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Perioperative Antidepressant Use Improves Body Image to a Greater Extent Compared to Those Not Taking Antidepressants in Patients Who Undergo Bariatric Surgery
Purpose of review:
This review highlights the salient data of the psychosocial concerns that influence outcomes of bariatric surgery and organ transplantation.
Recent findings:
Bariatric surgery has emerged as an important intervention with data supporting substantial and sustained weight loss, enhanced quality of life, remission of obesity-related medical comorbidities, and improved long-term patient and graft survival in transplant patients. Depression, suicide, anxiety, posttraumatic stress disorder, alcohol use, adherence, and psychopharmacology considerations can influence outcomes of both these surgeries.
Summary:
Obesity is increasingly prevalent among patients pursuing transplantation surgery, and it is often a factor in why a patient needs a transplant. However, obesity can be a barrier to receiving a transplant, with many centers implementing BMI criteria for surgery. Furthermore, obesity and obesity-related comorbidities after transplant can cause poor outcomes. In this context, many transplant centers have created programs that incorporate interventions (such as bariatric surgery) that target obesity in transplant candidates. A presurgery psychosocial assessment is an integral (and required) part of the process towards receiving a bariatric surgery and/or a transplantation surgery. When conducting a dual (bariatric and transplantation surgery) psychosocial assessment, it is prudent to understand the overlap and differentiation of specific psychosocial components that influence outcomes in these procedures.
Introduction:
For bariatric surgery candidates body image dissatisfaction (BID) may influence both psychological well-being and motivation to obtain surgery. This study aims to examine possible psychiatric predictors of BID. In particular, we explored the burden of new associated factors such as early trauma and attachment style (AS), which have not been assessed in previous literature.
Methods:
In this study, 536 patients with extreme obesity (mean Body Mass Index, BMI=43 kg/m2, SD=6.62) undergoing presurgical psychiatric evaluations as part of a mandatory workup before surgery were chosen as participants. A semi-structured clinical interview was performed to assess psychiatric diagnosis and patients' history of early trauma. BID was assessed using the Body Shape Questionnaire (BSQ). Depression, binge eating, and AS were assessed using self-report instruments.
Results:
Binge eating behavior (p<0.0001), depression severity (p<0.0001), female gender (p<0.0001), and the "need for approval" dimension of insecure AS (p<0.0001) were found to be independent and significant predictors of BSQ score. However, early trauma and BMI were not included in the significant regression model (F4,442=90.784, p<0.0001, adjR2=0.446).
Discussion:
Our results increased the understanding of BID among individuals with extreme obesity. Similar to previous studies, we reported that binge-eating, depressive symptoms, and gender influenced BID. Neither early trauma nor BMI were associated with BID. Our novel finding was the significance of insecure AS. Implications for multidisciplinary approaches to obesity treatment are discussed. Identifying critical features of BID to be targeted in pre- and post-operative behavioral interventions may open new possibilities for providing effective support for individuals over the course of their therapy.
Conclusions:
For some individuals living with obesity, developmental and relational processes such as insecure AS may play a substantial role in the development of BID.
Objective:
to investigate changes in body image perception in patients undergoing bariatric surgery, evaluating the accuracy/inaccuracy in body size estimation and satisfaction/dissatisfaction with own body after surgery.
Methods:
we performed a survey at the General Surgery outpatient clinic of the Clinics Hospital of the Federal University of Pernambuco. Thirty-six patients aged 18 years and older undergoing bariatric surgery participated. We carried out cross-sectional and quantitative studies using the Silhouetted Figures Scale.
Results:
in the descriptive analysis of the distortion and dissatisfaction score of the patients with the body image, the mean distortion was positive (6.43kg/m²), indicating that most people see themselves greater than they really are. On the other hand, in the dissatisfaction, we found a negative mean (-6.91kg/m²), indicating that the majority of the patients evaluated had a “BMI” lower than the current one (that is, a smaller silhouette). Regarding satisfaction with silhouette size, only 11.8% of women liked the post-surgical result, while among men there was 50% satisfaction.
Conclusion:
Although bariatric surgery significantly reduced BMI, the patients presented, for the most part, dissatisfaction with body weight, perceiving it greater than it actually was, thus characterizing a perceptual inaccuracy.
Background:
Although studies have associated postoperative weight loss with improvement in body image dissatisfaction, some individuals continue to report body image concerns after bariatric surgery. These concerns are linked to increased depressive symptoms and decreased self-esteem in bariatric populations.
Objective:
This study sought to explore preoperative factors that may predict early body image concerns 3 months after bariatric surgery.
Setting:
Academic medical center.
Method:
Data were analyzed from 229 patients evaluated for bariatric surgery who completed a 3-month postoperative psychology appointment and the Minnesota Multiphasic Personality Inventory, Second Edition, Restructured Form (MMPI-2-RF). Scales measuring depression, persecution, self-doubt, and inadequacy were examined. Medical records were reviewed for demographic characteristics, psychotropic medication usage, history of psychological treatment, and current or lifetime depression diagnosis.
Results:
Patients who preoperatively scored higher on demoralization (F [1, 227] = 35.40, P< .001), low positive emotions (F [1, 227] = 4.18, P< .05), ideas of persecution (F [1, 227] = 15.24, P< .001), self-doubt (F [1, 227] = 27.47, P< .001), and inefficacy (F [1, 227] = 21.34, P< .001) were significantly more likely to report body image concerns 3 months after bariatric surgery. Similarly, body image concerns were more common in patients with a preoperative depression diagnosis (χ(2) = 8.76, P<.01), current psychotropic medication usage (χ(2) = 7.13, P<.01), and history of outpatient therapy (χ(2) = 8.34, P<.01) and psychotropic medication (χ(2) = 9.66, P< .001).
Conclusion:
Bariatric surgery candidates with psychopathology and other psychological risk factors are more likely to report body image concerns early after bariatric surgery. Future research is warranted to determine whether this association remains further out from surgery.
Background: Massive weight loss (MWL) following bariatric surgery frequently results in an excess of overstretched skin causing physical discomfort and negatively affecting quality of life, self-esteem, body image, and physical functioning.
Methods: In this cross-sectional study 3 groups were compared: (1) patients prior to bariatric surgery (n = 79), (2) patients after bariatric surgery who had not undergone body contouring surgery (BCS) (n = 252), and (3) patients after bariatric surgery who underwent subsequent BCS (n = 62). All participants completed self-report questionnaires assessing body image (Multidimensional Body-Self Relations Questionnaire, MBSRQ), quality of life (IWQOL-Lite), symptoms of depression (PHQ-9), and anxiety (GAD-7).
