David B Sarwer

Temple University | TU · Department of Social and Behavioral Sciences

Physical appearance is an important aspect of daily life. Social psychological research has repeatedly demonstrated that more attractive individuals are judged more favorably by others. Also, they receive preferential treatment across a range of interpersonal situations. These observations also likely explain, in part, why tens of millions of peopl...

Introduction This survey of international experts in obesity management was conducted to achieve consensus on standardized definitions and to identify areas of consensus and non-consensus in metabolic bariatric surgery (MBS) to assist in an algorithm of clinical practice guidelines for the management of obesity. Methods A three-round Delphi survey...

Adipocyte dysregulation is one mechanism linking overweight and breast cancer recurrence. Exercise and weight loss are associated with a decreased risk of breast cancer recurrence in breast cancer survivors with overweight or obesity, which may be mediated through reduced leptin levels, increased adiponectin levels, and an elevated adiponectin to l...

Objective Type 1 endometrial cancer (EC) survivors who are overweight or obese are at increased risk of comorbidities and reduced quality of life. Lifestyle modification interventions (e.g., healthy eating, exercise) may help these women reduce excess weight and improve their quality of life. However, existing interventions have shown limited succe...

Introduction In June 2013, the American Medical Association (AMA), one of the most influential healthcare organizations in the United States, voted to recognize obesity as a disease. Many who supported this change believed that recognition by AMA of obesity as a disease would serve as a tipping point that would increase access to care, accelerate t...

Little is known about adherence to COVID-19 masking mandates on college campuses or the relationship between weather-related variables and masking. This study aimed to (1) observe students’ adherence to on-campus mask mandates and (2) estimate the effect of weather on mask-wearing. Temple University partnered in the Centers for Disease Control and...

Many students come to higher education with a history of trauma. College life may also expose students to traumatizing events. While the past decade has witnessed greater discussion of trauma-informed frameworks, it has not regularly been applied to the college environment. We advance the concept of a trauma-informed campus, where administrators, f...

Purpose Cancer and its treatments accelerate biological aging. This analysis tested the hypothesis that exercise and diet reduce oxidative stress and prevent telomere shortening in breast cancer survivors. Methods In a 2 × 2 factorial design, 342 breast cancer survivors who were insufficiently physically active and had overweight or obesity at enr...

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IntroductionIdentifying eating behaviors associated with suboptimal weight loss following bariatric surgery remains important. This study assessed the relationship between eating behaviors and weight loss following bariatric surgery in a racially diverse sample.Methods Participants were assessed before surgery and 6 and 12 months postoperatively, w...

According to The Aesthetic Society, over 75,000 rhinoplasty procedures were performed in 2021.¹ Just less than 40,000 procedures were performed in 2019, before the COVID-19 pandemic disrupted the typical delivery of health care. Other facial procedures have increased postpandemic, raising interesting questions about why. Have some individuals becom...

The past decade has witnessed significant progress in the development of new antiobesity medications, with several having greater efficacy than pharmacological agents previously approved by the Food and Drug Administration (FDA). Despite the potential of new medications to combat America's obesity crisis, access to these agents is severely limited....

Purpose: Physical inactivity and obesity increase risk for breast cancer recurrence and cardiovascular death; inflammation is hypothesized to mediate these associations. Methods: In a 4-arm randomized controlled trial, 318 breast cancer survivors with overweight or obesity were randomized to Exercise Alone, Weight Loss Alone, Exercise plus Weigh...

Background This mixed-methods study examined the general public’s knowledge and attitudes about vascularized composite allografts. The availability of these anatomical gifts to treat individuals with severe disfiguring injuries relies largely on decisions made by family members. If vascularized composite allograft transplantation is to become more...

Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are...

Objective: Adverse childhood experiences (ACEs) are associated with elevated risk for poor physical and psychological health outcomes. Nearly all of the literature on the association between ACEs and poor health focuses on the individual and family level; the potential role of neighborhood environment is overlooked. Understanding the relationship b...

