. Although patients described variability within these themes, describing different patterns of change, analysis revealed associations between themes and outcomes. In particular, those who reported successful weight loss also described the functionalization of food, the development of new coping strategies and a process of positive reinvention creating a new sense of self.

Effectiveness of lifestyle interventions to reduce binge eating symptoms in African American and Hispanic women

OBJECTIVE

Lifestyle interventions that promote physical activity and healthy dietary habits may reduce binge eating symptoms and be more feasible and sustainable among ethnic minority women, who are less likely to seek clinical treatment for eating disorders. The purpose of this study was to investigate (1) whether participating in a lifestyle intervention is a feasible way to decrease binge eating symptoms (BES) and (2) whether changes in BES differed by intervention (physical activity vs. dietary habits) and binge eating status at baseline (binger eater vs. non-binge eater) in African American and Hispanic women.

METHOD

Health Is Power (HIP) was a longitudinal randomized controlled trial to promote physical activity and improve dietary habits. Women (N = 180) who completed anthropometric measures and questionnaires assessing fruit and vegetable and dietary fat intake, BES and demographics at baseline and post-intervention six months later were included in the current study.

RESULTS

Over one-fourth (27.8%) of participants were categorized as binge-eaters. Repeated measures ANOVA demonstrated significant two- and three-way interactions. Decreases in BES over time were greater in binge eaters than in non-binge eaters (F(1,164) = 33.253, p < .001), and women classified as binge eaters who participated in the physical activity intervention reported greater decreases in BES than non-binge eaters in the dietary habits intervention (F(1,157) = 5.170, p = .024).

DISCUSSION

Findings suggest behavioral interventions to increase physical activity may lead to reductions in BES among ethnic minority women and ultimately reduce the prevalence of binge eating disorder and health disparities in this population.

Effects of Roux-en-Y gastric bypass surgery on eating behaviour and allopregnanolone levels in obese women with polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is associated with abnormal eating habits. We examined whether surgical treatment affected allopregnanolone levels and eating behaviour in nine women with PCOS who qualified for Rou-en-Y gastric bypass surgery. Blood samples were obtained to measure sex-hormone-binding globulin, total testosterone, progesterone, and allopregnanolone, and eating behaviour was evaluated using the Three-Factor Eating Questionnaire before surgery and at 6 and 12 months after surgery. Body mass index and total testosterone levels decreased, and progesterone and sex-hormone-binding globulin levels increased after bariatric surgery compared with pre-surgical values. In patients with anovulatory menstrual cycles, both the serum allopregnanolone level and the allopregnanolone/progesterone ratio were unchanged after surgery. The patients had high uncontrolled and emotional eating scores, and low cognitive restraint scores before surgery, and these scores had improved significantly at 6 and 12 months after surgery. The presurgical allopregnanolone levels were significantly correlated with uncontrolled eating. In conclusion, these results suggest that allopregnanolone appear to be part of the mechanism underlying the abnormal eating behaviour of obese PCOS patients by causing the loss of control over food intake. Roux-en-Y gastric bypass surgery can improve eating behaviour and clinical symptoms, and may facilitate weight loss in obese women with PCOS.

A screening tool to assess and manage behavioral risk in the postoperative bariatric surgery patient: The WATCH

Bariatric surgery is increasingly recognized as a highly effective treatment for individuals who are severely obese. Amount of weight loss and resolution of comorbidities surpass those of nonsurgical approaches; however, suboptimal weight loss and weight regain are not uncommon. These outcomes, though not fully understood, are likely at least partially explained by failure to make long-term behavioral and/or cognitive changes. We are unaware of any established clinical tools to guide providers in assessing postoperative behaviors and identifying those who may require specialized treatment. The goal of this paper is to introduce a brief screening tool, The WATCH, to help clinicians assess and identify patients who may be at risk for poor or untoward outcomes post bariatric surgery. We first review the literature on postoperative outcomes, including weight loss, resolution of comorbidities, suboptimal outcomes, and development of problematic eating behaviors. We then provide an easily-recalled, five-item tool that assesses outcomes, and discuss patient responses that may necessitate further intervention or referral.

Weight recidivism post-bariatric surgery: a systematic review

Obesity is considered a worldwide health problem of epidemic proportions. Bariatric surgery remains the most effective treatment for patients with severe obesity, resulting in improved obesity-related co-morbidities and increased overall life expectancy. However, weight recidivism has been observed in a subset of patients post-bariatric surgery. Weight recidivism has significant medical, societal and economic ramifications. Unfortunately, there is a very limited understanding of how to predict which bariatric surgical patients are more likely to regain weight following surgery and how to appropriately treat patients who have regained weight. The objective of this paper is to systematically review the existing literature to assess the incidence and causative factors associated with weight regain following bariatric surgery. An electronic literature search was performed of the Medline, Embase and Cochrane library databases along with the PubMed US national library from January 1950 to December 2012 to identify relevant articles. Following an initial screen of 2,204 titles, 1,437 abstracts were reviewed and 1,421 met exclusion criteria. Sixteen studies were included in this analysis: seven case series, five surveys and four non-randomized controlled trials, with a total of 4,864 patients for analysis. Weight regain in these patients appeared to be multi-factorial and overlapping. Aetiologies were categorized as patient specific (psychiatric, physical inactivity, endocrinopathies/metabolic and dietary non-compliance) and operation specific. Weight regain following bariatric surgery varies according to duration of follow-up and the bariatric surgical procedure performed. The underlying causes leading to weight regain are multi-factorial and related to patient- and procedure-specific factors. Addressing post-surgical weight regain requires a systematic approach to patient assessment focusing on contributory dietary, psychologic, medical and surgical factors.

