Female Bariatric Surgery Candidates Research Articles

Adipocyte size, adipose tissue fibrosis, macrophage infiltration and disease risk are different in younger and older individuals with childhood versus adulthood onset obesity.

The timing of obesity onset and age have been shown to affect the risk of obesity-related comorbidities, although the impact of each of these factors on markers of adipose tissue function remains unclear. The aim of this study was to determine whether differences in regional adipose tissue characteristics vary with age and age of obesity onset, and whether these differences are associated with the markers of cardiometabolic health. Adipose tissue samples were obtained from 80 female bariatric surgery candidates who were classified by age of obesity onset and age into 4 groups: (1) younger adults (<40 y) with childhood-onset obesity (<18 y) (Child-Young); (2) younger adults with adulthood-onset obesity (>18 y) (Adult-Young); (3) older adults (>55 y) with childhood-onset obesity (Child-Old); and (4) older adults with adulthood-onset obesity (Adult-Old). Adipocyte diameter, adipose tissue fibrosis, and macrophage infiltration were determined in subcutaneous (SAT) and visceral adipose tissue (VAT). Clinical parameters were obtained from participants' medical records. Visceral adipocyte size in the Child-Young group was the smallest of all the groups. Age affected visceral infiltration of M1-like cells with greater percent of M1-like cells in the Adult-Old and Child-Old groups. Though not significant, a stepwise increase in M2-like macrophages in VAT was observed with Adult-Young having the smallest followed by Adult-Old, Child-Young, and Child-Old having the greatest percent of M2-like macrophages. Pericellular fibrosis accumulation in SAT and VAT varied with both age and onset, particularly in the Child-Old group, which had the lowest fibrosis levels. Markers of cardiometabolic health (fasting glucose, glycated hemoglobin, total, HDL- and LDL-cholesterol and triglyceride concentrations) were positively and well-associated with adipose tissue characteristics of the Child-Old group but not of the Adult-Young group. Older adults with childhood-onset obesity, who had the greatest duration of obesity exposure, were particularly vulnerable to the cardiometabolic effects associated with perturbations in adipose tissue characteristics. These results suggest that age and age of obesity onset may have independent and cumulative effects on obesity pathology.

Adipocyte Size, Adipose Tissue Fibrosis, Macrophage Infiltration and Disease Risk Are Different in Younger and Older Individuals with Childhood and Adulthood Onset Obesity

ObjectivesThe timing of obesity onset and age have been shown to affect the risk of obesity-related comorbidities, although the impact of each of these factors on markers of adipose tissue function remains unclear. The aim of this study is to determine whether differences in regional adipose tissue characteristics vary with age and age of obesity onset, and whether these differences are associated with the markers of cardiometabolic health.MethodsAdipose tissue samples were from 80 female bariatric surgery candidates who were classified by age of obesity onset and age into 4 groups: 1) younger adults (<40 y) with childhood-onset obesity (< 18 y) (Childhood-Young); 2) younger adults with adulthood-onset obesity (>18 y) (Adulthood-Young); 3) older adults (>55 y) with childhood-onset obesity (Childhood-Old); and 4) older adults with adulthood-onset obesity (Adulthood-Old). Adipocyte diameter, adipose tissue fibrosis and macrophage infiltration were determined in subcutaneous (SAT) and visceral adipose tissue (VAT). Clinical parameters were obtained from participants’ medical records.ResultsVisceral adipocyte size in the Childhood-Young group was the smallest of all the groups. Age affected visceral infiltration of M1-like cells in both older groups, whereas onset, specifically childhood-onset, was related to visceral infiltration of M2-like cells in the Childhood-Old group. Fibrosis accumulation in SAT and VAT varied with age and onset, particularly in the Childhood-Old group having the lowest fibrosis levels. Markers of cardiometabolic health (fasting glucose, glycated hemoglobin, total, HDL- and LDL-cholesterol and triglyceride concentrations) were positively and well associated with adipose tissue characteristics of the Childhood-Old group but not of the Adulthood-Young group.ConclusionsOlder adults with childhood onset obesity, who had the greatest duration of obesity exposure, were particularly vulnerable to the cardiometabolic effects associated with perturbations in adipose tissue characteristics. These results, suggest that age and age of obesity onset may have independent and cumulative effects on obesity pathology.Funding SourcesSylvia Santosa holds a Canada Research Chair – Tier 2 in Clinical Nutrition. This research is also supported by a Discovery Grant from The Natural Science and Engineering Research Council of Canada.

