[Problematic Eating Behaviors after Bariatric Surgery: A National Study with a Portuguese Sample]

INTRODUCTION

Bariatric surgery is the most effective method for the treatment of morbid obesity. However, the development of eating psychopathology and the emergence of problematic eating behaviours have been reported in the literature. The aim of this crosssectional study was to characterize the post-bariatric population in terms of the frequency of problematic eating behaviours over time and to understand the related psychological features.

MATERIAL AND METHODS

This sample was composed of 155 bariatric patients that responded to several self-reported instruments assessing eating psychopathology, problematic eating behaviours, anxiety, depression and stress and impulsive behaviour.

RESULTS

Results showed that grazing, binge eating, concerns about body weight and shape, and negative urgency are significantly more frequent at 24 months after bariatric surgery (when compared to earlier postoperative assessments). Correlational analyses showed that eating psychopathology and problematic eating behaviours were significantly and positively associated with levels of anxiety, depression, stress and negative urgency. This study also reinforces the mediating role of negative urgency in the relationship between time elapsed since surgery and psychological distress, and problematic eating behaviours, accounting for a total of 32.3% and 27.2% of its variance, respectively.

DISCUSSION

The results suggest a growing trend of problematic eating behaviours and levels of impulsivity being reported by bariatric patients over time.

CONCLUSION

Given the established evidence that supports its impact on weight variability, early identification of problematic eating behaviours and of patients with a tendency to act impulsively in situations of negative emotionality should be a central concern in the follow-up of the bariatric population.

Compreender a Sintomatologia Depressiva após a Cirurgia Bariátrica: o Papel do Peso, da Alimentação e da Imagem Corporal

<strong>Introduction:</strong> Depressive symptoms have been reported as prevalent after bariatric surgery. This study aims to analyze the role of weight, eating behaviors and body image in depressive symptomatology in bariatric surgery patients assessed post- operatively.<br /><strong>Material and Methods:</strong> This is a cross-sectional study including 52 bariatric surgery patients assessed post-operatively with a follow-up time ranging from 22 to 132 months. Psychological assessment included a clinical interview (Eating Disorder Examination) to assess eating disorders psychopathology, and three self-report measures: Outcome Questionnaire 45 – general distress; Beck Depression Inventory – depressive symptoms; and Body Shape Questionnaire – body image.<br /><strong>Results: </strong>Our data show that depressive symptoms after surgery are associated with loss of control over eating, increased concerns with body image, and body mass index regain. Multiple linear regressions was tested including these variables and showed that body mass index regain after surgery, loss of control over eating and concerns with body image significantly explained 50% of the variance of post-operative depressive symptoms, being the concern with body image the most significant variable: greater dissatisfaction with body image was associated with more depressive symptoms.<br /><strong>Discussion:</strong> The results of this study showed that a subgroup of patients presents a significant weight gain after bariatric surgery, which is associated with episodes of loss of control over eating, concerns with body image and depressive symptoms.<br /><strong>Conclusion:</strong> These results stress the relevance of body image concerns after surgery and the importance of clinically addressing these issues to optimize psychological functioning after bariatric surgery.<br /><strong>Keywords:</strong> Depression; Preoperative Care; Psychiatric Status Rating Scales; Obesity, Morbid; Body Image; Bariatric Surgery.

[Understanding depressive symptoms after bariatric surgery: the role of weight, eating and body image]

INTRODUCTION

Depressive symptoms have been reported as prevalent after bariatric surgery. This study aims to analyze the role of weight, eating behaviors and body image in depressive symptomatology in bariatric surgery patients assessed post-operatively.

MATERIAL AND METHODS

This is a cross-sectional study including 52 bariatric surgery patients assessed post-operatively with a follow-up time ranging from 22 to 132 months. Psychological assessment included a clinical interview (Eating Disorder Examination) to assess eating disorders psychopathology, and three self-report measures: Outcome Questionnaire 45--general distress; Beck Depression Inventory--depressive symptoms; and Body Shape Questionnaire--body image.

RESULTS

Our data show that depressive symptoms after surgery are associated with loss of control over eating, increased concerns with body image, and body mass index regain. Multiple linear regressions was tested including these variables and showed that body mass index regain after surgery, loss of control over eating and concerns with body image significantly explained 50% of the variance of post-operative depressive symptoms, being the concern with body image the most significant variable: greater dissatisfaction with body image was associated with more depressive symptoms.

DISCUSSION

The results of this study showed that a subgroup of patients presents a significant weight gain after bariatric surgery, which is associated with episodes of loss of control over eating, concerns with body image and depressive symptoms.

CONCLUSION

These results stress the relevance of body image concerns after surgery and the importance of clinically addressing these issues to optimize psychological functioning after bariatric surgery.

The development of eating disorders after bariatric surgery

Surgical treatment for morbid obesity can be very effective in terms of weight loss and reduction of psychopathology. But the (re)emergence of eating problems after surgery is still poorly understood and may be underreported. We describe three cases in which eating disorder symptoms developed after bariatric surgery. The accelerated weight loss and heightened dieting restraint, as well as the systematic reminders to control the amount of food eaten which are crucial for treatment success, might trigger the development of eating disorders after surgery. Implications for pre-surgery assessment and preparation are discussed.

Molecular and cellular pathogenesis of autosomal dominant polycystic kidney disease

Autosomal dominant polycystic kidney disease (ADPKD) is one of the most common human life-threatening monogenic disorders. The disease is characterized by bilateral, progressive renal cystogenesis and cyst and kidney enlargement, often leading to end-stage renal disease, and may include extrarenal manifestations. ADPKD is caused by mutation in one of two genes, PKD1 and PKD2, which encode polycystin-1 (PC1) and polycystin-2 (PC2), respectively. PC2 is a non-selective cation channel permeable to Ca(2+), while PC1 is thought to function as a membrane receptor. The cyst cell phenotype includes increased proliferation and apoptosis, dedifferentiation, defective planar polarity, and a secretory pattern associated with extracellular matrix remodeling. The two-hit model for cyst formation has been recently extended by the demonstration that early gene inactivation leads to rapid and diffuse development of renal cysts, while inactivation in adult life is followed by focal and late cyst formation. Renal ischemia/reperfusion, however, can function as a third hit, triggering rapid cyst development in kidneys with Pkd1 inactivation induced in adult life. The PC1-PC2 complex behaves as a sensor in the primary cilium, mediating signal transduction via Ca(2+) signaling. The intracellular Ca(2+) homeostasis is impaired in ADPKD, being apparently responsible for the cAMP accumulation and abnormal cell proliferative response to cAMP. Activated mammalian target for rapamycin (mTOR) and cell cycle dysregulation are also significant features of PKD. Based on the identification of pathways altered in PKD, a large number of preclinical studies have been performed and are underway, providing a basis for clinical trials in ADPKD and helping the design of future trials.