Disparities in rates of peripheral diabetic neuropathy and lower extremity amputation exist in the United States. To investigate the factors linked to this disparity, we performed a systematic review of the literature on the subject published during the period 2000-20. Nineteen observational studies were included. Disparities in rates of lower extr...

An association between adverse childhood experiences (ACEs) and elevated body mass index (BMI) has been found in previous investigations. ACEs’ effects on BMI have been primarily considered via individual-level physiological and behavioral frameworks. Neighborhood factors, such as greenspace, are also associated with BMI and may merit consideration...

This study evaluated methods for creating a neighborhood adverse childhood experiences (ACEs) index, a composite measure that captures the association between neighborhood environment characteristics (e.g., crime, healthcare access) and individual-level ACEs exposure, for a particular population. A neighborhood ACEs index can help understand and ad...

Introduction: Vascularized composite allotransplantation (VCA) donation relies on obtaining surrogate authorization. Yet, many donor professionals have limited experience discussing composite allograft donation. Using virtual and interactive elements, the eLearning program, Communicating Effectively about Donation for Vascularized Composite Allotr...

Insufficient physical activity and obesity are associated with an increased risk of cancer recurrence and death in breast cancer survivors. Sex steroid hormones may mediate these associations. This study tested the hypothesis that exercise and diet, as compared to control, favorably change sex steroid hormones. This analysis of data from a subset o...

This study explored whether self-reported barriers to accessing a health care provider, gender-affirming procedures, and relevant psychosocial measures were related to experienced gender affirmation in a cross-sectional sample of trans individuals (N=101). Body image quality of life [b=0.181, t(4.277), p<0.001] and the number of gender-affirming pr...

Obesity is a leading cause of hypertension (i.e., high blood pressure [BP]). While hypertension can be managed with antihypertensive medication, substantial weight loss can also lower BP, reducing the need for antihypertensive medication. Articles in this review (n = 60) presented data on antihypertensive medication use among adults pre- and postop...

Background Women with obesity and infertility are counseled to lose weight prior to conception and infertility treatment to improve pregnancy rates and birth outcomes, although confirmatory evidence from randomized trials is lacking. We assessed whether a preconception intensive lifestyle intervention with acute weight loss is superior to a weight...

This chapter provides an overview of the psychology of facial aesthetics. The chapter begins with a review of the psychology of physical appearance. After considering the issue from the societal perspective, the chapter turns its focus on the psychologic characteristics of individuals who present for aesthetic treatments. The psychologic construct...

This entry provides an overview of psychosocial issues related to cosmetic medical treatments, including surgical and minimally invasive procedures. It includes a discussion of psychological factors that motivate individual patients to seek treatment. Psychiatric conditions commonly seen in these patients are described. Studies that have investigat...

Approximately 42% of American adults are obese (BMI >30 kg/m²).¹ Furthermore, 11.5% of women and 6.9% of men have clinically severe obesity (BMI >40 kg/m²).¹ Obesity, and clinically severe obesity in particular, is associated with approximately 200 comorbidites, including type 2 diabetes, hypertension, coronary heart disease, and osteoarthritis.² B...

Objective To determine whether there is an association between insurance-mandated precertification criteria for bariatric surgery and short-term inpatient healthcare utilization. Background Insurance-mandated precertification requirements are barriers to bariatric surgery. The value of their prescription, based on insurance type rather that the cl...

Obesity-associated breast cancer recurrence is mechanistically linked with elevated insulin levels and insulin resistance. Exercise and weight loss are associated with decreased breast cancer recurrence, which may be mediated through reduced insulin levels and improved insulin sensitivity. This is a secondary analysis of the WISER Survivor clinical...

Trauma is a response to a deeply distressing or disturbing event, such as sexual assault, violent crime, or childhood abuse. Trauma has impacted the majority of Americans, with racial/ethnic minority and socioeconomically disadvantaged populations being disproportionately affected. Extensive evidence demonstrates trauma’s harmful effects on physica...

