Psychosocial Functionality and Predictors in Bariatric Surgery Candidates

Objective: The aim of this study is to determine the level of depression, self-esteem, body satisfaction and quality of life in obese women as well as the predictors of psychosocial functionality. Methods: The study group consisted of 110 obese women participating in a diet and exercise program held in Kocaeli University Faculty of Medicine. Beck Depression Inventory, Rosenberg Self Esteem Scale, Body Satisfaction Scale and Obesity Related Problems Scale were used. Weight and height measurements were done using a calibrated digital scale and a height scale. Results: Psychosocial functionality of the study group was found to be moderately deteriorated and it showed signi-ficant relationship with depression, self-esteem and body dissatisfaction but not with BMI. In the linear regression model, in addition to self-esteem and body dissatisfaction, educational status of the obese women were determined as the predictors for psychosocial functionality. Discussion: Self-esteem, depression and body satisfaction are all concepts that are intertwined in obese individuals. In conclusion this study shows that body satisfaction and self-esteem were more important for psychosocial function of obese women, rather than BMI per se. The severe deterio-ration of psychosocial functionality of obese women with a higher educational status might well be related to more exposure to stigmatization and discrimination as a result of taking a more active role in society. There is a need for future studies where stigmatization is also investigated as a triggering cause of body dissatisfaction and low self-esteem, thus leading to a decrease in quality of life.

Considering the effects of self-esteem, eating attitudes and body satisfaction on obesity and bariatric surgery outcomes, psychiatric evaluation is important for the identification and treatment of psychopathology, improvement of self-esteem, eating attitudes and body satisfaction. In this study, it was aimed to determine the relation between eating behaviors, body dissatisfaction, self-esteem and psychological symptoms in patients seeking bariatric surgery. Our second aim was to determine whether depressive symptoms and anxiety had a mediating role in the relationship between body satisfaction and self-esteem and eating attitudes. The study included 200 patients. Patients' data were retrospectively evaluated. Psychometric evaluation performed during the preoperative period included psychiatric examination and administration of the Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg SelfEsteem Scale, Body-Cathexis Scale, and Dutch Eating Behaviors Questionnaire. There was a positive correlation between self-esteem and body satisfaction and a negative correlation between self-esteem and emotional eating (r= 0.160, p= 0.024; r= -0.261, p <0.001 respectively). Body satisfaction had an effect on emotional eating mediated by depression and an effect on external and restrictive eating mediated by anxiety. Furthermore, anxiety mediated the relations between self-esteem and external and restrictive eating behaviors. Our finding indicating that depression and anxiety have mediator effects on the relation between self-esteem, body dissatisfaction, and eating attitudes is significant since screening for these entities and their treatment is relatively more practical in clinical settings.

The aim of this study was to assess depressive symptoms, self-esteem, and eating psychopathology in bariatric surgery patients at the preoperative period (t0) and at the 6-month (t1) and 12-month (t2) follow-ups after laparoscopic sleeve gastrectomy (LSG). A second aim was to investigate associations between these variables and weight loss. The study participants were 48 bariatric surgery candidates and 50 non-obese controls. Both groups underwent assessment with the Sociodemographic Data Form, Hamilton Depression Rating Scale (HDRS), Eating Disorder Examination Questionnaire (EDE-Q), and Rosenberg Self-esteem Scale (RSES). These assessments were repeated for the patient group at t1 and t2. The HDRS, RSES, and EDE-Q scores were higher in the patients before LSG (t0) than in the control group. A significant progressive improvement was identified in the patient HDRS and RSES scores as well as EDE-Q weight and shape subscale scores at t1 and t2. However, the patient EDE-Q total and dietary restraint scores improved at t1 then stabilized. The patient EDE-Q eating concern subscale improved at t1, but then worsened. The patient HDRS scores at t2 were similar to the control group, but the EDE-Q and RSES scores were still higher than the control scores at t2. Regression analyses revealed no association between the preoperative scores and percent changes in postoperative scores for any scale and patient weight loss at t2. Depressive symptoms, self-esteem, and eating psychopathology showed an improving trend in patients after LSG. However, some aspects of eating psychopathology worsened despite an initial improvement. III, prospective cohort and case-control study.