Results: Overall, 62 patients (19.2%) reported having undergone a total of 90 BCS procedures. The most common were abdominoplasties (88.7%), thigh lifts (24.2%), and breast lifts (16.1%). Post-bariatric surgery patients differed significantly in most variables from pre-bariatric surgery patients. Although there were fewer differences between patients with and without BCS, patients after BCS reported better appearance evaluation (AE), body area satisfaction (BAS), and physical functioning, even after controlling for excess weight loss and time since surgery. No differences were found for symptoms of depression and anxiety, and most other quality of life and body image domains.
Discussion: Our results support the results of longitudinal studies demonstrating significant improvements in different aspects of body image, quality of life, and general psychopathology after bariatric surgery. Also, we found better AE and physical functioning in patients after BCS following bariatric surgery compared to patients with MWL after bariatric surgery who did not undergo BCS. Overall, there appears to be an effect of BCS on certain aspects of body image and quality of life but not on psychological aspects on the whole.
With aging, women's bodies undergo changes that can affect body image perception, yet little is known about body image in midlife. The purpose of this study was to examine associations between body image and depressive symptoms in Caucasian and African-American midlife women from the Study of Women's Health Across the Nation (SWAN) Chicago site. Body image was measured using the Stunkard Adult Female Figure Rating Scale, and a clinically significant level of depressive symptoms was defined as Center for Epidemiologic Studies Depression Scale (CES-D) score of ≥16 (N = 405; N = 63 (15.6 %) with clinically significant levels of depressive symptoms). Differences between perceived actual, perceived ideal, and actual body size and responses to questions concerning weight satisfaction and attractiveness were examined using logistic regression for associations with a CES-D score of ≥16. Women with body image dissatisfaction (odds ratio (OR) = 1.91; p = 0.04) or who perceived themselves as "unattractive" (OR = 7.74; p < 0.01) had higher odds of CES-D of ≥16. We found no significant difference by race. Our results were not confounded by BMI. These results suggest that midlife women with poor body image may be more likely to have clinically significant levels of depressive symptoms. Larger prospective studies are needed to better understand this association.
Studies of the association between depressive symptoms and mortality in elderly populations have yielded contradictory findings. To address these discrepancies, we test this association using the most extensive array of sociodemographic and physical health control variables ever studied, to our knowledge, in a large population-based sample of elderly individuals.
To examine the relation between baseline depressive symptoms and 6-year all-cause mortality in older persons, systematically controlling for sociodemographic factors, clinical disease, subclinical disease, and health risk factors.
A total of 5201 men and women aged 65 years and older from 4 US communities participated in the study. Depressive symptoms and 4 categories of covariates were assessed at baseline. The primary outcome measure was 6-year mortality.
Of the 5201 participants, 984 (18.9%) died within 6 years. High baseline depressive symptoms were associated with a higher mortality rate (23.9%) than low baseline depression scores (17.7%) (unadjusted relative risk [RR], 1.41; 95% confidence interval [CI], 1.22-1.63). Depression was also an independent predictor of mortality when controlling for sociodemographic factors (RR, 1.43; 95% CI, 1.23-1.66), prevalent clinical disease (RR, 1.25; 95% CI, 1.07-1.45), subclinical disease indicators (RR, 1.35; 95% CI, 1.15-1.58), or biological or behavioral risk factors (RR, 1.42; 95% CI, 1.22-1.65). When the best predictors from all 4 classes of variables were included as covariates, high depressive symptoms remained an independent predictor of mortality (RR, 1.24; 95% CI, 1.06-1.46).
High levels of depressive symptoms are an independent risk factor for mortality in community-residing older adults. Motivational depletion may be a key underlying mechanism for the depression-mortality effect.
Improvements in psychosocial status are an important aspect of successful outcomes after bariatric surgery. Relatively few studies have investigated the changes in psychosocial functioning at a number of points in the first few postoperative years. The present study was undertaken to assess the changes in quality of life and body image after gastric bypass surgery. The present study was performed at an academic medical center.
A total of 200 men and women were enrolled in the study and completed psychometric measures of quality of life and body image before surgery and again 20, 40, and 92 weeks postoperatively.
The participants reported significant improvements in several domains of health- and weight-related quality of life, as well as changes in body image, after surgery. These changes were correlated with the percentage of weight loss.
Those who undergo gastric bypass surgery experienced significant improvements in quality of life and body image within the first few months after surgery. These changes were, with few exceptions, maintained into the second postoperative year.
Although sexual functioning has been linked to sexual satisfaction, it only partially explains the degree to which women report being sexually satisfied. Other factors include quality of life, relational variables, and individual factors such as body image. Of the few studies that have investigated the link between body image and sexual satisfaction, most have considered body image to be a single construct and have shown mixed results.
The present study assessed multiple body image variables in order to better understand which aspects of body image influence multiple domains of sexual satisfaction, including sexual communication, compatibility, contentment, personal concern, and relational concern in a community sample of women.
Women between the ages of 18 and 49 years in sexual relationships (N = 154) participated in an Internet survey that assessed sexual functioning, five domains of sexual satisfaction, and several body image variables.
Body image variables included the sexual attractiveness, weight concern, and physical condition subscales of the Body Esteem Scale, the appearance-based subscale of the Cognitive Distractions During Sexual Activity Scale, and body mass index. Total score of the Sexual Satisfaction Scale for Women was the main outcome measure. Sexual functioning was measured by a modified Female Sexual Function Index.
Consistent with expectations, correlations indicated significant positive relationships between sexual functioning, sexual satisfaction, and all body image variables. A multiple regression analysis revealed that sexual satisfaction was predicted by high body esteem and low frequency of appearance-based distracting thoughts during sexual activity, even after controlling for sexual functioning status.
Several aspects of body image, including weight concern, physical condition, sexual attractiveness, and thoughts about the body during sexual activity predict sexual satisfaction in women. The findings suggest that women who experience low sexual satisfaction may benefit from treatments that target these specific aspects of body image.
Body esteem (BE) refers to self-evaluations of one's body or appearance. This article outlines a BE questionnaire for adolescents and adults that has 3 subscales: BE-Appearance (general feelings about appearance), BE-Weight (weight satisfaction), and BE-Attribution (evaluations attributed to others about one's body and appearance). The subscales have high internal consistency and 3-month test-retest reliability. Females scored lower than males on BE-Weight and BE-Appearance. BE-Weight was the only subscale uniquely related to weight, especially in females, with heavy individuals tending to be dissatisfied with their weight. BE-Appearance was the only subscale that consistently predicted self-esteem. BE-Appearance and BE-Weight covaried more with Neeman and Harter's (1986) Appearance subscale than with other self-esteem subscales; BE-Attribution covaried more with social self-esteem subscales than did BE-Appearance and BE-Weight.
The severely obese experience discrimination and embarrassment regarding their appearance, causing psychosocial distress. We assessed the importance of appearance, presentation and self-evaluation of appearance before and after weight loss, in severely obese subjects (BMI > 35 kg/m2).
