Adolescent Loss-of-Control Eating and Weight Loss Maintenance After Bariatric Surgery.
ABSTRACT: BACKGROUND:Loss-of-control (LOC) eating is common in adults undergoing bariatric surgery and is associated with poorer weight outcomes. Its long-term course in adolescent bariatric surgery patients and associations with weight outcomes are unclear. METHODS:Adolescents (n = 234; age range = 13-19 years) undergoing bariatric surgery across 5 US sites were assessed for postsurgery follow-up at 6 months and 1, 2, 3, and 4 years. Descriptive statistics and generalized linear mixed models were used to describe the prevalence of LOC eating episodes involving objectively large amounts of food and continuous eating, respectively. Generalized linear mixed models investigated the association of any LOC eating with short- and long-term BMI changes. RESULTS:At baseline, objectively large LOC eating was reported by 15.4% of adolescents, and continuous LOC eating by 27.8% of adolescents. Both forms of LOC eating were significantly lower at all postsurgical time points relative to presurgery (range = 0.5%-14.5%; Ps < .05). However, both behaviors gradually increased from 6-month to 4-year follow-up (Ps < .05). Presurgical LOC eating was not related to percent BMI change over follow-up (P = .79). However, LOC eating at 1-, 2-, and 3-year follow-up was associated with lower percent BMI change from baseline at the next consecutive assessment (Ps < .05). CONCLUSIONS:Although presurgical LOC eating was not related to relative weight loss after surgery, postoperative LOC eating may adversely affect long-term weight outcomes. Rates of LOC eating decreased from presurgery to 6-months postsurgery but increased thereafter. Therefore, this behavior may warrant additional empirical and clinical attention.
Project description:To document changes in Axis I psychiatric disorders after bariatric surgery and examine their relationship with postsurgery weight loss.As part of a three-site substudy of the Longitudinal Assessment of Bariatric Surgery Research Consortium, 199 patients completed the Structured Clinical Interview for DSM-IV before Roux-en-Y gastric bypass or laparoscopic adjustable gastric band. At 2 or 3 years after surgery, 165 (83%) patients completed a follow-up assessment (presurgery median body mass index = 44.8 kg/m, median age = 46 years, 92.7% white, 81.1% female). Linear-mixed modeling was used to test change in prevalence of psychiatric disorders over time, report remission and incidence, and examine associations between psychiatric disorders and weight loss.Compared with status presurgery, the prevalence of any Axis I psychiatric disorder was significantly lower at 2 and 3 years after surgery (30.2% versus 16.8% [p = .003] and 18.4% [p = .012], respectively). Adjusting for site, age, sex, race, presurgery body mass index, and surgical procedure, presurgery mood, anxiety, eating or substance use disorders (lifetime or current) were not related to weight change, nor were postsurgery mood or anxiety disorders (p for all > .05). However, having a postsurgery eating disorder was independently associated with less weight loss at 2 or 3 years (? = 6.7%, p = .035).Bariatric surgery was associated with decreases in psychiatric disorders through 3 years after surgery. Postsurgical eating disorders were associated with less weight loss after surgery, adding to the literature suggesting that disordered eating after surgery is related to suboptimal weight loss.
Project description:BACKGROUND:While presurgical eating behaviors have demonstrated limited prognostic value, cognitions regarding the effects of eating may serve as important predictors of weight loss outcomes after bariatric surgery. The Eating Expectancies Inventory (EEI) is a commonly used, self-report measure of expected consequences of eating; however, its psychometric and predictive properties have not yet been evaluated among bariatric surgery patients. OBJECTIVES:This study sought to examine the factor structure and internal consistency of the EEI among bariatric surgery candidates, to examine relationships between EEI factors and measures of eating psychopathology, and to explore the effects of eating expectancies on postsurgical weight loss. SETTING:Data originated from an interdisciplinary bariatric surgery center in the Midwest United States. METHODS:Two hundred sixty-two women completed self-report questionnaires before bariatric surgery. Presurgical data and available postsurgical weights (at 6, 12, and 18 mo) were obtained from medical records. RESULTS:Analyses indicated that the original 5-factor model was a good-to-excellent fit for the EEI data. All EEI factors demonstrated good reliability and were significantly associated with eating disorder symptoms and behaviors at baseline. Higher scores on EEI Factor 1 (negative affect) and Factor 5 (alleviates boredom) predicted poorer weight loss at 18 months postsurgery (n = 132). CONCLUSIONS:Findings support the reliability and validity of the EEI among female bariatric candidates. Presurgical eating expectancies were linked to pathologic eating patterns and also predicted postsurgical weight loss trajectories, suggesting that eating expectancies may have prognostic value as predictors of bariatric surgery outcomes.