To compare individuals with class II and III obesity with and without binge eating disorder (BED) in terms of sociodemographic characteristics, depressive symptoms, self-esteem, eating behaviors, and cognitive variables thought to be involved in the pathophysiology of the disease. The participants were selected from volunteer patients with body mass index ≥ 35 applying to the Ondokuz Mayıs University Medical Faculty, Turkey, for bariatric surgery between 01.07.2016 and 31.05.2019. The Beck Depression Inventory (BDI), Rosenberg Self-Esteem Scale (RSES), and Eating Disorder Examination Questionnaire (EDE-Q) were administered to all participants. Binge eating disorder (BED) was determined in 95 (34%) of the 278 individuals applying for bariatric surgery. The frequency of previous psychiatric diseases was higher in the BED group than in the non-BED group. BDI, RSES, total EDE-Q, weight concern, shape concern, and eating concern EDE-Q subscale scores were also higher in the BED group. Correlation analysis revealed positive low correlation between depression scores and total EDE-Q scores and all subscales scores, with the exception of restraint. Positive low correlation was determined between decreased self-esteem and body weight and shape concern. At multivariate regression analysis, cognitive variables explained 28.6% of variance in depressive symptoms in the BED group, and 21.5% of variance in self-esteem. The study results showed elevation in cognitive factors in patients with BED compared to the controls. Among these variables, eating and weight concern were shown to be associated with depressive symptoms, while eating concern was linked to self-esteem. Level III, case-control analytic study.

The Beck Depression Inventory (BDI) is commonly used in bariatric surgery psychological assessments. However, several items may be measuring physical consequences of obesity (e.g., sleep disturbance, chronic pain, or sexual dysfunction) rather than depressive symptoms. Bariatric surgery candidates (n = 210) completed a series of assessments including the BDI, a chronic pain assessment, and a semistructured clinical interview. Total BDI scores, subscale scores, and endorsement patterns of somatic versus cognitive-affective items were examined based on (1) the presence or absence of a depressive diagnosis or (2) the presence or absence of chronic pain, and optimal cut points were determined. Both the total BDI and cognitive-affective subscale had good discriminating accuracy between participants with and without depression, with an optimal cut point of 12 for the BDI and 7 for the cognitive-affective subscale. Bariatric surgery candidates with chronic pain had significantly higher mean total scores on the BDI (M = 12.5 +/- 7.5) than those without chronic pain (M = 9.02 +/- 6.7; p < 0.01), and those with chronic pain were significantly more likely to endorse many of the physical items than those without chronic pain. The BDI, with or without the somatic items, appears to be a reasonable screening measure for depressive symptoms among bariatric surgery candidates and the subpopulation of those with chronic pain, although future investigations may wish to examine whether other measures would have improved discrimination accuracy.

Overvaluation of shape and weight (OSW) involves defining self-worth by body shape/weight. Among persons seeking bariatric surgery, cross-sectional studies have found associations between OSW, depressive symptoms, and disordered eating. Relationships among OSW, depressive symptoms, binge eating symptoms, and BMI were analyzed both cross-sectionally and over time among 145 adults who had bariatric surgery. Participants completed the following measures pre-surgery and 1.5 to 3years post-surgery: Eating Disorder Examination Questionnaire (EDE-Q), Binge Eating Scale, Patient Health Questionnaire, and body weight and height. OSW was measured by averaging two items on the EDE-Q which ask participants to rate how much their weight/shape influences how they judge themselves as a person. Analyses included Wilcoxon signed-ranks, bootstrapped Pearson correlations, and bootstrapped hierarchical linear regressions. OSW was significantly associated with depressive symptoms and binge eating symptoms both pre- and post-surgery, but was not associated with BMI at either timepoint. Improvements in OSW were associated with concurrent changes in depression and binge eating; reductions in BMI were not significantly associated with changes in any of these variables. Findings suggest that self-evaluation is more important in regard to changes in depressive and binge eating symptoms than is BMI (and vice versa), and support the importance of assessing and treating psychological considerations among persons seeking bariatric surgery.