Appearance orientation (AO) and appearance evaluation (AE) sections of the Multi-dimensional Body Self Relations Questionnaire were completed by preoperative patients and those attending an annual follow-up after Lap-Band gastric restrictive surgery over a 2-year period. AO is a measure of the importance one places in appearance. AE is a self-evaluation of one's appearance.
Before surgery 322 consecutive patients (48 men and 274 women) completed the survey. AO was similar to that of community norms (mean scores 3.76 +/- SD 0.6 vs 3.84 +/- 0.6), with the exception of the super obese (BMI > 50 kg/m2) who placed significantly less importance on their appearance (3.34, +/- 0.8, p = 0.001). There was no change in AO at 1-4 years after surgery, with the exception of the super obese whose mean values rose to normal by 1 year. AE was very low before surgery compared with community normal values (1.6 +/- 0.6 vs 3.4 +/- 0.8, p < 0.001). Major improvement in mean AE was seen at 1 year after surgery (n = 209, 2.6 +/- 0.8, p < 0.001) and the improvement was maintained out to 4 years. The change in AE from pre-surgery to 1 year (n = 122 paired) correlated positively with the percentage of excess weight lost (r = 0.32, p < 0.01) and positively with measures of quality of life and psychological disturbance.
Major improvements in appearance evaluation occur with weight loss after surgery and this is associated with psychological benefit.
Current public health policy recommends weight loss for obese individuals, and encourages energy-restricted diets. Others advocate an alternative, 'non-diet' approach which emphasizes eating in response to physiological cues (eg hunger and satiety) and enhancing body acceptance.
To evaluate the effects of a 'health-centered' non-diet wellness program, and to compare this program to a traditional 'weight loss-centered' diet program.
Six-month, randomized clinical trial.
Free-living, general community.
Obese, Caucasian, female, chronic dieters, ages 30-45 y (n=78).
Six months of weekly group intervention in a non-diet wellness program or a traditional diet program, followed by 6 months of monthly after-care group support.
Anthropometry (weight, body mass index); metabolic fitness (blood pressure, blood lipids); energy expenditure; eating behavior (restraint, eating disorder pathology); psychology (self-esteem, depression, body image); attrition and attendance; and participant evaluations of treatment helpfulness. Measures obtained at baseline, 3 months, 6 months and 1 y.
(1 y after program initiation): Cognitive restraint increased in the diet group and decreased in the non-diet group. Both groups demonstrated significant improvement in many metabolic fitness, psychological and eating behavior variables. There was high attrition in the diet group (41%), compared to 8% in the non-diet group. Weight significantly decreased in the diet group (5.9+/-6.3 kg) while there was no significant change in the non-diet group (-0.1+/-4.8 kg).
Over a 1 y period, a diet approach results in weight loss for those who complete the intervention, while a non-diet approach does not. However, a non-diet approach can produce similar improvements in metabolic fitness, psychology and eating behavior, while at the same time effectively minimizing the attrition common in diet programs.
This narrative review examines the evidence and discusses the clinical relevance of depression as a risk factor for stroke morbidity and mortality. It also proposes recommendations for future research.
We used the Medline computer database to search the relevant original studies published in English from January 1966 to December 2001. Our key words were as follows: depressive disorder, cerebrovascular disease, stroke, vascular risk factors, and mortality. Articles that investigated the relation between antecedent depression and subsequent stroke morbidity and mortality were collected and reviewed.
Since 1990, 8 prospective studies have been published. Among these 8 studies, 6 addressed depression and stroke morbidity, 1 investigated the association of depression with stroke morbidity and stroke mortality, and 1 investigated the association with stroke mortality only. Of 7 studies examining the independent effect of depression on stroke morbidity, 6 were positive. With regard to stroke mortality, 2 studies found an independent association between depression and specific stroke mortality. The contributions and methodological limitations of these studies are discussed.
Emerging data suggest an association between depressive symptoms and increased risk for stroke morbidity and mortality. More methodologically sound studies are needed to elucidate causal pathways that link depression and cerebrovascular disease. They are also needed to determine the effect of depression intervention on reducing the risk of cerebrovascular events. Information on author affiliations appears at the end of the article.
Motivation for seeking obesity surgery has not been studied. The authors explored the patient's motivation for selecting surgery and examined for a relationship between primary motivating factors and weight outcomes.
208 (177F: 31M) unselected participants followed at least 1 year after Lap-Band placement completed a short questionnaire. 6 statements were scored 1-6 from the most important through to the least important. Statements included appearance, embarrassment, medical conditions, health concerns, physical fitness and physical limitation. Any additional factors were also sought.
Mean age, weight and BMI before surgery were 41+/-10 years, 129+/-16 kg and 46+/-8 kg/m(2) respectively. Responses to appearance and embarrassment correlated strongly and were grouped together. Medical conditions and health concerns account for 52%, appearance and embarrassment for 32%, and poor physical fitness and physical limitation for 16% of first choices. Those who scored 1 for appearance or embarrassment (n=67) had a lower presenting BMI (44 kg/m(2), P=0.03) and all but 1 were female (P<0.001). This group reported more depressive symptoms, poorer mental quality of life and poorer body image preoperatively. Men were more likely than women to be motivated by medical problems (P=0.007). Subjects motivated by a medical condition were more likely to have hypertension or diabetes and less likely to smoke. This group tended to be older. Weight history did not influence motivation. The first choice of motivating factor was not associated with weight outcomes at 1-3 years following surgery.
Health issues dominate the motivation for seeking surgery. Weight outcomes do not appear to be affected by the patient's primary motivating factor.
This study evaluated the relation among weight-based stigmatization, ideological beliefs about weight, and psychological functioning in an obese, treatment-seeking sample. Research Methods and Procedure: Ninety-three obese, treatment-seeking adults (24 men and 69 women) completed a battery of self-report questionnaires measuring psychological adjustment, attitudes about weight, belief in the controllability of weight, and the frequency of weight-based stigmatization.
Weight-based stigmatization was a common experience for participants. Frequency of stigmatizing experiences was positively associated with depression, general psychiatric symptoms, and body image disturbance, and negatively associated with self-esteem. Further, participants' own negative attitudes about weight problems were associated with their psychological distress and moderated the relation between the experience of stigmatization and body image.
Weight-based stigmatization is a common experience for obese individuals seeking weight loss treatment and appears to contribute to poor mental health adjustment. The negative effects of these experiences are particularly damaging for those who hold strong antifat beliefs.
This research was intended to further establish convergent and discriminant validity for a recent Body Esteem Scale (BES) which measures different dimensions of body satisfaction in young adults. One hundred and fifty-four male and 193 female undergraduates completed the BES, the Body Consciousness Questionnaire (BCQ), the Self-Esteem Scale, and several questions pertaining to exercise, food intake, and attractiveness. Good convergent and discriminant validity was demonstrated by the Male Upper Body Strength and Physical Condition subscales and by the female Weight Concern, Physical Condition, and Sexual Attractiveness subscales.
PURPOSE
This article describes the concept of disturbed body image in bariatric surgery patients.