Greater short-term weight loss in women 20-45 versus 55-65 years of age following bariatric surgery

BACKGROUND

Whether and how sex and age affect bariatric-surgery outcome is poorly understood. Estrogens regulate body composition in women and animals, and increase weight loss in a rodent model of gastric bypass, suggesting that premenopausal women may lose more weight following bariatric surgery.

METHODS

One thousand three hundred fifty-six female gastric-bypass or gastric-banding patients were retrospectively grouped as 20-45 years old (presumptively premenopausal; n = 1,199) and 55-65 years old (presumptively postmenopausal; n = 157). Mixed-model ANCOVA followed by Bonferroni-corrected t tests were used to categorically test the effect of age on percent excess body weight loss (%EBWL) at 1 and 2 years post-surgery, controlling for preoperative EBW and surgery type. Age effects were also tested dimensionally in all women and in 289 male patients.

RESULTS

Twenty- to forty-five-year-old women showed greater %EBWL 1 and 2 years post-surgery than 55-65-year-old women (p's < 0.0005). No age effect was detected in 20-25- vs. 30-35-, 30-35- vs. 40-45-, or 20-25- vs. 40-45-year-old women (p's > 0.2) This age effect was detected only after gastric banding, with 20-45-year-old women losing ∼7 kg more than 55-65-year-old women after 2 years. Dimensional analysis confirmed a significant inverse effect of age on bariatric surgery outcome in women, but did not detect any effect in men.

CONCLUSIONS

Results indicate that 55-65-year-old women lose less weight than 20-45-year-old women in the initial 2 years after bariatric surgery, especially gastric banding; this may be mediated by age- or menopause-associated changes in physical activity, energy expenditure, or energy intake.

Measurement of disordered eating in bariatric surgery candidates: a systematic review of the literature

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.

Psychosocial status and mental health in adolescents before and after bariatric surgery: a systematic literature review

OBJECTIVE

As long-term results of conservative treatment for obesity are discouraging, bariatric surgery is becoming a treatment option for extremely obese adolescents. However, mental and behavioral problems need to be respected when treating this vulnerable target group.

METHODS

A detailed systematic literature review on pre- and post-operative depressive, anxiety and eating disorder symptoms of adolescent patients was performed in PsychINFO, PubMed and Medline electronic databases.

RESULTS

Twelve studies met the inclusion criteria. Although strength of evidence was limited, results suggested that pre-operatively a third of adolescents suffered from moderate to severe depressive disorder symptoms and a quarter from anxiety disorder symptoms, while a substantial number showed eating disorder symptoms. Post-operatively, levels of depressive disorder symptoms significantly improved. Original articles on outcomes of eating and anxiety disorder symptoms after weight loss surgery were not found.

CONCLUSIONS

Further attention is needed on consistent clinical assessment of mental health disturbances and their consecutive treatment in adolescents. Future research should also focus on psychological and psychosocial predictors of weight loss after bariatric surgery.

Predictors of decreased binge eating following laparoscopic adjustable gastric banding using the Health Action Process Approach model

The current study aimed to examine predictors of reduced binge eating in patients undergoing laparoscopic adjustable gastric banding (LAGB) for severe obesity. Participants were 49 patients (13 males and 36 females) who completed measures of binge eating, behavioural intentions, planning and self-efficacy two weeks prior and three months after their operation. Reduced binge eating following surgery was predicted by behavioural intentions. Planning and volitional self-efficacy were unable to predict a significant amount of variance over and above intentions. The results highlight how the role of intentions must not be overlooked when investigating the prediction of health behaviour change and challenge the notion that post-intentional constructs that translate intentions into action are more important. Interventions aiming to increase preoperative levels of intention to follow the post-operative eating guidelines in patients presenting with binge eating might be a useful way of decreasing this behaviour in patients opting for LAGB surgery in order to achieve weight loss and physical well-being.