Project description:Studies on the impact of presurgery weight loss and lifestyle preparation on outcomes following bariatric surgery are needed.To evaluate whether a presurgery behavioral lifestyle intervention improves weight loss through a 24-month postsurgery period.Bariatric Center of Excellence at a large, urban medical center.Candidates for bariatric surgery were randomized to a 6-month behavioral lifestyle intervention or to 6 months of usual presurgical care. The lifestyle intervention consisted of 8 weekly face-to-face sessions, followed by 16 weeks of face-to-face and telephone sessions before surgery; the intervention also included 3 monthly telephone contacts after surgery. Assessments were conducted 6, 12, and 24 months after surgery.Participants who underwent surgery (n = 143) were 90.2% female and 86.7% White. Average age was 44.9 years, and average body mass index was 47.5 kg/m(2) at study enrollment. At follow-up, 131 (91.6%), 126 (88.1%), 117 (81.8%) patients participated in the 6-, 12-, and 24-month assessments, respectively. Percent weight loss from study enrollment to 6 and 12 months after surgery was comparable for both groups, but at 24 months after surgery, the lifestyle group had significantly smaller percent weight loss compared with the usual care group (26.5% versus 29.5%, respectively, P = .02).Presurgery lifestyle intervention did not improve weight loss at 24 months after surgery. The findings from this study raise questions about the utility and timing of adjunctive lifestyle interventions for bariatric surgery patients.
Project description:BACKGROUND:Past research suggests self-harm/suicidality are more common among adults who have undergone bariatric surgery than the general population. OBJECTIVES:To compare prevalence of self-harm/suicidal ideation over time and identify presurgery risk factors for postsurgery self-harm/suicidal ideation. SETTING:The Longitudinal Assessment of Bariatric Surgery-2 is a cohort study with presurgery and annual postsurgery assessments conducted at 10 U.S. hospitals. METHODS:Adults with severe obesity undergoing bariatric surgery between March 2006 and April 2009 (n?=?2458). Five-year follow-up is reported. Self-reported history of suicidality assessed retrospectively via the Suicide Behavior Questionnaire-Revised (SBQ-R) and self-reported self-harm/suicidal ideation assessed prospectively via the Beck Depression Inventory-Version 1 (BDI-1). RESULTS:The SBQ-R was completed by 1540 participants; 2217 completed the BDI-1 pre- and postsurgery. Over 75% of participants were female, with a median age of 46 years and body mass index of 45.9 kg/m2. Approximately one fourth of participants (395/1534) reported a presurgery history of suicidal thoughts or behavior (SBQ-R). The prevalence of self-harm/suicidal ideation (BDI-1) was 5.3% (95% confidence interval [CI], 3.7-6.8) presurgery and 3.8% (95% CI, 2.5-5.1) at year 1 postsurgery (P?=?.06). Prevalence increased over time postsurgery to 6.6% (95% CI, 4.6-8.6) at year 5 (P?=?.001) but was not significantly different than presurgery (P?=?.12). CONCLUSIONS:A large cohort of adults with severe obesity who underwent bariatric surgery had a prevalence of self-harm/suicidal ideation that may have decreased in the first postoperative year but increased over time to presurgery levels, suggesting screening for self-harm/suicidality is warranted throughout long-term postoperative care. Several risk factors were identified that may help with enhanced monitoring.
Project description:Elevated rates of psychopathology are noted among severely obese youth presenting for weight loss surgery. The role of mental health providers in this population is not well defined, and the selection of candidates is often the result of clinical judgment alone. The purpose of this study was to comprehensively evaluate psychiatric symptoms among a large sample of adolescents receiving laparoscopic adjustable gastric banding (LAGB) by (1) examining changes in depressive symptoms and quality of life in the year following surgery; (2) evaluating the interaction between patterns of change in depression, quality of life, and weight postsurgery; and (3) identifying presurgical psychological predictors of initial weight change.Participants were 101 severely obese adolescents aged 14 to 18 years receiving LAGB at the Center for Adolescent Bariatric Surgery at the Morgan Stanley Children's Hospital of New York Presbyterian/Columbia University Medical Center between August 2006 and December 2009. Measures of height, weight, depressive symptoms, and quality of life were obtained in the first year following surgery. Changes in the Beck Depression Inventory (BDI), Pediatric Quality of Life Inventory (PedsQL), and body mass index were analyzed using latent growth curve modeling.Short-term changes in psychiatric symptoms and weight were analyzed using latent growth curve modeling. Significant changes in total BDI (?slope = -0.885, SE = 0.279, P < .01; ?quadratic = 0.054, SE = 0.021, P < .001) and PedsQL (?slope = -0.885, SE = 0.279, P < .001) scores were observed following LAGB, and comparable postoperative changes between psychosocial variables and body mass index were also noted (BDI: covariance [COV] = 0.21, SE = 0.06, P < .001; PedsQL: COV = -0.41, SE = 0.10, P < .01). Two variables (family conflict/loss of control eating) were found to be significant predictors of weight change over the year following surgery (P < .05).Adolescents experienced notable improvements in initial depressive symptoms and quality of life after LAGB, and measures of preoperative binge eating and family conflict affected postsurgery body mass index among youth.ClinicalTrials.gov identifier: NCT01045499.