METHOD
Walker and Avant's (2011) method of concept analysis is used in this study.
FINDINGS
After bariatric surgery, the patient's body may change more rapidly than their allocentric (“inside, lived”) view of themselves, leading to physical and psychosocial sequelae.
CONCLUSION
If not prepared physically and psychologically for body image challenges after bariatric surgery, patients may experience disturbed body image in the postoperative phase.
IMPLICATIONS FOR NURSING PRACTICE
Understanding the concept of disturbed body image in postoperative bariatric surgery patients may allow health providers to provide preoperative teaching and preparation, as well as postoperative interventions to create congruence between the patient's internal and external selves.
Poor body image is common among individuals seeking bariatric surgery and is associated with adverse psychosocial sequelae. Following massive weight loss secondary to bariatric surgery, many individuals experience excess skin and associated concerns, leading to subsequent body contouring procedures. Little is known, however, about body image changes and associated features from pre‐to post‐bariatric surgery and subsequent body contouring. The objective of the present study was to conduct a comprehensive literature review of body image following bariatric surgery to help inform future clinical research and care. The articles for the current review were identified by searching PubMed and SCOPUS and references from relevant articles. A total of 60 articles examining body image post‐bariatric surgery were identified, and 45 did not include body contouring surgery. Overall, there was great variation in standards of reporting sample characteristics and body image terms. When examining broad levels of body image dissatisfaction, the literature suggests general improvements in certain aspects of body image following bariatric surgery; however, few studies have systematically examined various body image domains from pre‐to post‐bariatric surgery and subsequent body contouring surgery. In conclusion, there is a paucity of research that examines the multidimensional elements of body image following bariatric surgery.
Background:
Overhanging skin in postbariatric patients leads to a negative body image. In patients with obesity, negative body image is related to more depressive symptoms and a higher weight. This relationship might also be important in postbariatric patients, because improvement of body image via body contouring surgery (BCS) could lead to better weight loss results.
Objectives:
To evaluate the relationship between body image, depressive symptoms, and weight loss in a postbariatric population, focusing on desire for BCS.
Setting:
Outpatient clinic.
Methods:
One thousand twenty-four primary bariatric surgery patients were contacted, and 590 patients agreed to participate and filled in online questionnaires regarding body image (Body Shape Questionnaire and Multidimensional Body-Self Relations Questionnaire-Appearance Scales) and depression (Beck Depression Inventory-II). Differences between patients who had BCS, patients who desired BCS, and patients who did not desire BCS were studied. The mediating role of body image in the association between percentage total weight loss and depressive symptoms was assessed via a 2-mediator model.
Results:
There was a desire for BCS in 368 patients (62.4%); these patients had significantly lower scores on appearance evaluation and body image satisfaction scales and showed more depressive symptoms. Patients without a desire (n = 157, 26.6%) had lowest rates of depressive symptoms and a more positive body image. Sixty-five patients (11.0%) had undergone BCS. In the patients who desired BCS, percentage total weight loss was negatively affected by depressive symptoms via appearance evaluation and body-area satisfaction.
Conclusions:
There are striking differences regarding body image satisfaction and depressive symptoms when comparing postbariatric patients and without desire for BCS. Body image satisfaction is associated with less depressive symptoms in all postbariatric patients. In patients who desired BCS, body image is one of the mediators of the relationship between percentage total weight loss and depressive symptoms. Therefore, body image should be taken seriously and be part of outcome assessment in postbariatric patients.
Bariatric (weight loss) surgery is more popular than ever. The American Society for Metabolic and Bariatric Surgery in 2016 reported that 216,000 bariatric procedures were performed in the United States. Bariatric surgery has major physiological benefits; its use is expected to increase globally. However, patients may not anticipate the profound impact that rapid and massive weight loss may have on their body image after bariatric surgery. The construct of body image in this population needs to be explicated to facilitate continued research regarding this increasingly prevalent healthcare procedure. This article describes the formulation of a model of relevant concepts and dimensions within the construct of body image in the bariatric surgery patient. In the process of creating the model, we identified many factors influencing body image in patients before and after bariatric surgery, summarized eight measures, and developed a new definition based on prior work. Theoretical considerations are discussed. The long-term objective of this model building approach is to encourage researchers and clinicians to test the feasibility of systematic clinical measurement of body image at office visits before as well as multiple times after bariatric surgery.
Background
Many bariatric surgery candidates report body image concerns prior to surgery. Research has reported post-surgical improvements in body satisfaction, which may be associated with weight loss. However, research has failed to comprehensively examine changes in affective, behavioral, and cognitive body image.
Objectives
This research examined: 1) short-term changes in affective, behavioral, and cognitive components of body image from pre-surgery to 1- and 6-months following bariatric surgery, and 2) the association between percent weight loss and these changes.
Setting
Participants were recruited from a private hospital in the Midwestern United States.
Methods
88 females (original N=123; lost to follow-up: n=15 at 1-month and n=20 at 6-months post-surgery) completed a questionnaire battery, including the Body Attitudes Questionnaire, Body Checking Questionnaire, Body Image Avoidance Questionnaire, and Body Shape Questionnaire, and weights were obtained from patients’ medical records before and at 1- and 6-months post-surgery.
Results
Results indicated significant decreases in body dissatisfaction, feelings of fatness, and body image avoidance at 1- and 6-months following bariatric surgery, with the greatest magnitude of change occurring for body image avoidance. Change in feelings of fatness was significantly correlated with percent weight loss at 6-months, but not 1-month, post-surgery.
Conclusions
These findings highlight the importance of examining short-term changes in body image from a multi-dimensional perspective in the effort to improve post-surgical outcomes. Unique contributions include the findings regarding the behavioral component of body image, as body image avoidance emerges as a particularly salient concern that changes over time among bariatric surgery candidates.
Background:
Previous research suggests a relationship between weight and depression/suicidality, although few studies have examined the mechanisms underlying this association. This study examined the mediating role of self-esteem in the relationship between BMI and depression/suicidality, as well as the moderating role of gender in the mediated pathways.
Methods:
As part of a screening process in consideration for bariatric surgery, 3,101 adults (81.4% female, 18.6% male) were assessed one time. Five univariate mediation and five univariate moderated-mediation models were hypothesized and analyzed. For the mediation models, we entered five outcome variables separately: 1) severity of depressed mood, 2) diagnosis of Major Depressive Disorder, 3) lifetime history of suicide attempts, 4) suicidal ideation at the time of evaluation, and 5) severity of suicidality, BMI as the independent variable, and self-esteem as the mediator. For the moderated-mediated models, gender was examined as a moderator to examine whether self-esteem was a stronger mediator for one gender, compared to the other.
Results:
Findings supported the mediating role of self-esteem across all five outcomes. Further, the mediated effect was moderated by gender, such that the mediation effect was stronger for males, compared to females.