Patient-reported outcomes in bariatric surgery: a systematic review of standards of reporting

Bariatric surgery is increasingly being used to treat severe obesity, but little is known about its impact on patient-reported outcomes (PROs). For PRO data to influence practice, well-designed and reported studies are required. A systematic review identified prospective bariatric surgery studies that used validated PRO measures. Risk of bias in randomized controlled trials (RCTs) was assessed, and papers were examined for reporting of (i) who completed PRO measures; (ii) missing PRO data and (iii) clinical interpretation of PRO data. Studies meeting all criteria were classified as robust. Eighty-six studies were identified. Of the eight RCTs, risk of bias was high in one and unclear in seven. Sixty-eight different PRO measures were identified, with the Short Form (SF)-36 questionnaire most commonly used. Forty-one (48%) studies explicitly stated measures were completed by patients, 63 (73%) documented missing PRO data and 50 (58%) interpreted PRO data clinically. Twenty-six (30%) met all criteria. Although many bariatric surgery studies assess PROs, study design and reporting is often poor, limiting data interpretation and synthesis. Well-designed studies that include agreed PRO measures are needed with reporting to include integration with clinical outcomes to inform practice.

Examining the Binge Eating Scale in screening for binge eating disorder in bariatric surgery candidates

BACKGROUND

This study assessed the utility of the Binge Eating Scale (BES) as a measure of binge eating disorder (BED) in a bariatric surgery-seeking population by (a) determining the optimal BES cut score for predicting BED, (b) calculating concordance statistics, and (c) determining the predictive value of each BES item.

METHODS

Four hundred seventy-three patients presented for a psychological evaluation prior to Roux-en-Y gastric bypass surgery. The BES and the SCID semi-structured interview for BED were administered.

RESULTS

Receiver operating characteristic curve analyses identified an optimal BES cut score of 17, which correctly classified 78% of patients with BED. A cut score of 27 improved this statistic, but significantly increased the number of false negatives, which is undesirable for a screening assessment. Discriminant function analyses revealed that nearly all BES items significantly predicted BED.

CONCLUSIONS

The BES is a valid screener of BED for patients seeking bariatric surgery; however, false positives can be expected. Administering the BES as part of a comprehensive psychological evaluation can help improve the assessment and treatment of patients presenting for bariatric surgery.

Understanding Eating and Exercise Behaviors in Post Roux-en-Y Gastric Bypass Patients: A Quantitative and Qualitative Study

BACKGROUND

Weight regain following gastric bypass (GB) surgery continues to plague many individuals across the United States. However, understanding long-term eating and exercise behaviors to promote and sustain a lower weight following GB surgery is limited.

METHOD

The purpose of this study was to explore the perceptions and attitudes of eating and exercise behaviors associated with weight maintenance in post-GB patients (n=24) 2 or more years postsurgery. Demographic, anthropometric, and food record data were collected. Focus groups and personal interviews were used to understand behaviors and support systems associated with weight stabilization. Focus groups were audio-taped, transcribed, and organized into common themes.

RESULTS

All participants were female, with a mean of 6 years postsurgery, and had a mean age of 51.8±10.5 years. The majority were married (71%) and had a college degree (58%). Although the average weight regain postsurgery was estimated at 16.2±12.7 kg, most of the women (75%) had maintained a significant weight loss of at least 50% of their excess body weight. Themes associated with weight regain emerging from the focus groups included variable family support and a return to "old eating habits."

CONCLUSION

Focus group participants identified lack of long-term emotional support from family members and limited community support for weight loss surgery patients.

Roux-en-Y gastric bypass for morbid obesity: what are the preoperative predictors of weight loss?

Obesity has become an increasingly important health problem over the past 30 years. Presently around a quarter of the UK adult population are obese and this figure is set to increase further in the coming decades. The health consequences of obesity on multiple body systems have been well established as has the financial cost of the condition to both the individuals affected as well as to society as a whole. Bariatric surgery has been shown to be the only long term effective solution in terms of sustained weight loss and comorbidity resolution. The commonest bariatric procedure in the UK is the Roux-en-y gastric bypass which consistently results in the loss of 70%-80% of excess bodyweight. Results however are variable and in order to optimise resource allocation and avoid exposing patients unlikely to benefit from surgery to its inherent risks, much research has been done to try to identify those patients most likely to obtain a good result. The only factor which has been subjected to meta-analysis is that of preoperative weight loss which shows a positive association with postoperative weight loss following bypass surgery. Although the remaining data are not based on level 1 evidence those other preoperatively identifiable factors which are associated with an improved outcome include Caucasian or Hispanic ethnicity, higher educational status, non-shift-work working patterns, female gender and divorced or single marital status. Similarly increased levels of preoperative physical activity and an absence of binge eating behaviour are consistent with a favourable result whereas increased age, smoking and other socioeconomic factors have not been shown to have a significant impact. Conversely diabetes mellitus seems to have a slight negative correlation with postoperative weight loss; however, a history of sexual abuse or psychiatric illness has not been shown to have a lasting influence.