Project description:Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.
Project description:The variability and durability of improvements in pain and physical function following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) are not well described.To report changes in pain and physical function in the first 3 years following bariatric surgery, and to identify factors associated with improvement.The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study at 10 US hospitals. Adults with severe obesity undergoing bariatric surgery were recruited between February 2005 and February 2009. Research assessments were conducted prior to surgery and annually thereafter. Three-year follow-up through October 2012 is reported.Bariatric surgery as clinical care.Primary outcomes were clinically meaningful presurgery to postsurgery improvements in pain and function using scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (ie, improvement of ?5 points on the norm-based score [range, 0-100]) and 400-meter walk time (ie, improvement of ?24 seconds) using established thresholds. The secondary outcome was clinically meaningful improvement using the Western Ontario McMaster Osteoarthritis Index (ie, improvement of ?9.7 pain points and ?9.3 function points on the transformed score [range, 0-100]).Of 2458 participants, 2221 completed baseline and follow-up assessments (1743 [78.5%] were women; median age was 47 years; median body mass index [BMI] was 45.9; 70.4% underwent RYGB; 25.0% underwent LAGB). At year 1, clinically meaningful improvements were shown in 57.6% (95% CI, 55.3%-59.9%) of participants for bodily pain, 76.5% (95% CI, 74.6%-78.5%) for physical function, and 59.5% (95% CI, 56.4%-62.7%) for walk time. Additionally, among participants with severe knee or disability (633), or hip pain or disability (500) at baseline, approximately three-fourths experienced joint-specific improvements in knee pain (77.1% [95% CI, 73.5%-80.7%]) and in hip function (79.2% [95% CI, 75.3%-83.1%]). Between year 1 and year 3, rates of improvement significantly decreased to 48.6% (95% CI, 46.0%-51.1%) for bodily pain and to 70.2% (95% CI, 67.8%-72.5%) for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not (P for all ?.05). Younger age, male sex, higher income, lower BMI, and fewer depressive symptoms presurgery; no diabetes and no venous edema with ulcerations postsurgery (either no history or remission); and presurgery-to-postsurgery reductions in weight and depressive symptoms were associated with presurgery-to-postsurgery improvements in multiple outcomes at years 1, 2, and 3.Among a cohort of participants with severe obesity undergoing bariatric surgery, a large percentage experienced improvement, compared with baseline, in pain, physical function, and walk time over 3 years, but the percentage with improvement in pain and physical function decreased between year 1 and year 3.clinicaltrials.gov Identifier: NCT00465829.
Project description:OBJECTIVE:This study examines the course of eating pathology and its associations with change in weight and health-related quality of life following bariatric surgery. METHOD:Participants (N =?184) completed the eating disorder examination-bariatric surgery version (EDE-BSV) and the medical outcomes study 36-Item short form health survey (SF-36) prior to and annually following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) for up to 7?years. RESULTS:The prevalence of ? weekly loss of control (LOC) eating, picking/nibbling, and cravings declined post-RYGB and remained lower through 7 years (LOC: 5.4% at Year-7 vs. 16.2% pre-RYGB, p =?.03; picking/nibbling: 7.0% vs. 32.4%, p <?.001; and cravings: 19.4% vs. 33.6%, p =?.02). The prevalence of picking/nibbling was significantly lower 7 years following LAGB vs. pre-LAGB (29.4% vs 45.8%, p =?.049), while cravings (p =?.13) and LOC eating (p =?.95) were not. EDE-BSV global score and ratings of hunger and enjoyment of eating were lower 7 years following both RYGB and LAGB versus pre-surgery (p's for all <.05). LOC eating following RYGB was associated with less long-term weight loss from surgery (p <?.01) and greater weight regain from weight nadir (p <?.001). Higher post-surgery EDE-BSV global score was associated with less weight loss/greater regain (both p <?.001) and worsening/less improvement from surgery in the SF-36 mental component summary scores (p <?.01). DISCUSSION:Initial improvements in eating pathology following RYGB and LAGB were sustained across 7?years of follow-up. Individuals with eating pathology post-RYGB, reflected by LOC eating and/or higher EDE-BSV global score, may be at risk for suboptimal long-term outcomes.