Limitations:
The majority of the sample consisted of White females, limiting broad applicability of findings. All variables were assessed simultaneously, at baseline, limiting the ability to make causal attributions.
Conclusions:
Study findings suggest that self-esteem may help explain the relationship between BMI and depression/suicidality, particularly for men. Thus, interventions targeting self-esteem may be useful for improving psychological outcomes among those presenting for bariatric surgery.
Given the link between negative body image and depression symptoms, body image may affect the association between ADHD and depression symptoms. We evaluated the degree to which a variety of body image constructs mediated the association between ADHD and depression symptoms.
Participants were undergraduate psychology students (N = 627, age: M = 20.23, SD = 1.40, 60% female, 47% European American) who completed an online assessment.
Results indicated that ADHD symptoms were indirectly associated with increased depression symptoms, and that negative evaluation of physical appearance, overweight preoccupation, and body dissatisfaction mediated the association between ADHD and depression symptoms. ADHD symptoms were also directly associated with increased depression symptoms.
Body image appears to play a role in the association between ADHD and depression symptoms for college students. Implications for future research and clinical practice are discussed.
© 2015 SAGE Publications.
Many studies have reported the relationship between depression and diabetes, but the results have been inconsistent. Our aim was to conduct a systematic review through meta-analysis to assess the association of depression with the risk for developing diabetes.
We retrieved the studies concerning depression and the risk for diabetes. Meta-analysis was applied to calculate the combined effect values and their 95% confidence intervals. The risk for publication bias was assessed by the Egger regression asymmetry test.
As many as 33 articles were included in the meta-analysis, for a total of 2 411 641 participants. The pooled relative risk for diabetes was 1.41 (95% CI, 1.25-1.59) for depression, and the combined relative risk for type 2 diabetes mellitus was 1.32 (95% CI, 1.18-1.47).
Depressed people have a 41% increased risk for developing diabetes mellitus and a 32% increased risk for developing type 2 diabetes. The mechanisms underlying this relationship are still unclear and need further research.
Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.
Purpose
– In contrast to the attention it has received in related fields of research, body image has remained understudied within the field of public health. This is highly problematic, given a growing body of evidence implicating body dissatisfaction in a range of other public health concerns. The paper aims to discuss these issues.
Design/methodology/approach
– This commentary is based on a review of the public health, body image, eating disorder, and mental health literatures.
Findings
– Body dissatisfaction is implicated in a range of public health concerns, including impaired psychological health (e.g. depression) and eating- and weight-related problems (e.g. eating disorders, obesity).
Originality/value
– Given these associations, as well as the high levels of body dissatisfaction in the population, the authors argue for a critical need to address the prevalence of body image concerns as a public health issue worthy of greater consideration within programs and policies; dedicated funding for research on antecedents, consequences, and intervention strategies; and allocated resources for training.
Objective:Despite increasing use of the Eating Disorder Examination-Questionnaire (EDE-Q) in bariatric surgery patients, little is known about the utility and psychometric performance of this self-report measure in this clinical group. The primary purpose of the current study was to evaluate the factor structure and construct validity of the EDE-Q in a large series of bariatric surgery candidates.Methods and Procedures:Participants were 337 obese bariatric surgery candidates. Participants completed the EDE-Q and a battery of behavioral and psychological measures.Results:Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) produced a 12-item, 4-factor structure of the EDE-Q. The four factors, interpreted as Dietary Restraint, Eating Disturbance, Appearance Concerns, and Shape/Weight Overvaluation, were found to be internally consistent and converged with other relevant measures of psychopathology.Discussion:Factor analysis of the EDE-Q in bariatric surgery candidates did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE-Q in this and other diverse populations and consider means of improving this measure's ability to best assess eating-related pathology in bariatric surgery patients.Obesity (2008) doi:10.1038/oby.2008.142.
Research highlights
The current article presents and evaluates an Acceptance and Commitment Therapy (ACT) approach for obesity-related psychological struggles post-bariatric surgery. Some patients who have undergone bariatric surgery report loss of control over eating and distress concerning body figure and shape, which can affect other outcomes such as weight loss and quality of life post surgery. A recent randomized trial (n = 39) evaluating a 6-week treatment package of ACT following bariatric surgery found large and significant effects as compared with treatment as usual (TAU) on eating disordered behaviours, body dissatisfaction, psychological flexibility and quality of life. Though effects were found, questions remain regarding maintenance of outcomes and the process changes related to outcomes. The present study examines both the maintenance of behavioural change at a 6-month follow-up for the original study and the processes that may be involved in the outcomes. ACT led to gains in quality of life (es = 0.88) and body dissatisfaction (es = 0.77), as compared with TAU at follow-up. Both groups improved in eating disordered behaviours (ACT; es = 0.86 and TAU; es = 0.55). A series of multiple mediator tests supported the role of enhanced psychological flexibility in the changes seen in body dissatisfaction, eating disordered behaviour and quality of life. This study provides preliminary support for the ACT treatment model in terms of optimizing bariatric surgery outcomes.
Bariatric surgery (BS) is rated as the best evidence based treatment for obesity with regard to weight loss and maintenance of weight loss evaluated to date. Although BS interventions are effective, 20-30% of BS patients start to regain weight within 24 months. Emotional eating is a behavior pattern which has been found to predict poor outcome. The aim of this study is to evaluate the effects of acceptance and commitment therapy (ACT) for patients who underwent BS, with regard to emotional eating, body dissatisfaction and quality of life. This study is a randomized controlled trial (n = 39) with two conditions (1) ACT including two face-to-face sessions and support via an Internet application and (2) treatment as usual (TAU) comprising the standard follow-up used by the BS team. Results show that participants in the ACT condition significantly improve on eating disordered behaviors, body dissatisfaction, quality of life and acceptance for weight related thoughts and feelings, as compared to those in the TAU group. This study shows that it is possible to improve effects of BS by specifically targeting emotional eating behavior.:
Negative body image is a major concern of overweight persons, yet current obesity treatment programs have not addressed this problem. In the present study, 51 obese women were randomly assigned to cognitive behavioral body image therapy (CBT) or no-treatment. Patients were treated in small groups for 8 two-hour sessions. Therapy included information to challenge negative stereotypes of obesity, modification of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations, and elimination of body checking. No assistance was provided to change eating or exercise behaviors. CBT subjects showed significantly improved body image. Psychological symptoms, self-esteem, overeating, and eating guilt also improved. Weight was unchanged for most subjects and unrelated to treatment outcome overall.