PurposeObesity increases the risk of cancer recurrence and death in survivors of breast cancer. This study tested the hypothesis that exercise alone, diet alone, and the combination of exercise plus diet reduce body weight and improve body composition in survivors of breast cancer.Methods In this 2 × 2 factorial trial, 351 survivors of breast cance...

A growing body of evidence supports the efficacy and safety of bariatric surgery for clinically severe obesity. Despite this empirical support, bariatric surgery remains profoundly underutilized. The reasons for underutilization are likely multifactorial, including health insurance coverage and benefits design, lack of awareness about bariatric sur...

Psychological trauma impacts two-thirds of Americans, suggesting that many intensive care unit (ICU) patients have a history of trauma. Our manuscript calls for translating the well-established system of trauma-informed care to the ICU setting – an approach we term “trauma-informed intensive care.” While trauma-informed approaches are being increas...

Background Obesity is a chronic, relapsing, and progressive disease; it is associated with poor health‐related quality of life (HRQOL) in survivors of breast cancer. Methods In this 2 × 2 factorial trial, 351 survivors of breast cancer with overweight or obesity were randomized to 1 of 4 treatment groups for 52 weeks: control, exercise alone, diet...

Background Patients with obesity are at increased risk of developing severe COVID-19. The pandemic has caused delays in preoperative preparation, progression, and completion of bariatric surgeries. Objectives The aim of this study was to evaluate the impact of COVID-19 restrictions on bariatric surgery patients and assess their concern of COVID-19...

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Background Bariatric surgery is underutilized in the United States. Objective To examine temporal changes in patient characteristics and insurer type mix among adult bariatric surgery patients in Southeastern Pennsylvania and to investigate the associations between payer type, insurance plan type, cost-sharing arrangements (among traditional Medic...

Adverse childhood experiences (ACEs) are associated with numerous physical and mental health issues in children and adults. The effect of ACEs on development of childhood obesity is less understood. This systematic review was undertaken to synthesize the quantitative research examining the relationship between ACEs and childhood obesity. PubMed, Ps...

Objective: Early scientific reports of the COVID-19 pandemic suggested that the coronavirus was associated with more serious disease and mortality in older adults. However, additional research suggested that those with underlying comorbidities, including obesity, type 2 diabetes, heart and respiratory diseases were most at risk for more severe outc...

Health Psychology has received numerous papers over the past several months on topics related to the COVID-19 pandemic. Many of them concern depression, anxiety, stress, or other forms of distress in the general population or in health care workers. We have received far fewer papers on COVID-related health behaviors and health communications-factor...

Background A great deal of research has focused on the psychosocial characteristics of individuals who seek aesthetic procedures as well as the psychological changes they experience after successful treatment. Little research, however, has explored the experiences of transgender individuals who have undergone nonsurgical injectable procedures (NSIP...

Background Most patients who undergo bariatric surgery experience significant weight loss and improvements in obesity-related co-morbidities in the first 6–18 months after surgery. However, 20%–30% of patients experience suboptimal weight loss or significant weight regain within the first few postoperative years. Psychosocial functioning may contri...

Objective To describe the prevalence of female sexual dysfunction in a well-defined polycystic ovary syndrome (PCOS) population, and to assess the impact of common PCOS treatments on sexual function. Design Secondary analysis of a randomized controlled trial, oral contraceptive pills and weight loss in PCOS. Setting Two academic medical centers....

Objective: To examine effects of common treatments for PCOS on a panel of hormones(reproductive/metabolic). Design: Secondary analysis of blood from a RCT of three 16-week preconception interventions designed to improve PCOS-related abnormalities: continuous oral contraceptives(OCP, N=34 subjects), intensive lifestyle modification(Lifestyle, N =...