Changes in Sexual Functions of Female Patients After Bariatric Surgery: Relationship with Body Image, Depression, and Anxiety

Objectives: It is reported that sexual dysfunction is observed in female bariatric surgery (BS) candidates. The aim of this study is to determine the prevalence of sexual dysfunction in female BS candidates and to compare the pre-BS and 6 months post-BS sexual functions. Methods: We assessed 31 female candidates for BS. All participants were administered the sociodemographic and clinical characteristics form, Arizona Sexual Experiences Scale (ASEX), Beck Depression Scale (BDS), Body Image Scale (BIS), and Beck Anxiety Scale (BAS) before BS and 6 months after BS. Results: The pre-BS female sexual dysfunction rate was 77.4%. Six months after BS, the ASEX total scores (p = 0.005), BDS, BIS and BAS scores improved (p 0.05). There is positive correlation between the ASEX scores and level of depression (r = +0.367, p < 0.05), whereas there is negative correlation between the ASEX scores and the BIS scores (r =...

Psychopathology in severely obese women from a Canadian bariatric setting

Purpose – Evidence suggests high rates of psychiatric disorders in bariatric surgery candidates (e.g. Mitchell et al., 2012), although no rigorous studies have examined the prevalence in a Canadian sample. Improved understanding of the prevalence of psychopathology among female patients is an important area of study, as females comprise approximately 80 percent of surgical candidates (Martin et al., 2010; Padwal, 2005). The purpose of this paper is to assess the prevalence of Axis I disorders and associations with quality of life in a Canadian sample of female bariatric surgery candidates. Design/methodology/approach – Female patients (n=257) were assessed using a structured psychodiagnostic interview and completed a health-related quality of life questionnaire. Findings – Results indicated that 57.2 percent of patients met DSM-IV-TR criteria for a lifetime psychiatric disorder and 18.3 percent met criteria for a current psychiatric disorder. Major depressive disorder was the most common lifetime psychiatric disorder (35.0 percent) and binge eating disorder was the most prevalent current psychiatric disorder (6.6 percent). Patients scored significantly lower than Canadian population norms on all domains of the SF-36 (all p's&lt;0.001). Patients with a current Axis I disorder also reported significantly worse functioning on four mental health domains and one physical health domain (p's&lt;0.01) compared to patients without a current Axis I disorder. Originality/value – Results confirm high rates of psychiatric disorders in Canadian female bariatric surgery candidates and provide evidence for associated functional health impairment. Further study is needed to elucidate how pre-operative psychopathology may impact female patients’ post-operative outcomes.

Perceptions of obesity and cancer risk in female bariatric surgery candidates: Highlighting the need for physician action for unsuspectingly obese and high-risk patients

Objectives: Obesity markedly increases cancer risk, but little is known about perceptions of risk and cancer screening in obese women. The study objectives were to determine: 1) whether obese women perceive themselves to be obese or at high-risk for malignancy, 2) the perceived impact of obesity on cancer risk, 3) compliance with cancer screening, and 4) rates of menstrual dysfunction in this high-risk group.

Perceptions of obesity and cancer risk in female bariatric surgery candidates: Highlighting the need for physician action for unsuspectingly obese and high risk patients