Recent surveys suggest that nearly half of all women and a quarter of the men in the US dislike their looks. In this book, the author invites us to ignore the onslaught of advertising and other media images and consider the provocative possibility that the problem lies not in our bodies themselves, but in our relationship to them. In "The Body Image Workbook," user-friendly "helpsheets" take readers through a clinically tested interactive 8-step program that helps us to: discover our own unique body images; change self-defeating "private body talk"; free ourselves from appearance-preoccupied rituals and other troublesome habits; be kinder to our bodies through healthy practices and affirmations and create a lasting, positive relationship with our bodies through self-acceptance. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
College females completed multiple, standardized measures of their fear of fat, attitudinal body image, and binge eating and dieting. Situational weigh-in measures were taken, including latency to get on the scale and anxiety while being weighed. Based on current weight and a structured weight history questionnaire, three groups were constructed: normal-weight subjects without an overweight history (NW; n=24), normal-weight subjects who were formerly overweight (FOW; n=16), and those currently overweight (OW; n=24). Group comparisons revealed, as expected, that OW females, relative to their NW peers, had more weight-related anxieties, more negative body experiences, and more frequent past-year dieting. Consistent with Stunkard''s original proposition, the FOW group regarded their bodies as fatter and less affectively satisfying and expressed more weigh-in anxiety than NW participants. Currently normal-weight FOW subjects seldom differed from the currently OW individuals. Clinical and research implications are considered, particularly with regard to the psychological sequelae of weight loss.
Individuals with severe obesity commonly report poor body image. Improvement in body image has been found after conservative weight reduction programs as well as after bariatric surgery (gastric bypass, biliopancreatic diversion, or gastric banding). However, no studies investigating body image after laparoscopic sleeve gastrectomy (LSG) are available.
Of 70 consecutive patients who planned to undergo LSG at a comprehensive obesity center, 62 patients were included in the study and evaluated before surgery. Their mean body mass index (BMI) was 51.3 kg/m(2) and the patients' mean age before surgery was 43.8 years. One-year follow-up data were obtained for 51 patients (82.3 %). Body image was assessed using the body image questionnaire (BIQ-20), and depression was assessed using the Patient Health Questionnaire (PHQ-9).
Patients reported poor body image before surgery. One year after LSG, negative evaluations of the body and perceptions of body dynamics and vitality had markedly improved, without reaching healthy levels. No correlations between body image and weight-related parameters (BMI, percentage of excess weight loss) or mood after 1 year were found.
Body image improves after LSG. This improvement might reflect changes to patients' attitudes, beliefs, and thoughts rather than real weight lost. Further studies should investigate the factors that mediate improvement of body image after bariatric surgery.
Background: This study was undertaken to determine whether surgery for morbid obesity affects sexual attitudes and performance
in patients and their partners. Methods: Questionnaires concerning sexuality were sent to 94 patients who underwent gastric
restriction procedures and their partners. Twenty-eight patients at least 1 year post-operatively (range of 1-11 years, mean
4.2 years ± 3.24 sd) and 16 of their partners responded. The blinded questionnaires addressed the enjoyment and frequency
of sexual intercourse, orgasms, body image, number of partners, abuse, sexual problems and masturbation. Comparisons were
made before and after surgery. Patient answers were compared with their partners. Results: Preoperatively, 64% of patients
stated that they enjoyed sexual intercourse. Postoperatively, 50% of patients and 78% of partners stated that they enjoyed
sex more. Improved orgasms were noted by 44% of patients and 40% partners after surgery. Improvement in body image was also
achieved. Only 27% of patients felt they were attractive before surgery, while 80% felt they were more attractive after surgery;
94% of their partners agreed. While 48% of patients undressed in darkness in front of their partners before surgery, only
27% did so after surgery. Conclusions: Weight loss attained through bariatric surgery improves body image and sexuality. Sexual
intercourse and orgasms are improved postoperatively both for patient and partner.
In light of the failure of psychological approaches to obesity some clinicians and patients are turning to surgery. The present qualitative study aimed to explore patients' experiences of having obesity surgery and in-depth interviews were carried out with 15 men and women, who had had surgery in the past four years. The data were analysed using Interpretative Phenomenological Analysis (IPA). The patients described their experiences in terms of four broad themes: personal weight histories; the decision-making process, which involved general motivations such as worries about health and specific triggers such as symptoms; the impact of surgery on eating behaviour and their relationship with food; the impact of weight loss on health status, self-esteem and relationships with others. The central theme of control permeated all areas of the interviews. The current clinical climate highlights the importance of self-control and patient choice as the path to patient empowerment. Obesity surgery illustrates that in contrast to this perspective, imposed control and limited choice can sometimes paradoxically result in a renewed sense of control.
Depression is prevalent in patients with heart failure and is associated with a significant increase in hospitalizations and death. Primary results of the Sertraline Against Depression and Heart Disease in Chronic Heart Failure (SADHART-CHF) trial revealed that sertraline and placebo had comparable effects on depression and cardiovascular outcomes. In this study, we explored whether remission from depression was associated with better survival and aimed to characterize participants who remitted during the trial. Based on depression response during the 12-week treatment phase, SADHART-CHF participants were divided into 2 groups: (1) remission, defined as participants whose last measured Hamilton Depression Rating Scale (HDRS) score was <8, and (2) nonremission, defined as participants whose last measured HDRS score was ≥8. Patients who dropped out before having any repeat HDRS were not included. Baseline characteristics and survival differences up to 5 years were evaluated between the remission and nonremission groups. Of the 469 SADHART-CHF participants, 208 (44.3%) achieved remission, 194 (41.4%) remained depressed, and 67 (14.3%) dropped out or died without any repeat HDRS assessment. Patients in the remission group had significantly fewer cardiovascular events than those in the nonremission group (1.34 ± 1.86 vs 1.93 ± 2.71, adjusted p = 0.01). Men patients were more likely to remit than women patients (56.5 vs 44.8%, p = 0.02). The remission group had milder depressive symptoms at baseline compared to the nonremission group (HDRS 17.0 ± 5.4 vs 19.6 ± 5.5, Beck Depression Inventory scale 17.9 ± 6.5 vs 20.3 ± 7.2, p <0.001 for the 2 comparisons). In conclusion, this study indicates that remission from depression may improve the cardiovascular outcome of patients with heart failure.
Preliminary data suggest that patients with actively treated depression should expect the same outcomes after surgery. The objective of this study was to compare weight loss 12 months after gastric bypass surgery in patients taking antidepressants before surgery (AD) versus those who were not (non-AD).
IRB approval was obtained. All patients gave informed consent prior to participating in the study. Medication and weight loss histories were retrospectively reviewed in adult patients who were followed at 12 months post-surgery.
145 of 364 patients were taking antidepressants at baseline. There was no significant difference in weight loss between the AD and non-AD groups at 12 months (p > 0.05).
Taking antidepressant medication prior to gastric bypass surgery did not affect weight loss outcomes at 12 months.