The Food Craving Questionnaire-Trait in a bariatric surgery seeking population and ability to predict post-surgery weight loss at six months

Food cravings have been understudied in bariatric surgery patients and the Food Craving Questionnaire-Trait has not been validated in this population. Reliability and validity of the FCQ-T were examined and a regression analysis was run to determine whether or not preoperative scores on individual subscales of the instrument could predict weight loss at 6 months. The FCQ-T demonstrated excellent internal consistency in bariatric surgery-seeking patients, and individual subscales measuring emotion and mood were correlated with other measures of depression and anxiety. Endorsement of binge eating or emotional eating behaviors during a clinical interview was correlated with similar subscales on the FCQ-T. Higher scores on the subscale 'cues that may trigger food cravings' were associated with greater weight loss at 6 months post-surgery and higher scores on the subscale 'guilt from cravings and/or giving into them' was associated with less weight loss. Management of external cues may predict successful outcomes while emotional impact of cravings may indicate the need for further intervention to help manage specific food craving traits.

Psychological dimensions after laparoscopic sleeve gastrectomy: reduced mental burden, improved eating behavior, and ongoing need for cognitive eating control

BACKGROUND

Obesity as a chronic disease has spread worldwide. Conservative treatment, especially with severe obesity, often fails. Obesity surgery has been shown to be an effective treatment. Laparoscopic sleeve gastrectomy (LSG), as a restrictive procedure, has low risks and results in good weight loss outcomes. However, to date, no studies have investigated the changes in psychological dimensions-especially concerning eating behavior and cognitive restraint-after LSG. The present study investigated, for the first time, eating behavior (cognitive restraint, disinhibition, hunger), depression, and perceived stress before and 1 year after LSG. The setting was a university hospital, comprehensive obesity center.

METHODS

Of 59 patients who had undergone LSG from 2008 to 2010, 40 patients were evaluated using questionnaires on eating behavior, depression, and stress, with measurements made before and 1 year after surgery.

RESULTS

The body mass index had decreased, on average, by 15.5 kg/m(2) 1 year after LSG (62.7% excess weight loss). The eating behaviors had changed, with patients experiencing less hunger, fewer food cravings, and decreased disinhibition. Depressive symptoms and perceived stress improved. However, the results showed high levels in the dimension of cognitive restraint of eating 1 year after LSG.

CONCLUSIONS

Most psychological dimensions improved as expected. The patients were less distracted by food, experienced less hunger, and were less disturbed by emotional distress. However, we found persistent cognitive restraint, reflecting an ongoing need for central eating control. Additional investigations are needed to describe the communication between the gut and brain after surgery.

Preoperative predictors of weight loss following bariatric surgery: systematic review

BACKGROUND

Obesity affects 32% of adults in the USA. Surgery generates substantial weight loss, but 20-30% fails to achieve successful weight loss. Our objective was to identify preoperative psychosocial factors associated with weight loss following bariatric surgery.

METHODS

We performed a literature search of PubMed® and the Cochrane Database of Reviews of Effectiveness between 1988 and April 2010. Articles were screened for bariatric surgery and weight loss if they included a preoperative predictor of weight loss: body mass index (BMI), preoperative weight loss, eating disorders, or psychiatric disorder/substance abuse. One thousand seven titles were reviewed, 534 articles screened, and 115 included in the review.

RESULTS

Factors that may be positively associated with weight loss after surgery include mandatory preoperative weight loss (7 of 14 studies with positive association). Factors that may be negatively associated with weight loss include preoperative BMI (37 out of 62 studies with negative association), super-obesity (24 out of 33 studies), and personality disorders (7 out of 14 studies). Meta-analysis revealed a decrease of 10.1% excess weight loss (EWL) for super-obese patients (95% confidence interval (CI) [3.7-16.5%]), though there was significant heterogeneity in the meta-analysis, and an increase of 5.9% EWL for patients with binge eating at 12 months after surgery (95% CI [1.9-9.8%]).

CONCLUSIONS

Further studies are necessary to investigate whether preoperative factors can predict a clinically meaningful difference in weight loss after bariatric surgery. The identification of predictive factors may improve patient selection and help develop interventions targeting specific needs of patients.

Relationship of fruit, vegetable, and fat consumption to binge eating symptoms in African American and Hispanic or Latina women

African American (AA) and Hispanic or Latina (HL) women have the highest rates of overweight and obesity of any gender and ethnic groups. Binge eating disorder (BED) is the most common eating disorder in the United States and is linked to overweight and obesity. Traditional treatments for BED may not be appropriate or viable for AA and HL women, because they are less likely than whites to seek treatment for psychological conditions and may have less access to healthcare. Improving dietary habits in those with BED or subthreshold BED may reduce binge eating symptoms. The current study investigated the association of fruit, vegetable, and fat consumption to binge eating symptoms in AA and HL women. AA and HL women in the Health Is Power (HIP) study (N=283) reported fruit and vegetable intake, fat intake, and binge eating symptoms. Women were middle aged (M=45.8 years, SD=9.2) and obese (M BMI=34.5 kg/m(2), SD=7.5). Greater fat consumption was correlated with lower fruit and vegetable consumption (r(s)=-0.159, p<0.01). Higher BMI (r(s)=0.209, p<0.01), and greater fat consumption (r(s)=0.227, p<0.05) were correlated with increased binge eating symptoms. Multiple regression analysis demonstrated that for HL women (β=0.130, p=0.024), higher BMI (β=0.148, p=0.012), and greater fat consumption (β=0.196, p=0.001) were associated with increased binge eating symptoms (R(2)=0.086, F(3,278)=8.715, p<0.001). Findings suggest there may be a relationship between fat consumption and binge eating symptoms, warranting further study to determine whether improving dietary habits may serve as a treatment for BED in AA and HL women.