Background Despite plausibility of migraine headaches contributing to impaired sexual function among women, data are inconsistent and point to obesity as a potential confounder. Prospective studies that assess the relative importance of migraine improvements and weight loss in relation to sexual function could help elucidate associations among migr...

With the emergence of vascularized composite allografts (VCAs) for transplantation, donation professionals' ability to obtain authorization for these anatomical gifts has become paramount for its continued practice. Our national study examines the experience of organ procurement organization (OPO) professionals responsible for presenting the opport...

Background: Access to bariatric surgery is restricted by insurers in numerous ways, including by precertification criteria such as 3–6 months preoperative supervised medical weight management and documented 2-year weight history. Objectives: To investigate if there is an association between the aforementioned precertification criteria, insuran...

We hypothesized that weight loss with an intensive preconception lifestyle (IL) intervention of caloric restriction with meal replacements, daily orlistat and increased physical activity in women with obesity and unexplained infertility (UI) was more likely to result in Good Birth Outcome than a standard lifestyle modification (SL) with increased p...

Health care reform is one of the major topics in the 2020 Democratic presidential campaign and likely will remain a major issue in the general election. The leading candidates share a desire to offer affordable health care coverage to all Americans, but the debate on the approaches to achieve this goal is heated. Among the most popular proposals ar...

There is currently no consensus on the ideal body mass index (BMI) for kidney transplantation, yet an elevated BMI can limit access to transplantation. This study explored the attitudes of kidney transplant professionals regarding BMI as a selection criterion for kidney transplantation. Brief, in-person interviews were conducted at the 2016 America...

We are delighted to welcome you to the inaugural issue of CommonHealth, an interdisciplinary, peer-reviewed, open-access journal of the College of Public Health at Temple University. Establishment of this journal is an exciting milestone and a natural next step in our trajectory of growth and leadership in public health education and research. The...

Introduction: Poor psychological health is common among adults with extreme obesity (body mass index (BMI) > 40 kg/m ² ). While prior studies report an association between psychological conditions (i.e., depression) and risk of hypertension, less is known about this association among adults with extreme obesity. Additionally, the association betwee...

Background: Currently the most effective treatment for severe obesity in adolescents is weight-loss surgery coupled with lifestyle behavior change. In preparation for weight-loss surgery, adolescents are required to make changes to eating and activity habits (lifestyle changes) to promote long term success. Social media support groups, which are p...

Background The popularity of genital cosmetic procedures in women is increasing. These procedures are often assumed and promoted as having have a positive effect on women’s psychological well-being, particularly their self-esteem. Empirical support for these claims is lacking. Objectives To conduct a systematic review and meta-analysis of the impa...

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...

Approximately 70% of adults in the United States have obesity or are overweight and at risk of developing obesity over time. Obesity is associated with an increased risk of morbidity and mortality; the economic impact of the health care costs associated with obesity is anticipated to have a profound, detrimental effect on the country's economy with...

Youth with craniofacial conditions often have appearance and speech differences and are vulnerable to social stigmatization and body image disturbances. Given sociocultural pressures for female attractiveness, adolescent girls with craniofacial conditions may be especially vulnerable to body dissatisfaction and appearance-related social stigmatizat...

Rationale: Obesity is the primary risk factor for sleep apnea (OSA). Tongue fat is increased in obese persons with OSA, and may explain the relationship between obesity and OSA. Weight loss improves OSA, but the mechanism is unknown. Objectives: To determine the effect of weight loss on UA anatomy in persons with obesity and OSA. We hypothesized...

Objective: Young men are less likely to engage in weight loss behaviours than their female counterparts. This may be because of an increased likelihood for young men, particularly young black men, with overweight/obesity to misperceive their weight status. This study examined racial differences in weight status perception accuracy and associations...

Over the past 60 years, a growing body of research has investigated the psychological aspects of cosmetic surgery and related minimally-invasive treatments. While the earliest studies were influenced by psychoanalytic thinking, much of the work over the past several decades has been influenced by Thomas Cash's cognitive-behavioral theory of body im...