ObjectivesTo determine: 1) whether obese women perceive themselves to be obese or at risk for malignancy, 2) perceived impact of obesity on cancer risks, 3) compliance with cancer screening, and 4) rates of menstrual dysfunction. MethodsSurveys were administered to female patients presenting for bariatric weight loss surgery. Demographics, gynecologic history, perception of cancer risk, and screening history were collected/analyzed. Women were categorized as obese (BMI: 30–39kg/m2), morbidly obese (40–49kg/m2), super obese (≥50kg/m2) and compared. ResultsNinety-three women (mean age: 44.9years, mean BMI: 48.7kg/m2) participated and 45.7% felt they were in ‘good’, ‘very good’, or ‘excellent’ health despite frequent medical comorbidities. As BMI increased, women were more likely to correctly identify themselves as obese (23% of obese vs. 77% of morbidly obese vs. 85% of super obese; p<0.001) but there were no significant differences in comorbidities. Two-thirds of women correctly identified obesity as a risk factor for uterine cancer, yet 48% of those retaining a uterus perceived that it was “not likely/not possible” to develop uterine cancer. Menstrual irregularities were common as was evaluation and interventions for the same; 32% had prior hysterectomy. Participation in cancer screening was robust. ConclusionsWomen presenting for bariatric surgery have high rates of menstrual dysfunction. While they perceive that obesity increases uterine cancer risk, they often do not perceive themselves to be at risk. This disconnect may stem from the fact that many failed to identify themselves as obese perhaps because overweight/obesity has become the norm in U.S. society.

Comparative Analysis of Approaches for Assessing Energy Intake Underreporting by Female Bariatric Surgery Candidates

Objective: To test six variations in the Goldberg equation for evaluating the underreporting of energy intake (EI) among obese women on the waiting list for bariatric surgery, considering variations in resting metabolic rate (RMR), physical activity, and food intake levels in group and individual approaches. Methods: One hundred obese women aged 20 to 45 years (33.3 ± 6.08) recruited from a bariatric surgery waiting list participated in the study. Underreporting assessment was based on the difference between reported energy intake, indirect calorimetry measurements and RMR (rEI:RMR), which is compatible with the predicted physical activity level (PAL). Six approaches were used for defining the cutoff points. The approaches took into account variances in the components of the rEI:RMR = PAL equation as a function of the assumed PAL, sample size (n), and measured or estimated RMR. Results: The underreporting percentage varied from 55% to 97%, depending on the approach used for generating the cutoff points. The ratio rEI:RMR and estimated PAL of the sample were significantly different (p = 0.001). Sixty-one percent of the women reported an EI lower than their RMR. The PAL variable significantly affected the cutoff point, leading to different proportions of underreporting. The RMR measured or estimated in the equation did not result in differences in the proportion of underreporting. The individual approach was less sensitive than the group approach. Conclusion: RMR did not interfere in underreporting estimates. However, PAL variations were responsible for significant differences in cutoff point. Thus, PAL should be considered when estimating underreporting, and even though the individual approach is less sensitive than the group approach, it may be a useful tool for clinical practice.

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

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

Health and health-related quality of life: differences between men and women who seek gastric bypass surgery

Background The aim of this study was to examine the differences between male and female bariatric surgery candidates with respect to health-related quality of life (HRQOL), health, sociodemographic variables, and interactions among these variables in a bariatric surgery practice in the United States. Women seek bariatric surgery 5 times more often than men. Research on gender differences in HRQOL is limited, and the results are conflicting. Methods A total of 794 surgery candidates (mean age 42.2 y; body mass index 46.9 kg/m 2; 84.8% women) completed both a weight-related (Impact of Weight on Quality of Life-Lite questionnaire) and a generic (Medical Outcomes Study Short-Form-36) measure of HRQOL. Health was evaluated by questionnaire and clinical interviews. Results Compared to men, women reported reduced HRQOL on 3 of the 5 scales assessing obesity-specific HRQOL and also the physical aspects of general HRQOL. Women also had double the rate of depression (48.5% versus 22.5%), and men had double the rate of sleep apnea (80.3% versus 40.2%). Women were younger, less obese, and were less likely to be married. No gender differences were found in the association between HRQOL and co-morbidities. However, an increasing number of co-morbidities was associated with decreasing physical and mental HRQOL. Additionally, depression was associated with decreased mental HRQOL, and coronary heart disease was associated with decreased physical HRQOL. Conclusion Women's reduced HRQOL, particularly in self-esteem, sexual life, and physical functioning, and their greater rates of depression, might play a role in their decision to seek bariatric surgery. Although we could not determine causality, this study is a first step toward understanding why women seek surgery 5 times more often than men.