A prospective assessment of psychosocial factors among bariatric versus non-bariatric surgery candidates

Background

Psychological factors are considered potential contraindicators to bariatric surgery, but inconsistently predict surgical outcomes. We examined biomedical and psychosocial predictors of future bariatric candidacy in a population of veterans enrolling in a multidisciplinary weight management program.

Methods

Ninety-five obese veterans meeting bariatric surgery eligibility criteria participating in a weight control intake class from 2007 to 2008 completed the MOVE!23 questionnaire to assess biomedical, psychiatric, social, and eating behavior factors. Twenty-five patients from this cohort completed or obtained approval for bariatric surgery during the next 2 years of follow-up.

Results

Patients progressing to bariatric candidacy over follow-up differed from non-bariatric patients in multiple areas, including reporting significantly lower rates of depression (28% versus 48.7%, respectively; p = 0.04) and smoking (4% versus 16%; p = 0.05), better self-rated health (e.g., 28% versus 10.7% rating themselves as in excellent or very good health), and averaged 50% fewer cardiovascular risk factors (p = 0.01). Bariatric patients also rated themselves as significantly faster eaters (p = .03) and as having higher rates of obsessive compulsive disorder (OCD; 28% versus 7%; p = 0.04). Depression and OCD status predicted patients going on to bariatric candidacy independent of body mass index (BMI), biomedical status, and demographic factors.

Conclusions

Our results suggest that many of the commonly cited psychosocial contraindicators to bariatric surgery are already lower in patients considered for surgery relative to BMI equivalent treatment-seeking peers not approved for surgery. These differences may help explain inconsistent relationships between psychosocial factors and bariatric surgery outcomes.

The emergence of eating pathology after bariatric surgery: a rare outcome with important clinical implications

OBJECTIVE

The present review examines the extant literature regarding the post-operative development of eating disorders (e.g., EDNOS) in bariatric surgery patients.

METHOD

Internet, PsycINFO, Pubmed, and reference lists were examined to aggregate and compare literature from January 1985 to May 2010.

RESULTS

Several case studies and case series have investigated the emergence of eating disorders after bariatric surgery. Clinical considerations are outlined.

DISCUSSION

The development of classical eating disorders after bariatric surgery appears to be a rare occurrence; however, eating problems are far more common. Unfortunately no typology exists to classify such eating problems. Future research should examine the incidence, risk factors, symptomatology, course, and outcome of such eating disorders and eating problems. It is highly likely that such problems are underreported.

Predictive factors of weight loss 1 year after laparoscopic gastric bypass in obese patients

BACKGROUND

Substantial weight loss is achieved in majority of severely obese subjects undergoing laparoscopic gastric bypass (LGBP) but some fail to obtain expected results. Our aim was to identify preoperative factors that could influence weight loss (WL) 1 year after LGBP.

METHODS

We studied the predictive value of clinical, biological, and dietary preoperative factors on weight loss in obese patients referred for LGBP. WL was assessed according to mean absolute weight loss (AWL) and mean percent excess weight loss (%EWL) 1 year after LGBP.

RESULTS

One hundred twenty-three subjects were included (112 women, age 42 ± 10 years; weight 127 ± 23 kg; BMI 47 ± 8 kg/m(2)). Mean AWL was 39.4 ± 10.5 kg at 1 year, corresponding to a mean %EWL of 70.5 ± 21.2%. AWL was positively correlated with initial weight, BMI, and energy intake and negatively with age, female sex, and treatment for hypertension and diabetes. %EWL was negatively correlated with initial weight, BMI, and positively correlated with triglycerides and ferritinemia. In multivariate analysis, %EWL was negatively correlated only with initial BMI (p < 0.001). AWL was positively correlated with initial BMI and male sex (both p < 0.001), and negatively correlated with protein intake (p = 0.039) and treatment for diabetes (p = 0.021), but not with biomarkers of diabetes and insulin resistance.

CONCLUSION

Initial BMI appears to be a strong determinant of individual WL, but predictive factors differ when WL was expressed as %EWL or AWL. The treatment of diabetes rather than diabetes itself appears to affect WL.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence of all relevant eating disorders in patients waiting for bariatric surgery: a comparison between patients with and without eating disorders

OBJECTIVE

To study the prevalence of all relevant eating disorders in 157 obese patients waiting for bariatric surgery. Another aim was to explore for possible differences between gender, and those with and without ED. The dependent variables were: socio-demographic characteristics, BMI, obesity onset, and obesity-related somatic diseases.

METHODS

ED was assessed using the self-report questionnaire, "Eating Disorders in Obesity" (EDO). The patients answered a questionnaire that targeted socio-demographic and health information.