The effects of a 10 session group programme designed to discourage dieting behaviour and reduce preoccupation with body weight, food and eating were assessed in 87 women (mean age 40 years and mean body mass index 31.9) who attended three different agencies in Adelaide, South Australia. The subjects were selected on the basis of eating preoccupation and not body weight. Measurements of various psychological parameters and body weight were made at entry to the programme, at the completion of the programme and at 6 months, 1 year and 2 years after its completion. Eighty women completed the groups and data were obtained from 56 of them at 2 years. At the completion of the group programme and at 2 years there were significant improvements (P less than 0.01) in the psychological parameters self-esteem, depression, self-image, eating attitude, body image and assertion. At two years after the completion of the group, there was a significant (P less than 0.005) mean weight loss of 3.1 kg when compared to baseline. We conclude that this programme confers long-term beneficial effects on psychological function and body weight.
Characteristics of morbidity obese adults in the general population and morbidly obese adults presenting for obesity surgery were compared. Black morbidly obese women in the general population were less obese than black women obesity surgery patients, showed less emotional distress, and had fewer abnormal eating behaviours; age and socio-economic status were similar. A greater proportion of morbidly obese surgery patients were white women than would be expected either on the basis of the prevalence of morbid obesity in the general population or on census data. It was hypothesized that black women and white men avoid obesity surgery until they are physically debilitated by their overweight, while white women elect for obesity surgery when the emotional distress associated with obesity becomes debilitating.
To estimate the relative prevalence of different types and combinations of practices among weight-loss practitioners and to describe the relations between individual characteristics and various features of weight-loss regimens.
A telephone survey of a random digit-dialed probability sample of adults in the continental United States who reported that they were trying to lose weight.
A total of 1431 persons 18 years or older who were attempting to lose weight.
Self-reports of a detailed inventory of more than 35 specific practices that might be used as part of a voluntary weight-loss plan, along with information about individual characteristics such as current weight, weight-loss history, demographic profile, motivations to lose weight, sources of information, and knowledge about diet and health.
The average respondent had a current weight-loss attempt lasting from 5 to 6 months, had tried a similar plan before, and had averaged one attempt a year for the past 2 years. Seventy-one percent of women and 62% of men reported that they were both changing their diet and exercising more as part of a current weight-loss attempt. Frequently reported weight-loss practices included weighing oneself regularly (71% and 70% for women and men, respectively), walking (58% and 44%), using diet soft drinks (52% and 45%), taking vitamins and minerals (33% and 26%), counting calories (25% and 17%), skipping meals (21% and 20%), using commercial meal replacements, (15% and 13%), taking diet pills (14% and 7%), and participating in organized weight-loss programs (13% and 5%). Sex, education, and overweight status influenced the choice of a weight-loss practice.
Individual approaches to weight-loss vary and are characterized by their duration and by their recurrent nature. Policy efforts should be directed toward increasing the long-term effectiveness of individual weight-loss plans.
The role of possessing an abnormal body weight in the body image alterations of obese patients was evaluated in bariatric surgery subjects prior to and at long term after operation, when body weight and shape had become steadily normalized. Body image was assessed by the body dissatisfaction scale of the Eating Disorders Inventory, the Body Shape Questionnaire, and the Body Attitude Questionnaire. When the individuals were obese, a sharply impaired body image was observed; following operation, weight loss corresponded to normalization of body dissatisfaction, feeling of fatness, and physical attractiveness, whereas body disparagement and salience of shape, although improved in comparison to preoperative data, remained significantly different from that of controls. In the obese patients, some aspects of body image alterations are substantially accounted for by overweight status; other aspects reflect inner feelings, which are partially independent of the actual body weight and shape.
Depression and anxiety are common in medical patients and are associated with diminished health status and increased health care utilization. This article presents a quantitative review and synthesis of studies correlating medical patients' treatment noncompliance with their anxiety and depression.
Research on patient adherence catalogued on MEDLINE and PsychLit from January 1, 1968, through March 31, 1998, was examined, and studies were included in this review if they measured patient compliance and depression or anxiety (with n>10); involved a medical regimen recommended by a nonpsychiatrist physician to a patient not being treated for anxiety, depression, or a psychiatric illness; and measured the relationship between patient compliance and patient anxiety and/or depression (or provided data to calculate it).
Twelve articles about depression and 13 about anxiety met the inclusion criteria. The associations between anxiety and noncompliance were variable, and their averages were small and nonsignificant. The relationship between depression and noncompliance, however, was substantial and significant, with an odds ratio of 3.03 (95% confidence interval, 1.96-4.89).
Compared with nondepressed patients, the odds are 3 times greater that depressed patients will be noncompliant with medical treatment recommendations. Recommendations for future research include attention to causal inferences and exploration of mechanisms to explain the effects. Evidence of strong covariation of depression and medical noncompliance suggests the importance of recognizing depression as a risk factor for poor outcomes among patients who might not be adhering to medical advice.
Numerous studies examine the physical effects of Roux-en-Y gastric bypass (RYGBP) surgery on morbid obesity. However, the effects of this surgery on psychosocial issues such as body image have not been extensively studied.
This pilot study used a cross-sectional design to examine the effects of RYGBP surgery on patients' perceived body image. Four groups (n = 20) were assessed for perceived change in body image at 4 time intervals. These included pre-surgery, 1 to 3 weeks post-surgery, 6-months post-surgery, and 1-year post-surgery, with two measures of body image. One-way ANOVA was applied, with body image measures as the dependent variables, and time since surgery (group) as the independent variable. Planned post-hoc t-tests were applied to assess the differences between specific groups (pre vs. 1 week, pre vs. 6 months post, 6 months post vs. 1 year post).
Results of the one-way ANOVAs revealed significant improvement on perceptions of body image over time following surgery. Follow-up t-tests revealed that the most significant improvement occurred between pre-surgery and 6 months post-surgery. Although smaller, the change between 6 months post-surgery and 1 year post-surgery was also significant.
While RYGBP results in numerous medical and physical benefits, this study reveals that there are also dramatic improvements in perceived body image, demonstrating the impact of this surgery on a patient's psychosocial health.
Patients with chronic medical illness have a high prevalence of major depressive illness. Major depression may decrease the ability to habituate to the aversive symptoms of chronic medical illness, such as pain. The progressive decrements in function associated with many chronic medical illnesses may cause depression, and depression is associated with additive functional impairment. Depression is also associated with an approximately 50% increase in medical costs of chronic medical illness, even after controlling for severity of physical illness. Increasing evidence suggests that both depressive symptoms and major depression may be associated with increased morbidity and mortality from such illnesses as diabetes and heart disease. The adverse effect of major depression on health habits, such as smoking, diet, over-eating, and sedentary lifestyle, its maladaptive effect on adherence to medical regimens, as well as direct adverse physiologic effects (i.e., decreased heart rate variability, increased adhesiveness of platelets) may explain this association with increased morbidity and mortality.
Most past research has focused on body dissatisfaction among females. This paper provides a review and evaluation of studies that have examined body dissatisfaction among males. Body dissatisfaction in males has been associated with poor psychological adjustment, eating disorders, steroid use, exercise dependence, as well as other health behaviors. It is therefore important to understand the level of body dissatisfaction, as well as the factors that are related to this construct.