Correlates of Body Image Dissatisfaction in Extremely Obese Female Bariatric Surgery Candidates

This study investigated correlates of body image dissatisfaction in 131 extremely obese female bariatric surgery candidates. Female gastric bypass surgery candidates participating in a comprehensive psychiatric evaluation completed a battery of established self-report measures of body image and psychosocial functioning. Nine predictors of body image dissatisfaction were considered: body mass index (BMI), ethnicity, childhood onset of obesity, childhood teasing about weight, binge eating, depression, self-esteem, shame, and perfectionism. Stepwise multiple regression analysis revealed that the nine variables jointly accounted for 48% of the variance; three variables, depression, self-esteem and perfectionism, made significant independent contributions. Our findings highlight the importance of adult psychological functioning (depression, self-esteem and perfectionism) for predicting body image dissatisfaction in extremely obese female bariatric surgery candidates.

Gender and binge eating among bariatric surgery candidates

Bariatric surgery is an increasingly popular treatment for severe obesity. However, while rates of obesity are comparable across genders, women are much more likely to undergo bariatric surgery. Little research exists on gender differences among bariatric surgery candidates. This study examined gender differences and their correlates within a sample of 487 patients presenting for bariatric surgery. Results indicated that women were more depressed than men, dieted more, and were more likely to report that their weight interfered with feeling good about themselves. There were no differences in BED rates or binge eating. Furthermore, among women, both depression and self-esteem were associated with binge eating symptomatology. However, among men, only depression contributed to binge eating scores. These findings provide evidence for the significance of binge eating and depression among both male and female bariatric surgery candidates.

Childhood Maltreatment in Extremely Obese Male and Female Bariatric Surgery Candidates**

To examine rates of self-reported childhood maltreatment in extremely obese bariatric surgery candidates and to explore associations with sex, eating disorder features, and psychological functioning. Three hundred forty (58 men and 282 women) extremely obese consecutive candidates for gastric bypass surgery completed a questionnaire battery. The Childhood Trauma Questionnaire was given to assess childhood maltreatment. Overall, 69% of patients self-reported childhood maltreatment: 46% reported emotional abuse, 29% reported physical abuse, 32% reported sexual abuse, 49% reported emotional neglect, and 32% reported physical neglect. Except for higher rates of emotional abuse reported by women, different forms of maltreatment did not differ significantly by sex. Different forms of maltreatment were generally not associated with binge eating, current BMI, or eating disorder features. At the Bonferonni-corrected significance level, emotional abuse was associated with higher eating concerns and body dissatisfaction, and emotional neglect was associated with higher eating concerns. In terms of psychological functioning, at the Bonferonni-corrected level, emotional abuse and emotional neglect were associated with higher depression and lower self-esteem, and physical abuse was associated with higher depression. Extremely obese bariatric surgery candidates reported rates of maltreatment comparable with those reported by clinical groups and roughly two to three times higher than normative community samples. Reported experiences of maltreatment differed little by sex and were generally not significantly associated with current BMI, binge eating, or eating disorder features. In contrast, maltreatment-notably emotional abuse and neglect-were significantly associated with higher depression and lower self-esteem.

Binge eating and eating-related cognitions and behavior in ethnically diverse obese women.

To examine binge eating and eating-related cognitions and behavior in a sample of ethnically diverse women who are severely obese and seeking bariatric surgery. Female bariatric surgery candidates (62 African Americans, 18 Latinas, 130 whites) completed questionnaires on binge eating and eating-related cognitions and behavior and completed a structured clinical interview to confirm binge-eating disorder diagnosis. Ethnic minorities and whites did not differ in rates of binge-eating disorder (26.3%), binges per week (M = 0.95), or dietary restraint. Ethnic minorities reported less disinhibition, and there was a trend to report less hunger awareness than whites. After controlling for BMI and education, ethnicity accounted for significant variance in disinhibition (4%; p < 0.01). Ethnic minorities were younger, became overweight at a later age, and were overweight for fewer years than whites. Results suggest that ethnicity exerts an important influence on disinhibition and that ethnic differences are not caused by BMI or education. Findings point to the need to continue to investigate the role of ethnicity, binge eating, and disinhibition in severely obese women, so that culturally appropriate services can be provided.