RESULTS

Subgroups were based on the patients responses to items on the EDO: 1 patient (0.6%) with Bulimia Nervosa (BN), 6 (3.8%) with Eating Disorder Not Otherwise Specified (EDNOS), 21 (13.4%) with Binge Eating Disorder (BED), and 23 (14.6%) with Binge Eating (BE). The patients in the EDNOS group were those who lacked one criterion of the BN diagnosis. The patients in the BE group lacked one criterion of the BED diagnosis. Twenty-eight (17.8%) fulfilled the DSM-IV-TR criteria for ED. When patients with BE were added, 51 patients (32.5%) were identified with ED or sub-threshold ED. In the explorative part of the study, no gender differences in socio-demographic variables, BMI, obesity onset, and obesity-related somatic diseases emerged. With the exception of age, no differences were found in these variables between those with and without ED.

CONCLUSION

Employing all relevant eating disorders and binge eating symptoms (BE) for this population identified patients with pathological eating behaviors, which are not detected in previous studies measuring only BED and BE.

Patients who endorse more binge eating triggers before gastric bypass lose less weight at 6 months

BACKGROUND

Patients presenting for gastric bypass surgery often demonstrate binge eating behaviors. The present study sought to determine whether binge eating triggers are predictive of weight loss outcomes in bariatric surgery patients at 6 months postoperatively in the setting of a university hospital.

METHODS

A total of 48 patients presenting for gastric bypass surgery at an academic medical center in the Southeastern United States and who had returned for the 6-month follow-up visit were included in the present study. The patients were mostly women (85%), white (71%), and middle-aged (mean age 47 years), with an average weight of 100.9 kg. The patients completed the Inventory of Binge Eating Situations at baseline, and weight loss outcomes were assessed at 6 months. Weight loss success was indexed using 2 methods: the percentage of excess weight lost (continuous variable) and whether the patient was on track with their weight loss as defined by a ≥ 50% excess weight loss (dichotomous variable).

RESULTS

A significant negative correlation (r = -.31, P = .03) was found between the preoperative Inventory of Binge Eating Situations scores and the percentage of excess weight loss at 6 months after gastric bypass surgery. Logistic regression analysis showed that "on track" status at 6 months was predicted by the Inventory of Binge Eating Situations score at baseline (Wald chi-square = 3.97, df = 1, P = .046).

CONCLUSION

Careful assessment of binge eating situations could serve as a potential predictor of poor weight loss outcomes in patients seeking gastric bypass surgery. These findings support the baseline assessment of binge eating triggers and future research to examine the effectiveness of interventions for coping with binge eating triggers for gastric bypass surgery patients.

Hedonic hunger is increased in severely obese patients and is reduced after gastric bypass surgery

BACKGROUND

Overeating as a pathogenetic hallmark of obesity may be promoted by an increase in hedonic hunger, ie, the drive to eat palatable foods in the absence of energy need. Gastric bypass surgery, which effectively reduces severe obesity, might also affect hedonic hunger.

OBJECTIVE

The objective was to assess hedonic hunger in severely obese patients with and without a history of gastric bypass surgery.

DESIGN

Severely obese patients who had not undergone gastric bypass surgery (n = 123), gastric bypass patients (n = 136), and nonobese control subjects (n = 110) were examined with the Power of Food Scale (PFS)--a questionnaire that reliably measures an individual's motivation to consume highly palatable foods.

RESULTS

Compared with nonobese control subjects, severely obese patients achieved markedly higher aggregated PFS scores and subdomain scores related to generally available as well as physically present foods (all P < 0.001). On the aggregated score as well in those 2 subdomains, gastric bypass patients scored significantly lower than did non-gastric bypass obese patients (all P < 0.001) and did not differ significantly from the nonobese control group (P > 0.2). In contrast, in the PFS domain concerning food tasted, gastric bypass patients had significantly lower scores than did the nonobese control subjects (P = 0.04) and the severely obese patients (P = 0.008), both of whom did not differ significantly in this measure (P = 0.90).

CONCLUSION

In comparison with nonobese control subjects, severely obese patients display a marked increase in hedonic hunger that is not observed in patients who have undergone gastric bypass surgery, suggesting that the operation normalizes excessive appetite for palatable foods, which may be an important pathophysiologic feature of severe obesity.

Effectiveness of a prebariatric surgery insurance-required weight loss regimen and relation to postsurgical weight loss

Most US insurance companies require patients to participate in a medically supervised weight loss regimen prior to bariatric surgery. However, the utility of this requirement has not been documented. Data was collected from 94 bariatric surgery patients who were required, and 59 patients who were not required, by their insurance company to participate in a presurgical weight loss regimen. Weight change in the required group, as well as group differences in weight change, was examined from 3 and 6 months presurgery to 1 week presurgery, and from 1 week presurgery to 3 months postsurgery. Weight change presurgery was then used to predict weight loss postsurgery. In the 6 months prior to surgery, required patients gained 3.7 kg +/- 5.9 (s.d.) (P < 0.0005), which did not differ from nonrequired patients. From surgery to 3 months postsurgery, required patients lost 23.6 +/- 8 kg (P < 0.0005), also without differing from nonrequired patients. Patients who gained more weight prior to surgery, lost more weight postsurgery (P = 0.001), while controlling for initial weight. Findings suggest that the common weight loss regimen requirements of US insurance carriers were ineffective in producing presurgical weight loss in this sample. Most patients (>70%) in this sample gained weight prior to surgery, potentially taking advantage of final opportunities to overindulge in preferred foods. Required patients fared no better in terms of weight change postsurgically and, surprisingly, presurgical weight gain predicted better postsurgical weight loss outcome. Several potential explanations for this finding are offered.