Objective The aim of this study was to determine the effects of anxiety levels and emotion dysregulation on each other and their effects on psychosocial functioning in remitted BD patients. Methods Sixty-six patients with BD and 38 healthy controls were included in this study. All the patients were assessed with the Hamilton Depression Rating Scale, the Young Mania Rating Scale, the Bipolar Disorder Functioning Questionnaire, the State-Trait Anxiety Inventory (STAI) and the Difficulties in Emotion Regulation Scale (DERS). Healthy controls were only assessed with the STAI and the DERS. Results STAI and DERS scores were significantly higher in the patient group than in the control group. Higher scores of STAI and DERS were found to be associated with lower functionality in the patient group. The trait anxiety scores explained 22% of the variance in the psychosocial functionality scores of the patients while the total DERS score explained 51.5% of the variance in the trait anxiety scores. Patients on lithium treatment had less difficulty in regulating their emotions than those on valproic acid treatment. Conclusions In light of these findings, planning interventions for emotion regulation difficulties during the management of patients would reduce anxiety levels and contribute to improving patients’ psychosocial functionality.

Overweight and obesity: The significance of a depressed mood

The aim of this study was to investigate changes in food neophobia (fear of trying new foods), eating psychopathology and depression in patients with sleeve gastrectomy (SG) at preoperative (T0), 3-month (T1) and 6-month (T2) follow-up. This study was conducted with 87 adults (43 males, 44 females) undergoing SG. Participants were assessed using the characteristic form, the Food Neophobia Scale (FNS), the Eating Disorder Examination Questionnaire (EDE-Q) and the Beck Depression Inventory (BDI) at baseline. These assessments were repeated at T1 and T2. Higher scores on the FNS, EDE-Q, and BDI indicate greater levels of food neophobia, disordered eating behaviors and depressive symptoms, respectively. There was a significant increase in the total FNS score and the number of neophobic patients from T0 to T1 and then a slight decrease (from T1 to T2), but it was still significantly higher at T2 than at T0. A statistically significant and progressive reduction was observed in the total and subscale scores of the EDE-Q and total BDI score at both T1 and T2. The BDI total score, the EDE-Q total score and all EDE-Q subscale scores (except for the Restraint) were significantly higher in females than in males at T1 and T2. FNS total score and the number of neophobic patients were higher in males at T0, T1 and T2. Eating psychopathology and depressive symptoms may tend to improve after SG. Although it is possible to state that food neophobia has changed over time compared to before SG, it needs to be supported by studies.

Introduction: depression is more frequent among people with obesity (PwO) compared to the general population. Depression seems to improve after bariatric surgery (BS) at short term, but data are inconclusive at long term. Besides, it is not known whether depressive symptoms among PwO are similar to those people with a major depression without obesity. Objectives: we aimed to study whether there are differences regarding depressive symptomatology among subjects seeking BS or patients after BS in the long-term compared with subjects with MDD. Methods: the Beck Depression Inventory (BDI) was administered to three groups: 52 patients seeking BS (OB), 135 patients with a BS with a minimum follow-up of 18 months (BS) and 45 subjects with a MDD (MDD). Results: the MDD obtained the higher score with the BDI whether compared to the OB (18.9 ± 12.7 vs 14.2 ± 6.9; p = 0.01) or the BS (18.9 ± 12.7 vs 8.1 ± 8; p < 0.0001). Also, BS presented a lower BDI than the OB (8.1 ± 8 vs 14.2 ± 6.9; p < 0.0001). The MDD scored higher in the psychological domain than patients in the OB (9.9 ± 7.5 vs 5.7 ± 5.1; p < 0.0001) as well as in the BS (9.9 ± 7.5 vs 3.1 ± 3; p < 0.0001). There was a negative correlation between a greater score in the somatic domain and %EPP (p = 0.04). Conclusions: at long term, depressive symptomatology among subjects with a BS remained lower compared to PwO seeking BS.PwO presented a different cluster of depression compared to individuals with a MDD. BS reduces the somatic depressive cluster at long term, although its presence is associated to a lesser weight loss.