Background In the subspecialty of female genital cosmetic procedures, patient satisfaction and quality of life are key outcome measures. As such, valid and reliable patient-reported outcome measures (PROMs) examining these outcomes are essential. Objectives To identify and scrutinize all PROMs developed for female patients undergoing genital cosme...

This chapter provides an overview of lifestyle modification approaches to treat obesity. Lifestyle modification for weight loss is likely the most frequently used approach to weight loss and typically includes some combination of caloric restriction, increased levels of physical activity, and the implementation of behavior change strategies. The ch...

Importance: To our knowledge, no randomized clinical trials have assessed the effects of the combination of weight loss and home-based exercise programs on lymphedema outcomes. Objective: To assess weight loss, home-based exercise, and the combination of weight loss and home-based exercise with clinical lymphedema outcomes among overweight breas...

Background: Bariatric surgery is underutilized in the United States. Objectives: This study examined whether utilization of bariatric surgery is associated with payer and insurance plan type, after removing potential socio-demographic confounders. Setting: The study used Pennsylvania Health Care Cost Containment Council’s data in five counties of...

Introduction: This study uses clinical practice data to determine whether recommended weight management clinician behaviors are associated with weight status improvement in children aged 6-12 years who are overweight or obese. Methods: Electronic health record data (2009-2014) from 52 clinics were used. Weight status was examined from 1 visit to...

Background: The prebariatric surgery assessment process can be challenging to patients and serve as a barrier to surgery. There is limited evidence to support its utility in improving postoperative outcomes for the majority of patients. Objectives: To assess the relationship between preoperative care and postoperative weight loss and follow-up i...

(Abstracted from JAMA Surg 2019; doi: 10.1001/jamasurg.2018.1162) Adults with severe obesity who seek bariatric surgery have impairments in several domains of sexual functioning. About half are dissatisfied with their sexual life.

Faces are among the most salient and relevant visual and social stimuli that humans encounter. Attractive faces are associated with positive character traits and social skills and automatically evoke larger neural responses than faces of average attractiveness in ventral occipito-temporal cortical areas. Little is known about the behavioral and neu...

Background: Adolescents females with severe obesity are less likely to be sexually active, but those who are sexually active engage in risky sexual behaviors. Objectives: To examine patterns and predictors of sexual risk behaviors, contraception practices, and sexual health outcomes in female adolescents with severe obesity who did or did not un...

Importance: Short-term improvements in sexual functioning are reported after bariatric surgery, but to our knowledge, little is known about the durability of these improvements. Objective: To determine the percentage of adults with impairment in sexual functioning who experience durable improvements in sexual functioning after bariatric surgery...

Outcomes of bariatric surgery, while frequently impressive, are not universal and vary between patients and across surgical procedures. Between 20% and 30% of patients experience suboptimal weight loss or significant weight regain within the first few postoperative years. The reasons for this are not fully understood, but likely involve both physio...

Despite the effectiveness of bariatric surgery, both with respect to weight loss and improvements in obesity-related comorbidities, it remains underutilized. Only 1% of the currently eligible population undergoes surgical treatment for obesity, with roughly 228,000 individuals receiving bariatric surgery in the United States each year. Several barr...

Purpose of the Review Sexual functioning is an important, yet often overlooked, aspect of quality of life for many individuals with obesity. Recent Findings With the growing recognition of obesity as a significant, international public health issue, a developing body of research has investigated the relationship between obesity and sexual function...

Objective Think Health! ¡Vive Saludable! evaluated a moderate‐intensity, lifestyle behavior‐change weight‐loss program in primary care over 2 years of treatment. Final analyses examined weight‐change trajectories by treatment group and attendance. Methods Adult primary care patients (n = 261; 84% female; 65% black; 16% Hispanic) were randomly assi...