The review is divided into three sections: body dissatisfaction among children, adolescents and adults. Within each section, levels of body dissatisfaction are examined, as well as the research that relates to sociocultural influences on body dissatisfaction. Difficulties in drawing valid conclusions from the data due to methodological problems are highlighted.
From the current data, it would appear that there are strong similarities in the levels of body dissatisfaction of male and female children, with most children demonstrating high levels of body satisfaction. During adolescence, boys are about equally divided between wanting to lose weight and increasing weight, but there are few studies that have examined a desire for increased muscle size. In adulthood, men evidence a stronger desire to lose weight as they get older.
Overall, past studies have primarily focused on questions that are relevant to females, and there is a need to conduct studies that evaluate areas of body dissatisfaction that have greater relevance for males. This will then allow a better understanding of the relationship between body dissatisfaction and psychological and behavioral problems experienced by males at all stages of the lifespan.
This study investigated the psychiatric diagnoses and psychiatric treatment histories of 90 bariatric surgery candidates.
Prior to surgery, all participants completed the Weight and Lifestyle Inventory, the Questionnaire on Eating and Weight Patterns, and the Beck Depression Inventory-II. Participants also underwent a behavioral/psychological evaluation with a psychologist, which reviewed responses to the measures and provided further assessment of participants' psychiatric status. The evaluation also was used to produce a recommendation on the patients' psychological appropriateness for surgery.
Almost two-thirds of patients received a psychiatric diagnosis, the most common of which was major depressive disorder. Nearly two-fifths of all participants, and more than half of those given a psychiatric diagnosis, were engaged in some form of psychiatric treatment at the time of the evaluation. Nevertheless, 64% of patients were unconditionally approved for surgery; 31% were recommended for additional psychiatric or nutritional counseling prior to surgery. Three patients were not recommended for surgery.
Results of this study provide important information on the preoperative psychiatric status and treatment histories of bariatric surgery candidates. Given the increasing population of bariatric surgery patients, evaluation of patients' preoperative psychiatric status may play an important role in maximizing successful postoperative outcomes.
This article summarizes the relationship between body image and obesity among adults. It begins with an overview of the etiology of body image dissatisfaction among obese persons. This section will discuss the prevalence and nature of body image dissatisfaction, and its relationship to symptoms of psychopathology. The article then focuses on the assessment of body image and provides an overview of the commonly used psychometric measures. It next turns to the role of psychotherapeutic interventions to treat body image dissatisfaction as a component of comprehensive weight reduction programs. The article concludes by proposing several areas for future study.
Bariatric surgery has become an increasingly popular treatment option for individuals with extreme obesity (defined as a BMI > or = 40 kg/m2) or those with less severe obesity accompanied by significant comorbidities. Sustained postoperative weight loss and improvements in obesity-related health problems make bariatric surgery the most effective treatment for this population. Nevertheless, most experts agree that psychosocial and behavioral factors contribute to successful postoperative outcomes. This paper reviews the literature on the preoperative psychosocial status, eating behaviors, and quality of life of patients who seek bariatric surgery. In addition, the paper examines studies that investigated changes in these factors postoperatively. The review concludes with an agenda for future research in this area.
Body image is a multifaceted construct commonly associated with obesity. This study examined changes in body dissatisfaction, and shape and weight concerns in bariatric surgery patients from baseline to 6 and 12 months post-surgery.
109 extremely obese patients who underwent gastric bypass surgery completed the Body Shape Questionnaire (BSQ), and the Shape and Weight Concern subscales of the Eating Disorder Examination-Questionnaire (EDE-Q) at baseline, and 6 and 12 months post-surgery.
Patients experienced substantial weight loss and reported statistically significant reductions in BSQ, and Shape and Weight Concern scores from baseline to 6 and 12 months post-surgery. Improvements on the BSQ and Shape Concern scale were maintained between 6 and 12 months post-surgery, while patients reported continued reductions in weight and Weight Concern scale scores. Moreover, at 6 and 12 months follow-up, over 80% of female patients had body image scores comparable to published norms. Correlations between change in BMI and the body image measures were variable, and degree of weight loss did not predict body image scores 6 or 12 months post-surgery.
Results from the present study illustrate significant and immediate post-surgical reductions in body dissatisfaction and concerns, along with weight loss in bariatric patients. Such improvements indicate a normalization of body image-related concerns in these patients, the majority of who remain overweight or obese despite the substantial post-surgical weight losses. Changes in weight and body image relate poorly to each other, suggesting that mediating factors may be involved.
Depression and cardiovascular diseases are both common among elderly. Depression is suspected to be an independent risk factor for the onset of coronary heart disease, yet it is not clear to what extent and if depression also is associated with the onset of other diseases of the circulatory system.
To estimate the risk of depression as an independent risk factor for various cardiovascular diseases (CVD) and explore the effects of heterogeneity and methodological quality.
Meta-analyses and meta-regression analyses of longitudinal cohort and case-control studies reporting depression at baseline and CVD outcomes at follow-up.
MEDLINE (1966-2005) and PSYCHINFO (1966-2005).
Of the 28 studies that met the inclusion criteria, 11 were assesed as high quality studies. Although depressed mood increased the risk for a wide range of CVDs, heterogeneity was substantial in most cases. Only the overall combined risk of depression for the onset of myocardial infarctions (n=8, OR=1.60, 95%CI 1.34-1.92) was homogenous. Clinically diagnosed major depressive disorder was identified as the most important risk factor for developing CVD.
Depression seems to be an independent risk factor for the onset of a wide range of CVDs, although this evidence is related to a high level of heterogeneity.
Primary care patients with anxiety and depression often describe multiple physical symptoms, but no systematic review has studied the effect of anxiety and depressive comorbidity in patients with chronic medical illnesses.
MEDLINE databases were searched from 1966 through 2006 using the combined search terms diabetes, coronary artery disease (CAD), congestive heart failure (CHF), asthma, COPD, osteoarthritis (OA), rheumatoid arthritis (RA), with depression, anxiety and symptoms. Cross-sectional and longitudinal studies with >100 patients were included as were all randomized controlled trials that measure the impact of improving anxiety and depressive symptoms on medical symptom outcomes.
Thirty-one studies involving 16,922 patients met our inclusion criteria. Patients with chronic medical illness and comorbid depression or anxiety compared to those with chronic medical illness alone reported significantly higher numbers of medical symptoms when controlling for severity of medical disorder. Across the four categories of common medical disorders examined (diabetes, pulmonary disease, heart disease, arthritis), somatic symptoms were at least as strongly associated with depression and anxiety as were objective physiologic measures. Two treatment studies also showed that improvement in depression outcome was associated with decreased somatic symptoms without improvement in physiologic measures.
Accurate diagnosis of comorbid depressive and anxiety disorders in patients with chronic medical illness is essential in understanding the cause and in optimizing the management of somatic symptom burden.