Comprehensive interview assessment of eating behavior 18-35 months after gastric bypass surgery for morbid obesity

BACKGROUND

Weight loss surgery induces a marked change in eating behavior. However, not much work has been done characterizing the eating behavior after weight loss surgery. We conducted a detailed analysis of patients' eating behavior 18-35 months after Roux-en-Y gastric bypass surgery, determined whether preoperative eating disorders might be associated with non-normative postoperative eating, and examined the association of such eating behaviors with weight loss and psychopathology.

METHODS

A sample of 59 patients who had undergone Roux-en-Y gastric bypass was interviewed in person after surgery about a range of eating behaviors, including binge eating, chewing and spitting out food, picking at and nibbling food, and nocturnal eating and compensatory behaviors such as vomiting and laxative and diuretic misuse. An established semistructured interview was used. The prevalence of preoperative eating disorders was assessed retrospectively. The eating-related and general psychopathology and quality of life were assessed using self-report questionnaires before and after surgery.

RESULTS

Subjective bulimic episodes were reported by 25% and vomiting for weight and shape reasons by 12% of the participants, on average, 2 years after surgery. Subjective bulimic episodes were significantly associated with a preoperative binge eating disorder, with more eating-related and general psychopathology after surgery, and with less weight loss.

CONCLUSION

A substantial subgroup of patients with a preoperative eating disorder will develop binge eating after surgery that might be associated with less weight loss. A subsample will start vomiting for weight and shape reasons after bariatric surgery. Clinicians must probe carefully for these behaviors postoperatively to identify patients in need of treatment of pathological eating behaviors.

Compensatory eating disorder behaviors and gastric bypass surgery outcome

OBJECTIVE

This study prospectively examined the role of compensatory eating disorder behavior on gastric bypass (GB) surgery weight-loss outcome.

METHOD

The compensatory behaviors of 199 GB patients were evaluated presurgically using the Questionnaire of Eating and Weight Patterns. Hierarchical linear regression was used to assess the presence of compensatory behavior on 6-month postsurgery body mass index (BMI), and 1-year postsurgery BMI, controlling for age, sex, race, age becoming overweight, number of weeks postsurgery, and presurgery BMI.

RESULTS

The presence of presurgery compensatory behavior emerged as a small but significant predictor of lower BMI 6-months postsurgery although not at 1-year postsurgery. Other common predictors for lower BMI at 6-months and 1-year postsurgery were lower presurgery BMI and greater number of weeks postsurgery. Female sex also predicted lower BMI 1-year postsurgery.

DISCUSSION

These results must be taken with caution as they contradict clinical guidelines. Future research is needed to replicate these findings.

Compulsão alimentar antes e após a cirurgia bariátrica

RACIONAL: A obesidade é distúrbio de origem multifatorial complexa que congrega aspectos de ordem psicológica, social, biológica e requer abordagem multidisciplinar. É considerada fator de risco para a compulsão alimentar, de modo que a dinâmica emocional do obeso contribuiria para desencadear o ato compulsivo. OBJETIVO: Analisar os indícios de compulsão alimentar em pacientes submetidos à cirurgia bariátrica, antes e dois anos após a operação. MÉTODOS: Foi realizado estudo prospectivo em 50 pacientes submetidos à cirurgia bariátrica pela técnica de Fobi-Capella. Os instrumentos de avaliação psicológica, aplicados antes e após dois anos, foram o teste das Pirâmides Coloridas de Max Pfister e entrevista clínica semi-estruturada. O teste foi aplicado antes e após a operação para identificar indícios de compulsão. A entrevista somente no pós-operatório. RESULTADOS: Citando somente os dados principais, os dados mostraram estabilidade e capacidade para lidar com conflitos em 16% dos pacientes antes da operação e em 10% após. Para a capacidade de controle e adaptação, 36% dos pacientes apresentavam fortes indícios de atitude de controle e rigidez antes da operação e 32% após. Quanto aos indicadores de impulsividade, agressividade e irritabilidade, houve fortes indícios de atitudes agressivas e impulsivas em 28% antes da operação e em 36% após. Quanto ao comportamento beliscador, eram presentes em 94% dos pacientes no pré-operatório e em 60% no pós. Quanto à preferência alimentar, foi a por alimentos calóricos sem menção à bebidas alcoólicas no pré-operatório, e no pós-operatório por alimentos de fácil ingestão. Quanto ao motivo atribuído aos episódios compulsivos, antes da operação 4% dos pacientes relataram estado de nervosismo, 24% afirmaram distúrbios de humor e 52% identificaram sentimentos de impotência ou submissão. No pós, foram 10%, 28% e 38%. Quanto às respostas compensatórias, eram elas ingestão de doces em 12%; ingestão de petiscos em 2% e comer indiscriminadamente tudo que estivesse ao alcance em 64% dos pacientes. Após, 18%, 10% e 22%. CONCLUSÃO: Os pacientes apresentam indícios de compulsão alimentar antes e após a operação. Ela está relacionada a aspectos psicológicos. Os hábitos e preferências alimentares modificam-se após a operação, de modo que os pacientes passam a consumir alimentos de fácil ingestão frente a situações que os faziam comer compulsivamente, não sendo observado trocas de compulsão. O comportamento alimentar inadequado persiste ou é agravado após a operação.