The Obesity-related Problems scale (OP) is a self-assessment module developed to measure the impacts of obesity on psychosocial functioning. Our principal aim was to evaluate the construct validity and responsiveness of the OP scale. Our specific aims were to test: (1). the psychometric performance of OP; (2). if OP scores differed by gender and weight category; (3). if OP scores are inversely related to mental well-being; (4). if weight reduction in the obese is accompanied by improvements in psychosocial functioning (OP). Four samples were used: 6863 subjects in the SOS cross-sectional study; 2128 in the SOS intervention study; 1017 nonobese in the SOS reference study; and 3305 obese subjects in the XENDOS study. Psychosocial functioning was measured by OP. Overall mood was measured by MACL. Anxiety and depression symptoms were measured by HAD. Psychometric testing provided strong support for the construct validity of OP. Factor analysis confirmed the homogeneity of the construct and multitrait/multi-item scaling analysis demonstrated strong item-convergent/discriminant validity. Reliability coefficients were high and floor and ceiling effects were small. Psychometric results were cross-validated and replicated in subgroups by gender, age and body mass index (BMI). As expected, large differences in OP were observed between obese and nonobese (P<0.0001). Obese women reported more weight-related psychosocial problems than obese men (P<0.0001). Psychosocial disturbances (OP) among the obese were significantly related to poor mood (MACL; P<0.0001) and anxiety and depression symptoms (HAD; P<0.0001). Change in OP over time was strongly correlated with weight loss (P<0.0001). A distinct dose-response effect between weight reduction and improvements in OP was demonstrated. Scores on psychosocial functioning (OP) and mental well-being (MACL, HAD) in nonobese (BMI<30) surgical patients at 4-y follow-up were equal to scores observed in nonobese reference subjects (NS). OP is a psychometrically valid obesity-specific measure suitable for evaluating HRQL effects of obesity interventions. The negative impact of obesity on psychosocial functioning is considerable and disturbances are connected with poor mental well-being. Weight reduction in the obese is followed by improvements in both psychosocial functioning and mental well-being.

Cognitive behavioral therapy for insomnia (CBT-I) has been shown to improve both sleep and depressive symptoms, but predictors of depression outcome following CBT-I have not been well examined. This study investigated how chronotype (i.e., morningness-eveningness trait) and changes in sleep efficiency (SE) were related to changes in depressive symptoms among recipients of CBT-I. Included were 419 adult insomnia outpatients from a sleep disorders clinic (43.20% males, age mean ± standard deviation = 48.14 ± 14.02). All participants completed the Composite Scale of Morningness and attended at least 4 sessions of a 6-session group CBT-I. SE was extracted from sleep diary; depressive symptoms were assessed using the Beck Depression Inventory (BDI) prior to (Baseline), and at the end (End) of intervention. Multilevel structural equation modeling revealed that from Baseline to End, SE increased and BDI decreased significantly. Controlling for age, sex, BDI, and SE at Baseline, stronger evening chronotype and less improvement in SE significantly and uniquely predicted less reduction in BDI from Baseline to End. Chronotype did not predict improvement in SE. In an insomnia outpatient sample, SE and depressive symptoms improved significantly after a CBT-I group intervention. All chronotypes benefited from sleep improvement, but those with greater eveningness and/or less sleep improvement experienced less reduction in depressive symptom severity. This suggests that evening preference and insomnia symptoms may have distinct relationships with mood, raising the possibility that the effect of CBT-I on depressive symptoms could be enhanced by assessing and addressing circadian factors.