Psychosocial evaluation for bariatric surgery: the Boston interview and opportunities for intervention

The process of psychosocial evaluation for weight loss surgery (WLS) is one that goes beyond serving the function of information-gathering (Bauchowitz et al. in Surg Obes Relat Dis 3:554-558, 2007; Friedman et al. in Surg Obes Relat Dis 3:376-382, 2007; Lanyon and Maxwell in Obes Surg 17:321-328, 2007; Sogg and Mori in Obes Surg 14:370-380, 2004; Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008). This process offers myriad opportunities for delivering significant and powerful interventions that can enhance the patient's success in the WLS process. A discussion of the unique opportunities for psychosocial intervention afforded by the pre-surgical evaluation process is presented, using The Boston Interview for Bariatric Surgery (Sogg and Mori in Surg Obes Relat Dis 4:455-463, 2008) as the organizing framework.

Evaluating preoperative weight loss, binge eating disorder, and sexual abuse history on Roux-en-Y gastric bypass outcome

BACKGROUND

Roux-en-Y gastric bypass patients often undergo preoperative dieting and psychological assessment before surgery. We examined preoperative weight loss, binge eating disorder (BED), and sexual abuse history and the interactions of these predictors to determine whether a cautionary approach to Roux-en-Y gastric bypass is warranted.

METHODS

Consecutive subjects undergoing Roux-en-Y gastric bypass at our institution from January 1997 to December 2002 were reviewed. The postoperative excess weight loss (EWL) at 1, 3, 6, 12, 18, and 24 months and the perioperative complications were measured. EWL was compared at 12 and 24 months postoperatively in the categories of the presence/absence of preoperative weight loss, BED, and sexual abuse history. The perioperative complications were examined in the preoperative weight change groups.

RESULTS

Of 154 patients, 121 were included. No significant difference in EWL or perioperative complications was observed between those who lost or gained weight preoperatively. Of the 121 patients, 32% and 17% reported a history of BED and sexual abuse, respectively. No statistically significant difference was observed in the EWL between those with and without BED at 12 and 24 months postoperatively. The EWL in those with and without a sexual abuse history at 12 and 24 months was 57.67% and 66.32% (P <.05) and 64.40% and 70.97% (P = NS). No statistically significant interaction between EWL and sexual abuse*BED/sexual abuse*preoperative weight loss was observed.

CONCLUSION

Only sexual abuse history at postoperative month 12 had a negative effect on EWL. Otherwise, physicians can expect to see successful EWL in these subjects up to 24 months postoperatively. We recommend that additional investigation be done of those with BED and a sexual abuse history.

Preoperative binge eating status and gastric bypass surgery: a long-term outcome study

BACKGROUND

The primary purpose of the study was to evaluate the effect of preoperative binge status on long-term weight loss outcomes.

METHODS

IRB approval was obtained. This prospective study was initiated in 1997 at a large teaching hospital. Adult patients who participated in the study and attended post-surgery clinic visits for at least 12 months were included. Patients completed the gormally binge eating scale (BES), the beck depression inventory (BDI), and the SF-36 at baseline prior to surgery. All data are expressed as mean +/- SD. Data were analyzed using a Student's t test, pairwise correlation and regression analysis as appropriate.

RESULTS

A total of 157 patients (135 women) aged 45 +/- 10 years were recruited. Their preoperative BMI was 50.7 +/- 8.0 kg/m(2). Thirty-seven patients were classified as severe binge eaters (BES >or= 27) prior to surgery. There was no significant difference in their weight loss compared to the rest of the group at any time point up to 6 years after surgery. Patients with significant depressive symptoms (BDI >13) had no significant difference in their weight loss outcomes compared to the rest of the group. Pre-surgery SF-36 scores did not predict differences in weight loss outcome.

CONCLUSION

Pre-surgical binge status, incidence of depressive symptoms and health related quality of life were not predictive of poor weight loss outcomes in patients up to 6 years after gastric bypass surgery, who were able to make lifestyle changes in preparation for surgery and who adhered to scheduled post surgery clinic visits.