The impact of bariatric surgery (BS) on the sexual functioning of patients is poorly studied. Our aim was to analyze the sexual function, depressive symptoms, and self-esteem of morbidly obese women (MOW) undergoing BS. Quality of sexual life was prospectively evaluated in 43 consecutive MOW (18-50years) who underwent BS. Female sexual function index (FSFI), Beck depression inventory (BDI), and Rosenberg self-esteem scale (RSES) questionnaires were administered to evaluate sexual satisfaction, depressive symptoms, and self-esteem, respectively. A control group of 36 healthy, non-obese, female patients (HW) was recruited for comparison. Results of questionnaires were compared between three periods (before BS and at 3- and 6-month follow-up) and between MOW and HW. Before BS, the FSFI score was significantly lower in MOW compared to HW (17 ± 12 vs 27 ± 8, p = 0.0001) while at 3- and 6-month post-BS, a significant amelioration (p = 0.01) occurred. In particular, after BS, all components of the FSFI score (sexual desire, excitement, lubrification, orgasm, satisfaction, and pain) were ameliorated. The pre-BS BDI score was higher in MOW than in HW (8 ± 6 vs 5 ± 5, p = 0.004) while at postoperative months 3 and 6, a significant amelioration was found (p = 0.025 and 0.005, respectively). Before BS, no significant differences occurred in the RSES score between MOW and HW (30 ± 7 vs 32 ± 6, p = 0.014), whereas the MOW RSES scores at 6-month post-BS were improved when compared with the HW RSES scores. BS results in a significant improvement in the quality of sexual life, depressive symptoms, and self-esteem in MOW.

Obesity is associated with a great number of complications, including type 2 diabetes mellitus and psychiatric pathology. Bariatric surgery is the best solution to weight loss and improvement of complications in morbid obese patients. This study aims to analyze the evolution of type 2 diabetes mellitus and psychopathologic variables before and after bariatric surgery and assess the importance of different variables in weight loss. This is a longitudinal study, which evaluates 75 patients before and after bariatric surgery (47 - LAGB - laparoscopic adjustable gastric band; 19 - RYGB - Roux-en-Y gastric bypass; 9 - sleeve) with a follow-up time between 18 and 46 months. A clinical interview and self report questionnaires were applied - Eating Disorder Examination questionnaire - EDE-Q and Beck Depression Inventory - BDI. Results show an improvement in type 2 diabetes mellitus after surgery (X2 (1) = 26.132, p < 0.001). There was not a significant improvement among psychiatric pathology when we controlled the analysis for the type of surgery. It was verified that type 2 diabetes mellitus, depression and eating disorders in post-operative period are associated with less weight loss. This model explains 27% of weight variance after surgery (R2 = 0.265) and it is significant F (3.33) = 2.981, p = 0.038. Type 2 diabetes mellitus, psychiatric pathology and eating disorders after surgery influenced weight loss. It was not clear in what way this relation was verified, neither the relation that these metabolic and psychological variables may have during the postoperative period. Type 2 diabetes mellitus improved after surgery. Type 2 diabetes mellitus, depression and eating disorders influenced weight loss in the postoperative period. These variables did not influence weight loss in the preoperative period.

ObjectiveThis review aimed to examine the validity of self‐report screening questionnaires for identifying eating disorder (ED) risk in adults and adolescents with overweight/obesity.MethodFive databases were searched from inception to September 2020 for studies assessing validation of self‐report ED screening questionnaires against diagnostic interviews in adolescents and adults with overweight/obesity. The review was registered with PROSPERO (https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=220013).ResultsTwenty‐seven papers examining 15 questionnaires were included. Most studies validated questionnaires for adults (22 of 27 studies), and most questionnaires (12 of 15) screened for binge eating or binge‐eating disorder (BED). The Eating Disorder Examination Questionnaire (sensitivity = .16–.88, specificity = .62–1.0) and Questionnaire on Eating and Weight Patterns (sensitivity = .07–1.0, specificity = .0–1.0) were most frequently validated (six studies each). Five studies of three questionnaires were in adolescents, with the Adolescent Binge‐Eating Disorder Questionnaire having highest sensitivity (1.0) but lower specificity (.27). Questionnaires designed to screen for BED generally had higher diagnostic accuracy than those screening for EDs in general.DiscussionQuestionnaires have been well validated to identify BED in adults with overweight/obesity. Validated screening tools to identify other EDs in adults and any ED in adolescents with overweight/obesity are lacking. Thus, clinical assessment should inform the identification of patients with co‐morbid EDs and overweight/obesity.Public SignificanceIndividuals with overweight/obesity are at increased risk of EDs. This review highlights literature gaps regarding screening for ED risk in this vulnerable group. This work presents possibilities for improving care of individuals with overweight/obesity by reinventing ED screening tools to be better suited to diverse populations.